Position Statement – December 2011

The flawed proposition of drug legalisation

Various well funded pressure groups have mounted campaigns to overturn the United Nations Conventions on drugs. These groups claim that society should accept the fact of drugs as a problem that will remain and, therefore, should be managed in a way that would enable millions of people to take advantage of an alleged ‘legal right’ to use drugs of their choice.

It is important to note that international law makes a distinction between “hard law” and “soft law.” Hard law is legally binding upon the States. Soft law is not binding. UN Conventions, such as the Conventions on Drugs, are considered hard law and must be upheld by the countries that have ratified the UN Drug Conventions.

International narcotics legislation is mainly made up of the three UN Conventions from 1961 (Single Convention on Narcotic Drugs), 1971 (Convention on Psychotropic Substances), and 1988 (Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances):

• The 1961 Convention sets out that “the possession, use, trade in, distribution,import, export, manufacture and the production of drugs is exclusively limited to medical and scientific purposes”. Penal cooperation is to be established so as to ensure that drugs are only used licitly (for prescribed medical purposes).

• The 1971 Convention resembles closely the 1961 Convention, whilst
establishing an international control system for Psychotropic Substances.

• The 1988 Convention reflects the response of the international community to increasing illicit cultivation, production, manufacture, and trafficking activities. International narcotics legislation draws a line between licit (medical) and illicit (non-medical) use, and sets out measures for prevention of illicit use, including penal measures. The preamble to the 1961 Convention states that the parties to the Convention are “Recognizing that addiction to narcotic drugs constitutes a serious evil for the individual and is fraught with social and economic danger to mankind”. The Conventions are reviewed every ten years and have consistently been upheld.

The UN system of drug control includes the Office of Drugs and Crime, the International Narcotics Control Board, and the Commission on Narcotic Drugs. The works of these bodies are positive and essential in international drug demand and supply reduction. They are also attacked by those seeking to legalise drugs.

It is frequently and falsely asserted that the so-called “War on Drugs” is inappropriate and has become a very costly and demonstrable failure. It is declared by some that vast resources have been poured into the prevention of drug use and the suppression of illicit manufacturing, trafficking, and supply. It is further claimed that what is essentially a chronic medical problem has been turned into a criminal justice issue with inappropriate remedies that make “innocent” people criminals. In short, the flawed argument is that “prohibition” monies have been wasted and the immeasurable financial resources applied to this activity would be better spent for the general benefit of the community.

The groups supporting legalisation are: people who use drugs, those who believe that the present system of control does more harm than good, and those who are keen to make significant profits from marketing newly authorised addictive substances. In addition to pernicious distribution of drugs, dealers circulate specious and misleading information. They foster the erroneous belief that drugs are harmless, thus adding to even more confused thinking.

Superficially crafted, yet pseudo-persuasive arguments are put forward that can be accepted by many concerned, well intentioned people who have neither the time nor the knowledge to research the matter thoroughly, but accept them in good faith. Frequently high profile people claim that legalisation is the best way of addressing a major social problem without cogent supporting evidence. This too influences others, especially the ill informed who accept statements as being accurate and well informed. Through this ill-informed propaganda, people are asked to believe that such action would defeat the traffickers, take the profit out of the drug trade and solve the drug problem completely.

The total case for legalisation seems to be based on the assertion that the government assault on alleged civil liberties has been disastrously and expensively ineffective and counter-productive. In short, it is alleged, in contradiction to evidence, that prohibition has produced more costs than benefits and, therefore, the use of drugs on a personal basis should be permitted. Advocates claim that legalisation would eliminate the massive expenditure incurred by prohibition and would take the profit out of crime for suppliers and dealers. They further claim that it would decriminalise what they consider “understandable” human behaviour and thus prevent the overburdening of the criminal justice system that is manifestly failing to cope. It is further argued irrationally that police time would not be wasted on minor drug offences, the courts would be freed from the backlog of trivial cases and the prisons would not be used as warehouses for those who choose to use drugs, and the saved resources could be used more effectively.

Types of drug legalisation

The term “legalisation” can have any one of the following meanings:

1. Total Legalisation – All illicit drugs such as heroin, cocaine, methamphetamine, and marijuana would be legal and treated as commercial products. No government regulation would be required to oversee production, marketing, or distribution.

2. Regulated Legalisation – The production and distribution of drugs would be regulated by the government with limits on amounts that can be purchased and the age of purchasers. There would be no criminal or civil sanctions for possessing, manufacturing, or distributing drugs unless these actions violated the regulatory system. Drug sales could be taxed.

3. Decriminalisation – Decriminalisation eliminates criminal sanctions for drug use and provides civil sanctions for possession of drugs. To achieve the agenda of drug legalisation, advocates argue for:

• legalising drugs by lowering or ending penalties for drug possession and use – particularly marijuana;

• legalising marijuana and other illicit drugs as a so-called medicine;
• harm reduction programmes such as needle exchange programmes, drug injection sites, heroin distribution to addicts, and facilitation of so-called safe use of drugs that normalize drug use, create the illusion that drugs can be used safely if one just knows how, and eliminates a goal of abstinence from drugs;

• legalised growing of industrial hemp;
• an inclusion of drug users as equal partners in establishing and enforcing drug policy; and

• protection for drug users at the expense and to the detriment of non-users under the pretence of “human rights.”

The problem is with the drugs and not the drug policies

Legalisation of current illicit drugs, including marijuana, is not a viable solution to the global drug problem and would actually exacerbate the problem. The UN Drug Conventions were adopted because of the recognition by the international community that drugs are an enormous social problem and that the trade adversely affects the global economy and the viability of some countries that have become transit routes.

The huge sums of illegal money generated by the drug trade encourage money laundering and have become inextricably linked with other international organised criminal activities such as terrorism, human trafficking, prostitution and the arms trade. Drug Lords have subverted the democratic governments of some countries to the great detriment of law abiding citizens.

Drug abuse has had a major adverse effect on global health and the spread of communicable diseases such as AIDS/HIV. Control is vitally important for the protection of communities against these problems. There is international agreement in the UN Conventions that drugs should be produced legally under strict supervision to ensure adequate supplies only for medical and research purposes. The cumulative effects of prohibition and interdiction combined with education and treatment during 100 years of international drug control have had a significant impact in stemming the drug problem. Control is working and one can only imagine how much worse the problem would have become without it. For instance:

• In 2007, drug control had reduced the global opium supply to one-third the level in 1907 and even though current reports indicate recent increased cultivation in Afghanistan and production in Southeast Asia, overall production has not increased.

• During the last decade, world output of cocaine and amphetamines has stabilized; cannabis output has declined since 2004; and opium production has declined since 2008. We, therefore, strongly urge nations to uphold and enhance current efforts to prevent the use, cultivation, production, traffic, and sale of illegal drugs. We further urge our leaders to reject the legalisation of currently illicit drugs as an acceptable solution to the world’s drug problem because of the following reasons:

• Only 6.1% of people globally between the ages of 15 and 64 use drugs (World Drug Report 2011 UNODC) and there is little public support for the legalisation of highly dangerous substances. Prohibition has ensured that the total number of users is low because legal sanctions do influence people’s behaviour.

• There is a specific obligation to protect children from the harms of drugs, as is
evidenced through the ratification by the majority of United Nations Member States of the UN Convention on the Rights of the Child (CRC). Article 33 states that Member States “shall take all appropriate measures, including legislative, administrative, social and educational measures, to protect children from the illicit use of narcotic drugs and psychotropic substances as defined in the relevant international treaties, and to prevent the use of children in the illicit production and trafficking of such substances”.

• Legalisation sends the dangerous tacit message of approval, that drug use is
acceptable and cannot be very harmful.

• Permissibility, availability and accessibility of dangerous drugs will result in
increased consumption by many who otherwise would not consider using them.

• Enforcement of laws creates risks that discourage drug use. Laws clearly define what is legal and illegal and emphasise the boundaries.

• Legalisation would increase the risks to individuals, families, communities and world regions without any compensating benefits.

• Legalisation would remove the social sanctions normally supported by a legal system and expose people to additional risk, especially the young and vulnerable.

• The legalisation of drugs would lead inevitably to a greater number of dependencies and addictions likely to match the levels of licit addictive substances. In turn, this would lead to increasing related morbidity and mortality, the spread of communicable diseases such as AIDS/HIV and the other blood borne viruses exacerbated by the sharing of needles and drugs paraphernalia, and an increased burden on the health and social services.

• There would be no diminution in criminal justice costs as, contrary to the view held by those who support legalisation, crime would not be eliminated or reduced. Dependency often brings with it dysfunctional families together with increased domestic child abuse.

• There will be increases in drugged driving and industrial accidents.

• Drug Control is a safeguard protecting millions from the effects of drug abuse and addiction particularly, but not exclusively, in developing countries.

• Statements about taxation offsetting any additional costs are demonstrably flawed and this has been shown in the case of alcohol and tobacco taxes. Short of governments distributing free drugs, those who commit crime now to obtain them would continue to do so if they became legal.

• Legalisation would not take the profit out of the drug trade as criminals will always find ways of countering legislation. They would continue their dangerous activities including cutting drugs with harmful substances to maximise sales and profits. Aggressive marketing techniques, designed to promote increased sales and use, would be applied rigorously to devastating effect.

• Other ‘legal’ drugs – alcohol and tobacco, are regularly traded on the black market and are an international smuggling problem; an estimated 600 billion cigarettes are smuggled annually (World Drug report 2009). Taxation monies raised from these products go nowhere near addressing consequential costs.

• Many prisons have become incubators for infection and the spread of drug related diseases at great risk to individual prisoners, prison staff and the general public. Failure to eliminate drug use in these institutions exacerbates the problem.

• The prisons are not full of people who have been convicted for mere possession of drugs for personal use. This sanction is usually reserved for dealers and those who commit crime in the furtherance of their possession.

• The claim that alcohol and tobacco may cause more harm than some drugs is not a pharmacokinetics of psychotropic substances suggest that more, not less, control of their access is warranted.

• Research regularly and increasingly demonstrates the harms associated with drug use and misuse. There is uncertainty, yet growing evidence, about the long-term detrimental effects of drug use on the physical, psychological and emotional health of substance users.

• It is inaccurate to suggest that the personal use of drugs has no consequential and damaging effects. Apart from the harm to the individual users, drugs affect others by addiction, violence, criminal behaviour and road accidents. Some drugs remain in the body for long periods and adversely affect performance and behaviour beyond the time of so-called ‘private’ use. Legalisation would not diminish the adverse effects associated with drug misuse such as criminal, irrational and violent behaviour and the mental and physical harm that occurs in many users.

• All drugs can be dangerous including prescription and over the counter medicines if they are taken without attention to medical guidance. Recent research has confirmed just how harmful drug use can be and there is now overwhelming evidence (certainly in the case of cannabis) to make consideration of legalisation irresponsible.

• The toxicity of drugs is not a matter for debate or a vote. People are entitled to their own opinions but not their own facts. Those who advocate freedom of choice cannot create freedom from adverse consequences.

• Drug production causes huge ecological damage and crop erosion in drug producing areas.

• Nearly every nation has signed the UN Conventions on drug control. Any government of signatory countries contemplating legalisation would be in breach of agreements under the UN Conventions which recognise that unity is the best approach to combating the global drug problem. The administrative burden associated with legalisation would become enormous and probably unaffordable to most governments. Legalisation would require a massive government commitment to production, supply, security and a bureaucracy that would necessarily increase the need for the employment at great and unaffordable cost for all of the staff necessary to facilitate that development.

• Any government policy must be motivated by the consideration that it must first do no harm. There is an obligation to protect citizens and the compassionate and sensible method must be to do everything possible to reduce drug dependency and misuse, not to encourage or facilitate it. Any failures in a common approach to a problem would result in a complete breakdown in effectiveness. Differing and fragmented responses to a common predicament are unacceptable for the wellbeing of the international community. It is incumbent on national governments to cooperate in securing the greatest good for the greatest number.

ISSUED this 21st day of December, 2011 by the following groups:
Drug Prevention Network of the Americas (DPNA)
Institute on Global Drug Policy
International Scientific and Medical Forum on Drug Abuse
International Task Force on Strategic Drug Policy
People Against Drug Dependence & Ignorance (PADDI), Nigeria
Europe Against Drugs (EURAD)
World Federation Against Drugs (WFAD)
Peoples Recovery, Empowerment and Development Assistance (PREDA)
Drug Free Scotland

Conference in Moses Room, House of Lords, 28th November 2002-11-28 CONSENSUS OF CONFERENCE

● In the light of the most recent international evidence regarding the adverse effects of cannabis, we urge the Prime Minister and the Home Secretary to reconsider their determination to reclassify Cannabis from a schedule B to schedule C drug.

● We are concerned that reclassification sends the message ‘it is ok to take cannabis’ or ‘cannabis is harmless’ or ‘taking cannabis is legal now’, especially to young people. We therefore strongly oppose reclassification.

● Instead, we urge the Prime Minister and the Home Office not to play down the many adverse and sometimes irreversible health effects of cannabis but to send out the clear message that cannabis is both harmful and, for that reason, illegal.

● We urge the Prime Minister – in the light of recent evidence – to reassess the adverse physical, emotional, mental and spiritual impact cannabis abuse has on individuals, but also to assess the adverse effects of cannabis on society including families with a special reference to ethnic minorities, the education system, the National Health Service, the Police, the criminal justice system.

● We are concerned that drug prevention is not given the emphasis it deserves, that ‘mixed messages’ are sent out and in particular we are very concerned at public funding of organisations whose ‘drug education material’ appears to promote rather than prevent drug abuse.

● We urge the Prime Minister to allocate more resources on prevention of cannabis abuse. Prevention is better than cure. We believe that these resources will be well spent. Our society and especially our young people deserve to be protected from cannabis abuse.

Illegal drugs not only harm a user’s mind and body, they devastate families, communities, and neighborhoods. They jeopardize public safety, prevent too many Americans from reaching their full potential, and place obstacles in the way of raising a healthy generation of young people.

To address these challenges, today we are releasing the 2012 National Drug Control Strategy — the Obama Administration’s primary policy blueprint for reducing drug use and its consequences in America. The President’s inaugural National Drug Control Strategy, published in 2010, charted a new direction in our approach to drug policy. Today’s strategy builds upon that approach, which is based on science, evidence, and research. Most important, it is based on the premise that drug addiction is a chronic disease of the brain that can be prevented and treated. Simply put, we are not powerless against the challenge of substance abuse — people can recover, and millions are in recovery. These individuals are our neighbors, friends and family members. They contribute to our communities, our workforce, our economy, and help make America stronger.

Our emphasis on addressing the drug problem through a public health approach is grounded in decades of research and scientific study. There is overwhelming evidence that drug prevention and treatment programs achieve meaningful results with significant long-term cost savings. In fact, recent research has shown that each dollar invested in an evidence-based prevention program can reduce costs related to substance use disorders by an average of $18.

But reducing the burden of our nation’s drug problem stretches beyond prevention and treatment. We need an all of the above approach. To address this problem in a comprehensive way, the President’s new strategy also applies the principles of public health to reforming the criminal justice system, which continues to play a vital role in drug policy. It outlines ways to break the cycle of drug use, crime, incarceration, and arrest by diverting non-violent drug offenders into treatment, bolstering support for reentry programs that help offenders rejoin their communities, and advancing support for innovative enforcement programs proven to improve public health while protecting public safety.

Together, we have achieved significant reform in the way we address substance abuse. And the Affordable Care Act will — for the first time — require insurers to cover treatment for drug addiction the same way they would other chronic diseases. This is a revolutionary shift in how we address drug policy in America.
Over the past three decades, we have reduced illegal drug use in America. Over the long term, rates of drug use among young people today are far lower than they were 30 years ago. More recently cocaine use has dropped nearly 40 percent and meth use has dropped by half. And we can do more. As President Obama has noted, we have successfully changed attitudes regarding rates of smoking and drunk driving, and with your help we can do the same with our illegal drug problem.

Source: R. Gil Kerlikowske
Director, White House Office of National Drug Control Policy 18th April 2012

Removing branding and wrapping cigarettes in plain packaging helps remove the appeal of smoking according to new a Cancer Research UK-funded study published in Tobacco Control.
The researchers found that more women than men smoked less and found smoking less enjoyable when using the plain packs.
Some smokers also claimed that they would be more likely to attempt quitting if all cigarettes came in the dark brown unbranded packs used in this study.
In the first study of its kind nearly 50 young adult smokers used non branded cigarette packets in normal everyday situations for two weeks. The researchers then compared the reaction to this packaging to the reactions of using regular packs for two weeks.
The plain brown packs were given a fictional name with standard branding and the health warning “Smoking Kills”. Twice weekly questionnaires were followed up with face to face interviews for more in depth analysis of reaction.
Plainly wrapped cigarettes were rated negatively against the original packs. Taking out the cigarettes less often, handing out cigarettes less frequently and hiding the pack more were all reported as a result of the plain packaging.
Dr Crawford Moodie, the study’s lead author based at the University of Stirling, said: “Despite the small size of this study it adds an important real world dimension to the research on the way smokers respond to plain packaging. The study confirms the lack of appeal of plain packs, with the enjoyment and consumption of cigarettes being reduced. We’re now looking to build on this research to understand more about the impact of packaging on smokers.”
The UK government is expected to begin a public consultation on the future of tobacco packaging later this year.
Australia should be the first country in the world to wrap cigarettes in plain packaging. The Australian government has announced that all tobacco must be sold in plain packaging from July 1, 2012. Picture health warnings will also cover 75 per cent of the front and 90 per cent of the back of packs.
Jean King, Cancer Research UK’s director of tobacco control, said: “While a small study, this research provides important insights into the power of cigarette packaging. Colourful and slickly designed packs are one of the last remaining avenues for tobacco companies to market their deadly product, so it’s interesting to see what might happen if and when this is removed. It’s important to remember that smoking remains the single biggest preventable cause of death in the UK, so preventing more people from starting and helping smokers to quit is vital. We look forward to the possibility of removing the silent salesman of cigarette packets.”

Source: http://www.cancerresearchuk.org/ 8tj Sept. 2011

ABSTRACT

The most extensive study of drug courts—a five-year examination of 23 courts and six comparison jurisdictions in eight states—found that these court programs can significantly decrease drug use and criminal behavior, with positive outcomes ramping upward as participants sensed their judge treated them more fairly, showed greater respect and interest in them, and gave them more chances to talk during courtroom proceedings.
WASHINGTON, D.C., July 18, 2011—Proponents of the adage that one person can change the world need look no farther than the country’s nearly 1,400 adult drug courts, which couple substance-abuse treatment with close judicial supervision in lieu of incarceration.
The most extensive study of drug courts—a five-year examination of 23 courts and six comparison jurisdictions in eight states—found that these court programs can significantly decrease drug use and criminal behavior, with positive outcomes ramping upward as participants sensed their judge treated them more fairly, showed greater respect and interest in them, and gave them more chances to talk during courtroom proceedings.
“Judges are central to the goals of reducing crime and substance use. Judges who spend time with participants, support them, and treat them with respect are the ones who get results,” said the Urban Institute’s Shelli Rossman, who led the research team from the Institute’s Justice Policy Center, the Center for Court Innovation, and RTI International.
Drug court participants who had more status hearings with the judge and received more praise from the judge later reported committing fewer crimes and using drugs less often than those who had less contact and praise. Court programs whose judges exhibited the most respectfulness, fairness, enthusiasm, and knowledge of each individual’s case prevented more crimes than other courts and prevented more days of drug use. And, when drug court participants reported more positive attitudes toward their judge, they cut drug use and crime even more.
While drug court costs are higher than business-as-usual case processing, they save money, the study determined, by significantly reducing the number of crimes, re-arrests, and days incarcerated. Drug courts save an average of $5,680 per participant, returning a net benefit of $2 for every $1 spent.

The Study

Drug courts emerged in the late 1980s and early 1990s as drug arrests and prosecutions exploded, overwhelming traditional courts’ capacity to process cases expeditiously.
The Multi-Site Adult Drug Court Evaluation, funded by the U.S. Department of Justice’s National Institute of Justice, was conducted in two phases. The first, in 2004, surveyed 380 drug courts, more than half of which required both an eligible charge and a clinical assessment for offenders to enrol. Few courts allowed participants with prior convictions for violent misdemeanour or felony offences. More than a third of courts served only those who were diagnosed as addicted to or dependent on drugs; others also served regular users or those with any level of use.
In the study’s second phase, researchers selected 23 drug courts in Florida, Georgia, Illinois, New York, Pennsylvania, South Carolina, and Washington, and six comparison sites in Florida, Illinois, North Carolina, and Washington. Between March 2005 and fall 2009, the team visited each location multiple times to document program characteristics and operations; interviewed a sample of 1,156 drug court participants and 625 comparison group members as many as three times (baseline interview and interviews 6 and 18 months later); administered a drug test at the 18-month mark; and obtained criminal histories, recidivism data, and budget information from state agencies and the FBI.

More Key Findings

Drug court participants who perceived the consequences of failing the program as more undesirable engaged in less substance use and crime. And those who received more judicial supervision and drug testing, or who attended more than 35 days of substance abuse treatment, reported fewer crimes and fewer days of drug use.
Drug court participants, compared to similar offenders processed through standard dockets, reported fewer days of drug use (2.1 vs. 4.8 days per month) and fewer crimes committed (52.5 vs. 110.1) when questioned about the past year at the 18-month interview.
Relative to similar offenders in the comparison group, those initially reporting more frequent drug use showed a larger reduction in drug use at the 18-month interview. Offenders with violent histories had a greater reduction in crime than others.
Although drug courts prevent a great deal of small-cost crime, overall savings are driven by a reduction in the most serious offending by relatively few individuals. Drug courts are especially likely to save money, therefore, if they enrol serious offenders.
The Takeaways: Implications for Policy and Practice
The researchers recommend that
judges hold frequent judicial status hearings, especially for high-risk participants;
administrators assign judges who are committed to the drug court model;
judges get training on best practices regarding judicial demeanour and effective communication with participants;
courts broaden participant eligibility, particularly to include those with mental health problems and histories of violent offences;
programs include sufficient drug treatment; and
courts administer drug tests more than once a week during the program’s initial phase

Source: http://www.urban.org/url.cfm?ID=901438 July 18th 2011

In this Dutch study, promoting parental rule setting and classroom alcohol education together nearly halved the proportion of adolescents who went on to drink heavily. Rarely have such strong and sustained drinking prevention impacts been recorded from these types of interventions.

Summary

This Dutch study tested the long-term impact of the Örebro intervention (first developed and tested in Sweden) targeting parental rule-setting in relation to the drinking of their adolescent children, allied with classroom alcohol education. The parenting element entailed a brief presentation from an alcohol expert at the first parents’ meeting at the start of each school year on the adverse effects of youth drinking and the negative effects of permissive parental attitudes towards children’s alcohol use. After this parents of children from the same class were meant to meet to agree a shared set of rules about alcohol use. In fact, only half the schools did this; the remainder used the later mailing to send a checklist of candidate rules to parents for them to select from and return to the school. Three weeks after this meeting, a summary of the presentation and the result of the classroom discussion was sent to parents’ home addresses. Classroom alcohol education consisted of four lessons from trained teachers at the schools plus a booster a year later, using mainly computerised modules to foster a healthy attitude to drinking and to train the pupils in how to refuse offers of alcohol.
The 19 schools which joined the study were randomly allocated to the parenting intervention alone, to classroom alcohol education alone, to the combination of both, or to act as control schools which carried on with alcohol education as usual.
An earlier paper from the same study reported that relative to education as usual, among the 2937 (of 3490) 12–13-year-olds not already drinking weekly and who met other criteria for the study, the combined parenting and education intervention curbed the initiation of weekly drinking and heavy weekly drinking over the next 22 months (and reduced the frequency of drinking). In contrast, on their own, neither the parenting elements nor the lessons made any significant difference when the whole sample of children not yet drinking weekly at the start were included in the analyses.

Main findings

The featured report tested whether these effects were still apparent a year later, 34 months after the start of the study and when the pupils averaged just over 15 years of age, a time when two thirds of Dutch youngsters are already drinking weekly and will soon (age 16) be able to legally buy alcohol. Of the 2937 in the initial sample of non-weekly drinkers, 2533 (86%) completed the follow-up assessment. The probable responses of the remainder were estimated on the basis of prior assessments and other data. As before, the parenting elements or alcohol education alone had made no statistically significant differences to drinking, but the impacts of both together in retarding uptake of weekly and heavy weekly drinking were greater than a year before chart. Compared to 59% and 27% in education-as-usual control schools, after the combined intervention 49% and 15% of pupils were drinking weekly or drinking heavily each week. After adjusting for other factors, the results meant that in combined intervention schools, the odds of these patterns of drinking versus less extreme drinking had been reduced to 0.69 relative to education as usual, highly statistically significant findings. Put another way, for every four pupils allocated to parenting plus alcohol education, one was prevented from drinking weekly and also one from drinking heavily each week at age 15.

The authors’ conclusions

In a liberal drinking culture where adolescent and underage drinking is common, targeting both parents and young adolescent pupils (but not either on their own) exercises a sustained and substantial restraining influence on the development of regular and regular heavy drinking as the youngsters approach the legal alcohol purchase age. The findings underline the need to target adolescents as well as their parents and of targeting adolescents at an early age, before they start to drink regularly and when family factors are a major influence on youth drinking. Doing so has the potential to create appreciable public health gains.

Source: Koning I.M., van den Eijnden R.J., Verdurmen J.E. et al.
American Journal of Preventive Medicine: 2011, 40(5), p. 541–547.

Celebrities and millionaires with no history of addiction research or helping addicts to reclaim destroyed lives campaigned globally in June to make drugs even more available – citing reasons based on theory not fact. David Raynes tells the truth

COMPARE STATISTICS: HARMS OF LEGAL vs ILLEGAL DRUGS

• “More deaths are caused each year by tobacco use than by all deaths from HIV, illegal drug use, alcohol use, motor vehicle injuries, suicides, and murders combined,” states the US Centre for Disease Control (www.cdc.gov/tobacco/data_ statistics/fact_sheets/health_effects/tobacco_related_
mortality). UK figures are below.

• 880 deaths/year involve heroin or morphine
(latest figures from the Office of National Statistics at http://www.statistics.gov.uk/pdfdir/poi0311.pdf)

• 8,664 deaths/year involve alcohol (http://www.statistics.gov.uk/cci/nugget.asp?id=1091

• 81,400 deaths of people in England alone aged 35+ were attributable to tobacco (http://www.ic.nhs.uk/pubs/smoking10)

• An estimated 462,900 hospital admissions in England alone of people aged 35+ were attributable to smoking (ibid).

Source: Addiction Today July/August 2011

Reports that school prevention programs aimed at curbing alcohol misuse in children are somewhat helpful, enough so to deserve consideration for widespread use, according to a large, international systematic review.

The most significant program effects were reductions in episodes of drunkenness and binge drinking, reviewers found.

“School-based prevention programs that take a social skills-oriented approach or that focus on classroom behavior management can work to reduce alcohol problems in young people,” David Foxcroft, lead review author said. “However, there is good evidence that these sorts of approaches are not always effective.”

The reasons for inconsistent results with these programs are unclear, said Foxcroft, from Great Britain’s Oxford Brookes University.

Foxcroft and co-author Alexander Tsertsvadze, at the University of Ottawa Evidence-Based Practice Center, in Canada, analyzed 53 randomized controlled trials done in a wide range of countries with youth ages 5 to 18 when studies began.

Forty-one studies took place in North America, six in Europe and six in Australia. One was conducted in India and one in Swaziland. Two studies transpired in multiple locations.

Most studies assessed generic prevention programs that targeted several risky behaviors, such as drinking, smoking and drug abuse, while the rest focused on alcohol-specific programs.

The researchers compared drinking among the youngsters who took part in various school-based programs to the drinking done by students who were not. The youngsters in the comparison groups might have participated in other alcohol-prevention programs, such as family-based ones, or they might have just experienced the ordinary school curriculum.

The authors concluded that their evidence supported the use of certain generic prevention programs over alcohol-specific ones. They cited the Life Skills Training Program, the Unplugged Program and the Good Behavior Game as particularly effective interventions.

The review appears in the May 2011 issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

“These findings are important,” David Jernigan, Ph.D., director of the Center on Alcohol Marketing and Youth at the Johns Hopkins Bloomberg School of Public Health, said. “Efforts to reduce young people’s drinking through school-based programs are legion. A $300 million federal program supporting school-based prevention ended last year, partly based on research findings that these programs do not work. This review does not find that. Instead it indicates that there is something in certain school-based programs that in fact can work.”

Jernigan emphasizes that “school-based programs are so often expected to do the whole job of prevention, and this is an unfair expectation.” He describes school-based programs functioning as “lonely voices” in an environment saturated with marketing messages promoting youthful drinking. The amount of drinking in a youngster’s home and community and the price of alcohol are other major influences that need addressing, he said. Until then, “we can’t expect large effects from school-based programs alone.”

Health Behavior News Service is part of the Center for Advancing Health.

Source: www.cadca.org 12th May 2011

A new assessment tool may allow doctors to evaluate the impact of methamphetamine on babies exposed in the womb. The tool may help identify which babies will go on to develop problems due to exposure to the drug, according to a new study.

Medical News Today reports that doctors at the Warren Alpert Medical School of Brown University andWomen & InfantsHospital inProvidence,RI, looked at the effects of prenatal exposure to methamphetamine in 185 newborns and compared them with 195 newborns who were not exposed to meth, but were exposed to alcohol, tobacco or marijuana before birth.

They reported at the Pediatric Academic Societies meeting inDenver that an assessment tool called the NICU Network Neurobehavioral Scale (NNNS) was used to evaluate the babies during the first four days of life and again when they were one month old.  The tool evaluates the babies’ muscle tone, reflexes, behavior, motor development and stress.

The researchers said that the tests could help identify which babies are doing well and which are the ones who could benefit from intervention and prevention services.

Source: www.drugfree.org/join-together  3^rd May 2011

Contact address: Fabrizio Faggiano, Department of Medical Sciences, University of Piemonte Orientale A. Avogadro, Via Santena 5 bis, Novara, 28100, Italy. fabrizio.faggiano@med.unipmn.it.
Editorial group: Cochrane Drugs and Alcohol Group.
Publication status and date: Edited (no change to conclusions), published in Issue 3, 2008.

Citation: Faggiano F, Vigna-Taglianti F, Versino E, Zambon A, Borraccino A, Lemma P. School-based prevention for illicit drugs’ use. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD003020. DOI: 10.1002/14651858.CD003020.pub2.

Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
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Abstract

Background

Drug addiction is a chronic, relapsing disease. Primary interventions should be aimed to reduce first use, or prevent the transition from experimental use to addiction. School is the appropriate setting for preventive interventions.
Objectives
To evaluate the effectiveness of school-based interventions in improving knowledge, developing skills, promoting change, and preventing or reducing drug use versus usual curricular activities or a different school-based intervention .
Search strategy
We searched the Cochrane Drug and Alcohol Group trial register (February 2004), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 2, 2004), MEDLINE (1966 to February 2004) , EMBASE (1988 to February 2004), and other databases. We also contacted researchers in the field and checked reference lists of articles.
Selection criteria
Randomised controlled trials (RCT), case controlled trials (CCT) or controlled prospective studies (CPS) evaluating school-based interventions designed to prevent substance use.
Data collection and analysis
Two authors independently extracted data and assessed trial quality.
Main results
32 studies (29 RCTs and three CPSs) were included with 46539 participants. Twenty eight were conducted in the USA; most were focused on 6th-7th grade students, and based on post-test assessment.

RCTs

(1) Knowledge versus usual curricula
Knowledge focused programs improve drug knowledge (standardised mean difference (SMD) 0.91; 95% confidence interval (CI) 0.42 to 1.39).
(2) Skills versus usual curricula
Skills based interventions increase drug knowledge (weighted mean difference (WMD) 2.60; 95% CI 1.17 to 4.03), decision making skills (SMD 0.78; CI 95%: 0.46 to 1.09), self-esteem (SMD 0.22; CI 95% 0.03 to 0.40), peer pressure resistance (relative risk (RR) 2.05; CI 95%: 1.24 to 3.42), drug use (RR 0.81; CI 95% 0.64 to 1.02), marijuana use (RR 0.82; CI 95% 0.73 to 0.92) and hard drug use (RR 0.45; CI 95% 0.24 to 0.85).
(3) Skills versus knowledge
No differences are evident.
(4) Skills versus affective
Skills-based interventions are only better than affective ones in self-efficacy (WMD 1.90; CI 95%: 0.25 to 3.55).

Results from CPSs

No statistically significant results emerge from CPSs.
Authors’ conclusions
Skills based programs appear to be effective in deterring early-stage drug use.
The replication of results with well designed, long term randomised trials, and the evaluation of single components of intervention (peer, parents, booster sessions) are the priorities for research. All new studies should control for cluster effect.
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Plain language summary

School-based prevention for illicit drugs’ use
Drug addiction is a long-term problem caused by an uncontrollable compulsion to seek drugs. People may use drugs to seek an effect, to feel accepted by their peers or as a way of dealing with life’s problems. Even after undertaking detoxification to reach a drug-free state, many return to opioid use. This makes it important to reduce the number of people first using drugs and to prevent transition from experimental use to addiction. For young people, peers, family and social context are strongly implicated in early drug use. Schools offer the most systematic and efficient way of reaching them. School programs can be designed to provide knowledge about the effects of drugs on the body and psychological effects, as a way of building negative attitudes toward drugs; to build individual self-esteem and self-awareness, working on psychological factors that may place people at risk of use; to teach refusal and social life skills; and to encourage alternative activities to drug use, which instil control abilities.
The review authors found 32 controlled studies, of which 29 were randomised, comparing school-based programs aimed at prevention of substance use with the usual curriculum. The 46,539 students involved were mainly in sixth or seventh grade. Programs that focused on knowledge improved drug knowledge to some degree, in six randomised trials. Social skills programs were more widely used (25 randomised trials) and effectively increased drug knowledge, decision-making skills, self-esteem, resistance to peer pressure, and drug use including of marijuana (RR 0.8) and hard drugs (heroin) (RR 0.5). The programs were mainly interactive and involved external educators in 20 randomised trials. Effects of the interventions on assertiveness, attitudes towards drugs, and intention to use drugs were not clearly different in any of the trials.
Most trials were conducted in the USA and, as a nation’s social context and drug policies have a significant influence on the effectiveness of the programs, these results may not be relevant to other countries. Measures of change were often made immediately after the intervention with very little long-term follow up or investigation of peer influence, social context, and involvement of parents.

Source: http://onlinelibrary.wiley.com and www.cochranlibrary.com 2008

A new study released by the U.S. Department of Education Institute of Education Sciences conducted an experimental evaluation of mandatory random student drug testing (MRSDT) programs in 36 high schools within 7 school districts.i About half of the schools in each district were randomly assigned to the treatment group and half to the control group. Treatment schools began implementing MRSDT programs while control schools did not. MRSDT programs in public schools are limited to students who participate in athletics and extracurricular activities. In this study, some of the testing pools in schools with MRSDT were comprised of only athletes while others included athletes and extracurricular activity participants, leaving many students untested in those schools.

The frequency of drug testing and drug test panels in schools with MRSDT programs varied. All seven school districts tested for marijuana, amphetamines, and methamphetamines. Cocaine and opiates were included in six of the seven district panels. Districts also tested for an assortment of other substances. Students in all schools were surveyed and tracked over one year. Researchers compared students who participated in activities which made them subject to drug testing in schools with MRSDT to students who participated in the same activities in schools without MRSDT. Results are encouraging and provide extensive supportive of MRSDT programs.

Students subject to MRSDT reported a statistically significant lower rate of past 30-day use of substances included in their schools’ drug testing panels (16%) than comparable students in schools without MRSDT (22%). This included alcohol for three districts and nicotine for two districts. Similar differences were also found between the two groups on other substance use measures, though were not
statistically significant.

Contrary to what USA Today reports in “High school drug testing shows no long-term effect on use” (July 15, 2010),ii this study has demonstrated the value of MRSDT. Specifically USA Today highlights that MRSDT did not impact students’ plans to use drugs in the future. It is true that there was no difference between the percentage of students subject to MRSDT (34%) and the percentage not subject to MRSDT (33%) that reported they planned to use substances within the next 12 months. However,
MRSDT programs subject eligible students to random drug testing during the school year only; the summer months are a time when student substance use is no longer monitored. MRSDT programs are designed to deter substance use when students are in school. This study demonstrates that MRSDT is effective at achieving this goal.

Commentary August 12, 2010

It is sometimes claimed that drug testing programs deter student participation in extracurricular activities. In this study, MRSDT had no effect on the participation rates by students in activities that subjected them to drug testing. Nearly the same percentage of students in schools with MRSDT participated in activities covered by their schools’ testing programs (53%) as the percentage of students in schools without MRSDT who participated in such activities (54%). This indicates that students in
schools with MRSDT programs knew their participation in such activities subjected them to testing and it did not deter them from participation.
USA Today is critical of this study because there was no spillover effect on students who were not subject to MRSDT in schools with testing programs. This is not a surprise considering the MRSDT programs were studied for one year of implementation. As drug testing programs expand and include options for students to voluntarily enter the testing pool (as opposed to mandatory participation only
through extracurricular activities), a spillover effect in time is possible. Random student drug testing programs reinforce schools’ comprehensive substance use prevention programs as a deterrent against youth substance use. These programs offer students a good reason not to use drugs, including alcohol and tobacco which can be included in testing panels along with other illegal drugs.

Voluntary random drug testing programs also are used in public schools either as a single option or in combination with a mandatory program. This allows students, with a parent’s permission, to make an active choice to participate in random drug testing. The U.S. Department of Education is to be commended for supporting this ambitious study and shedding light on the many benefits of school-based random student drug testing programs. For more information on IBH and random student drug testing visit www.ibhinc.org and www.PreventionNotPunishmment.org.
Robert L. DuPont, M.D.

Source: Institute for Behavior and Health. USA 12th August 2010

Abstract

This study tests the impact of an in-school mediated communication campaign based on social marketing principles, in combination with a participatory, community-based media effort, on marijuana, alcohol and tobacco uptake among middle-school students. Eight media treatment and eight control communities throughout the US were randomly assigned to condition. Within both media treatment and media control communities, one school received a research-based prevention curriculum and one school did not, resulting in a crossed, split-plot design.
Four waves of longitudinal data were collected over 2 years in each school and were analyzed using generalized linear mixed models to account for clustering effects. Youth in intervention communities (N = 4216) showed fewer users at final post-test for marijuana [odds ratio (OR) = 0.50, P = 0.019], alcohol (OR = 0.40, P = 0.009) and cigarettes (OR = 0.49, P = 0.039), one-tailed. Growth trajectory results were significant for marijuana (P = 0.040), marginal for alcohol (P = 0.051) and non-significant for cigarettes (P = 0.114).
Results suggest that an appropriately designed in-school and community-based media effort can reduce youth substance uptake. Effectiveness does not depend on the presence of an in-school prevention curriculum.

Source: Health Education Research Vol. 21, Issue 1 2005

The excerpts below are from two Rand studies, Would Legalizing Marijuana in California Help?
Beau Kilmer, Jonathan P. Caulkins, Brittany M. Bond, Peter H. Reuter 2010

And What We Do and Don’t Know About the Likely Effects of Decriminalization and Legalization by Robert J. MacCoun and Peter Reuter. 1999

Since it is often difficult to read the whole of a large study I have pulled out parts which I think may be useful to those of us fighting the legalisation of drugs – with particular reference to Prop. 19 in California

Taken together, the available evidence suggests that the nonprice impact on consumption might be on the order of a 35-percent increase in past-month use. Given the ambiguity and noisiness of the data, estimates in the range of 5 to 50 percent seem plausible.

Throughout California in 2008, there were 181 admissions to hospitals in which marijuana abuse or dependence was listed as the primary reason for the hospitalization. Even though the average charge per episode exceeded $22,000, the total cost of these episodes is just over $2 million, so relatively small vis-à-vis the other costs and savings.

Perhaps more important from a cost perspective are the additional 25,000 admissions for which marijuana is listed as a supplemental diagnosis (second, third, or fourth diagnosis). Of these cases, nearly 4,000 were for schizophrenia (with an average charge of $20,300 per episode) and another 2,300 were for psychoses (with an average cost of $12,700). As the scientific
literature is still unclear as to whether marijuana use causes these conditions or just complicates treating them, we do not consider the cost here of these nonprimary diagnoses. More research is needed before an accurate assessment can be conducted, but the implications of these research findings could be important in terms of the burden imposed. For more details
on this, see Pacula (2010a).

Dependence and Abuse
How would the number of marijuana users meeting clinical criteria for abuse or dependence change with a change in the policy? Over this decade, the number of users meeting these criteria in the previous year as a fraction of people reporting use of marijuana in the past year in nationally representative samples has been fairly stable (~16 percent). One way to project what
could happen to dependent users post-legalization is to assume that this relationship between the number dependent and past-year users remains the same.

We start by making an assumption about legalization’s effect on consumption. For this example, we consider a 58-percent increase in annual consumption and refer interested readers to Pacula (2010a) for more information about this starting value. With 525,000 users estimated to meet Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV)
criteria for marijuana abuse or dependence in California in 2009 (Pacula, 2010a), a 58-percent increase would suggest a rise of 305,000, bringing the total number of users meeting clinical criteria for abuse or dependence to 830,000. Of course, there is tremendous uncertainty surrounding this number because of uncertainty about the baseline assumptions that generated
the predicted change in annual prevalence. If we adopt alternative plausible assumptions, we generate a range of 144,000 to 380,000, implying that the total number of users meeting clinical criteria for abuse or dependence would be in the range of 669,000 to 905,000.

There are currently no estimates in the literature of the social cost of a user meeting clinical criteria for abuse or dependence; thus, it is not possible to quantify this increase’s budgetary impact on California taxpayers. But, to the extent that dependence and abuse impose costs in the form of reduced productivity, higher health-care costs, or lost time with the family, a rise
in dependence represents a real loss to the citizens of California.

Drugged Driving
While driving under the influence of marijuana or any other intoxicating substance can be risky, a question remains about whether marijuana use impairs individuals sufficiently to cause crashes and fatalities. While there is significant experimental literature suggesting a diminished effect on response rates and performance under very strictly controlled conditions, evidence
from epidemiological studies has been less conclusive (Ramaekers et al., 2004; Blows et al., 2005). The notable exception in the literature are cases in which alcohol is used in conjunction with marijuana, in which case the evidence is clear that the combined effect of these two drugs impairs driving significantly more than alcohol alone (Bramness, Khiabani, and two drugs impairs driving significantly more than alcohol alone (Bramness, Khiabani, andMørland, 2010; Jones et al., 2003; Dussault et al., 2002).

Given the current uncertainty of the science in determining the role of marijuana use alone in accidents, it is impossible to determine how much an increase in marijuana use would translate into more accidents or, worse
yet, fatal crashes. However, a simple calculation suggests that, if someone believes that marijuana is causally responsible for many crashes that involve marijuana using drivers, legalization’s effect on crashes could be a first-order concern for them. Based on Fatality Analysis Reporting System (FARS) data, Crancer and Crancer (2010) report that blood tests established that one or both drivers had used marijuana near the time of the accident in 5.5 percent of passenger-vehicle fatal crashes (2008 in California). Causality is complicated in multicar crashes, but, even just considering single-vehicle fatal crashes, Crancer and Crancer found that 126 fatalities in crashes with marijuana involved drivers, 75 percent of whom had alcohol levels below 0.08.
There is no empirical evidence concerning an elasticity of fatal accident rates with respect to marijuana price, prevalence, or quantity consumed, and, as we have underscored repeatedly, there is enormous uncertainty concerning how legalization might affect those outcomes.

However, 50- or 100-percent increases in use cannot be ruled out; nor can the possibility that marijuana-involved traffic crashes would increase proportionally with use. So it would be hard to dismiss out of hand worries that marijuana legalization could increase traffic fatalities by at least 60 per year (126 × 50% = 63)—especially since this represents increases in fatalities
associated only with single-vehicle crashes and ignores the role marijuana might play in multivehicle fatalities. See Pacula (2010a) for a more detailed analysis. There is no satisfactory way to compare the importance of some number of traffic deaths to dollar-denominated outcomes, such as tax
revenues, but, when economists are forced to come up with such a number, they often use figures on the order of $4 million to $9 million per death (Viscusi and Aldy, 2003). Whereas we are reasonably confident that additional costs of marijuana treatment and of ED mentions and hospitalizations related directly to use per se are not first-order concerns, we cannot rule out that possibility with respect to legalization’s effects on drugged driving.

Use of Other Substances
Legalization will reduce marijuana prices and increase marijuana use. Either effect could affect the use of other substances. We take them up in reverse order. Increased marijuana use could lead to greater use of other substances in various ways. For example, it is possible that becoming dependent on marijuana affects neural pathways in a way that increases vulnerability to abusing other substances. However, almost all the literature and
controversy concerns a possible causal effect of use short of dependence.

The use of marijuana typically precedes the use of such substances as cocaine and heroin, and people who use marijuana earlier and more heavily are more likely to go on to more and heavier use of these substances (Kandel, 2002). These facts have given rise to the so-called gateway
hypothesis—the hypothesis being that the pattern is not merely coincidence but instead reflects causal linkages, so that anything that increases or reduces use of marijuana might thereby cause an increase or reduction in use of these other substances.

Few topics in the drug-policy literature have stirred greater passions than the gateway hypothesis. While everyone agrees about the descriptive facts (e.g., cocaine use is usually preceded by marijuana use), there are sharp differences about whether the patterns reflect a causal relationship and, if so, what the causal mechanism is. Skeptics are fond of pointing out that
cocaine use is also usually preceded by drinking milk (i.e., most cocaine users tried milk before they first experimented with cocaine, but no one believes that drinking milk puts one at risk for greater cocaine use).
The gateway effect, if it exists, has at least two potential and quite different sources (MacCoun, 1998). One interpretation is that it is an effect of the drug use itself (e.g., trying marijuana increases the taste for other drugs or leads users to believe that other substances are more pleasurable or less risky than previously supposed). A second interpretation stresses peer groups
and social interactions. Acquiring and using marijuana regularly may lead to differentially associating with peers who have attitudes and behaviors that are prodrug generally, not only with respect to marijuana. One version of this is the possibility that those peers will include people who sell other drugs, reducing the difficulty of locating potential supplies. If the latter
is the explanation, then legalization might reduce the likelihood of moving on to harder drugs compared to the current situation.

Many studies have examined the gateway effect, and Room et al. (2010, p. 35) provide a concise appraisal of the international, multidisciplinary evidence:
Cannabis use is more strongly associated with other illicit drug use than alcohol or tobacco use, and the earliest and most frequent cannabis users are the most likely to use other illicit drugs. Animal studies provide some biological plausibility for a causal relationship between cannabis and other types of illicit drug use. Well-controlled longitudinal studies suggest that selective recruitment to cannabis use does not wholly explain the association between cannabis use and the use of other illicit drugs. This is supported by discordant twin studies [that] suggest that shared genes and environment do not wholly explain the association. Nonetheless, it has been difficult to exclude the hypothesis that the pattern of use reflects the common characteristics of those who use cannabis and other drugs. We say nothing more about gateway effects because there simply is no consensus about it.

Farrelly et al. (2001) use a proxy for marijuana use, and their results suggest that, when marijuana use goes up, so does tobacco use.

Cocaine. A number of studies suggest that marijuana and cocaine are economic complements, but many of these studies use the problematic decriminalization variable as a proxy for marijuana price (Thies and Register, 1993; Grossman and Chaloupka, 1998; Saffer and Chaloupka,
1999). Williams and colleagues (2006) use actual marijuana prices in their analysis of cocaine use among college students in the United States. For college students in the 1990s, they estimate the cross-price participation elasticity for cocaine to be between -0.44 and -0.49.
This means that a 10-percent decrease in the price of marijuana would increase the prevalence of cocaine use by 4.4 to 4.9 percent.

Excerpts below from the Rand Testimony to the Subcommittee on Criminal Justice, Drug Policy and Human Resources of the House Committee on Government Reform – July 13th l999 (Peter Reuter and Robert J. MacCoun

Several lines of evidence on the deterrent effects of marijuana laws and on decriminalization experiences in the United States. the Netherlands and Australia –suggest that eliminating (or significantly reducing) criminal penalties for first-time possession of small quantities of marijuana has either no effect or a very small effect on the prevalence of marijuana use.
….. Decriminalisation was not associated with any detectable changes in adolescent attitudes toward marijuana. [now, in 2010 we can already see that
So-called medical marijuana and Prop.19 in CA have changed adolescent attitudes

….The initial decriminalization (in the Netherlands) phase had no detectable impact on levels of cannabis use, consistent with evidence from the US and Australia. Survey data showed literally no increase in youth or adult use from 1976 to about l984, and Dutch rates were well below those in the US. …..But between l980 and l988 (the commercialization regime mid l980s to l995) the number of coffee shops selling cannabis in Amsterdam increased tenfold,…. .….and began to promote the drug more openly.

As commercial access and promotion increased, the Netherlands saw rapid growth in the number of cannabis users, an increase not mirrored in other nations. Whereas 15% of l8-20 year olds reported having used marijuana in l984, the figure more than doubled to 33% in 1992. Since l992 the Dutch figure has continued to rise but that growth is paralleled in the US and most other rich Western nations…..

…..Legalization would eliminate the harms caused by prohibition, but it would not eliminate the harms caused by drug use……..we believe that legalization would significantly increase the number of drug users and the quantity of drugs consumed. ……

……If legalization produced a significantly large increase in total use, total drug harm would go up, even if each incident of use became somewhat safer. Because Total Drug Harm = Average Harm Per Use x Total Use, total harm can rise even if average harm goes down………….Thus legalization is a very risky strategy for reducing drug-related harm.

Research Summary

Fifth-grade students who took part in comprehensive, interactive school-based prevention programs starting as early as first grade were half as likely as their peers to use alcohol or other drugs, act out violently, or engage in sexual activity, according to a new study from the National Institute on Drug Abuse (NIDA).
“This study provides compelling evidence that intervening with young children is a promising approach to preventing drug use and other problem behaviors,” said NIDA Director Nora Volkow. “The fact that an intervention beginning in the first grade produced a significant effect on children’s behavior in the fifth grade strengthens the case for initiating prevention programs in elementary school, before most children have begun to engage in problem behaviors.”
Researchers led by Brian Flay of Oregon State University studied students at 20 public elementary schools in Hawaii who had participated daily in Positive Action (PA), a comprehensive K-12 program focusing on social and emotional development. Students who had received the PA lessons the longest had the least amount of problem behaviors, the study found.
The authors will next look at whether the PA program had lasting effects on older students.

Source: American Journal of Public Health June 18, 2009

Media reports on illicit drugs “reduce acceptability and increase perception of risk” among young people, study finds.
Mainstream media reporting is far more likely to deter young people from using illicit drugs than encourage their use, a new Australian study has found.
But the study also found that types of reports most likely to have the strongest impact on young people – those on social and health consequences of drug taking – were underrepresented in the media.
The study by the Drug Policy Modelling Program at the National Drug and Alcohol Research Centre at the University of NSW, and funded by the Commonwealth Department of Health and Ageing, measured the impact of media reports on illicit drugs on the attitudes of over 2,000 young people aged 16 – 24.
The study also analysed 4,000 newspaper reports referring to illicit drugs and found that just over half focussed on criminal justice and legal issues, while only 24 per cent highlighted the health or social problems associated with drug taking.
Participants were shown eight different types of reports and their responses were measured.
Chief Investigator of the study Dr Caitlin Hughes, a Research Fellow at NDARC’s Drug Policy Modelling Program (DPMP), said that while drugs are one of the most common motifs in popular culture and one of the most frequently reported on there is very little research anywhere in the world on how media reporting on illicit drug issues influences attitudes or behaviour on illicit drug use..
“We know from related fields that media messages can influence people’s knowledge, attitudes and behaviour.
“It is commonly assumed that news media can incite drug use,” said Dr Hughes.
“Our research has found that the opposite is the case. Most media portrayals appear to reduce interest in illicit drugs, at least in the short term.
“They increase perceptions of risk, reduce perceptions of acceptability and reduce the reported likelihood of future drug use,” said Dr Hughes.
”But the irony is that the messages that are most effective at deterring youth interest in drugs are currently under-represented in Australian news media,” said Dr Hughes.
News items which focussed on the health and social issues – for example evidence about cannabis and psychosis or cannabis and poor educational outcomes – were more likely to have a deterrent effect than reports on drug busts and arrests.

“Our results show clearly there is an opportunity to better harness the media to shape young peoples’ attitudes to illicit drugs.
We are not saying news media is the silver bullet in drug prevention, but given news media is so pervasive we do think it ought to be recognised, both within Australian and internationally, as a potentially powerful tool for preventing illicit drug use.”

Key points:
• A total of 2,296 youth aged 16-24 years completed the survey
• All youth were shown 8 different media messages about drugs (on the two most commonly used drugs in Australia – cannabis and ecstasy)
• 66.4% and 86.5% of participants had weekly or more frequent contact with television news, online news, radio news and/or print newspapers
• Most news media messages elicited moderate to large impacts on youth attitudes. Negative health or social messages elicited large impacts on youth attitudes.
• Messages on ecstasy had greater impact on youth than messages on cannabis
• Females more likely to be deterred from use than males
• People who have never used drugs more likely to be deterred than current users
• Reports on criminal arrests significantly less persuasive than reports about negative health or social consequences
• Across all drugs, criminal justice/law enforcement topics accounted for 55% of all topics
• 60% of articles emphasised that illicit drugs lead to legal problems. 14% health problems, 10% social problems, 10% cost to society and 6% other (4% neutral and 2% benefits)
• Tabloids were more likely to emphasise legal problems: 71% compared to 61% for broadsheet
• 11 newspapers, one national, seven major metropolitan, in Sydney, Canberra, Melbourne, Brisbane and Perth and three local in Geelong, Newcastle and Sydney were reviewed

What they said: (comments from the focus groups).
Re power of media to dissuade youth drug use:
“Media is probably one of the few ways that prevention message(s) can keep being pushed.” (20 year old female)
“When I was younger… the way that that was portrayed in the media totally shaped the way that I saw drugs.” (22 year old female)
Re fatal overdose of a young person:
“I think that would convince me not to take drugs. Just „cause……I feel sorry for her.” (17 year old male)

Source: Media reporting on illicit drugs in Australia: trends and impacts on youth attitudes to illicit drug use. Drug Policy Modelling Program, September 2010. It can be accessed through: http://www.dpmp.unsw.edu.au

Researchers at King’s College London’s Institute of Psychiatry say a personality-based intervention for substance abuse that was delivered by teachers was successful in reducing drinking rates, particularly binge drinking, among adolescents.

In the article titled “Personality-Targeted Interventions Delay Uptake of Drinking and Decrease Risk of Alcohol-Related Problems When Delivered by Teachers,” principal Investigator Dr. Patricia Conrod and colleagues evaluated 2,506 adolescents, with a mean age of 13.7, using the Substance Use Risk Profile scale; a 23-item questionnaire which assesses personality risk for substance abuse along four dimensions including sensation-seeking, impulsivity, anxiety-sensitivity, and hopelessness.

Of the 1,159 students identified by researchers as being at high risk for substance abuse, 624 received intervention as part of the Adventure Trial and a matched high risk group of 384 received no intervention. School based interventions consisted of two 90 minute group sessions conducted by a trained educational professional. In order to adequately evaluate the students, the teachers attended a 3-day rigorous workshop, followed by 4 hour supervision and feedback session. An 18 point checklist was used to determine whether the teachers demonstrated a good understanding of the aims and components of the programs.

Although the trial is designed to evaluate mental health symptoms, academic achievement, and substance use uptake over a 2 year period, the authors have focused their findings on the six month outcomes of drinking and binge-drinking rates, quantity by frequency of alcohol use, and drinking-related problems. Reporting on the efficacy of the intervention at six months, author and Trial Coordinator Maeve O’Leary-Barrett writes, “Receiving an intervention significantly decreased the likelihood of reporting drinking alcohol at follow-up, with the control group 1.7 times more likely to report alcohol use than the intervention group (odds ratio, 0.6).”

Furthermore, receiving an intervention also predicted significantly lower binge-drinking rates in students who reported alcohol use at baseline (odds ratio, 0.45), indicating a 55 percent decreased risk of binge-drinking in this group compared with controls. In addition, high-risk intervention-school students reported lower quantity by frequency of alcohol use and drinking-related problems compared with the non-treatment group at follow-up.

The Adventure Trial is the first to evaluate the success of the personality-targeted interventions as delivered by teachers. The findings at six months suggest that this approach may provide a sustainable school-base prevention program for youth at risk for substance abuse.

In the JAACAP article, Principal Investigator Dr. Patricia Conrod and colleagues comment on the success of their program by stating, “In-house personality-targeted interventions allow schools to implement early prevention strategies with youth most at risk for developing future alcohol-related problems and provide the potential for follow-up of the neediest individuals.”

Source: Journal of the American Academy of Child and Adolescent Psychiatry. Sept. 2010

An Evaluation of the Kids, Adults Together Programme (KAT)

INTRODUCTION
A key influence on the timing of young people’s first alcohol use is the family (Spoth et al. 2002) and a number of substance misuse prevention programmes (mainly in the USA) have tried to influence families. Most are based in schools, which potentially provide an efficient way to reach large numbers of young people and their families (Bryan et al. 2006). However, in practice, school-based initiatives have not always managed to engage significant numbers of parents (Lloyd et al. 2000; Rothwell et al. 2009; Stead et al. 2007; Ward and Snow 2008).
This report describes the findings from an exploratory evaluation of a new school-based alcohol misuse prevention programme – Kids, Adults Together (KAT), which engaged with parents as well as children. The programme comprised a classroom component for children, a family fun evening, and a DVD. The research study evaluated the development and early implementation of KAT, and aimed to establish the theoretical basis for the programme. It explored implementation processes and acceptability, and identified plausible precursors of the intended long-term outcome which could be used as indicators of likely effectiveness.
METHODS
Mixed qualitative data-collection methods were used during two phases of evaluation. The first phase of the evaluation investigated how KAT had originated and developed; its relationship to existing evidence and theory; and its aims. Methods used were an analysis of thirty-two documents selected by the programme organizers and meant to provide an ‘audit trail’ of programme development up until the start of the evaluation; a literature search; and interviews with six members of the working group who had been involved in setting up the programme, the programme organiser and his assistant, the KAT DVD producer and the organiser of the Australian PAKT programme (on which KAT is based).
The second phase comprised observation of the classroom preparation and KAT family events in two pilot schools; focus groups with forty-one children; interviews with both head teachers and with teachers who delivered the classroom preparation; follow-up interviews with the programme organisers and six Working Group members; interviews with twelve parents who attended the KAT family events; and a questionnaire for parents of all 110 children who had been involved in the classroom preparation. There were two rounds of focus groups and parent interviews: the first as soon as possible after the KAT event at each school and the second months later.
Programme aims
The main aim of KAT was identified as reducing the number of children and young people who engaged in alcohol misuse. Exploration of the programme’s implementation suggested that family communication should be reaffirmed as its primary objective. This was consistent with the social development model (Catalano and Hawkins 1996) which links family communication with children’s alcohol-related behaviour later in life.
Acceptability
KAT achieved high levels of acceptability among pupils, parents and school staff. Parents enjoyed the fun evening, and thought it was delivered in an, engaging and non lecturing way. Participants thought it was good that the KAT programme had been run in the school setting, and felt that such work should be delivered to children at a young age. Staff in both pilot schools believed that the way in which the evening was promoted as an opportunity for parents to find out what their children had been working on helped avoid a perception that the fun evening was designed to lecture parents.
INITIAL IMPACT
Communication
The KAT programme’s most significant and persistent impact on communication was the effect on family conversations about parental drinking. Many children who thought their parents drank too much alcohol reported trying to change their (parents’) behaviour.
The classroom preparation was effective in promoting communication about alcohol issues amongst members of the class but outside the classroom, its effect was minimal, and until the work had culminated in the fun evening, few children said much at home about it. Most children were very keen to go to the fun evening, to show off their work, to see what it was like and to enjoy the refreshments and entertainment. Many put pressure on their parents to attend.
The fun evening acted as a catalyst for setting off conversations about what children had done in the classroom and activities during the evening. The DVD was effective in extending the influence of the programme beyond the school-based components.
Knowledge
Both children and parents reported having gained new knowledge about alcohol as a result of their involvement with the KAT programme.
Attitudes
There was little evidence that involvement in KAT (as a whole or its constituent components) had led to changes in parents’ or children’s attitudes to alcohol consumption. Overall the children held critical attitudes towards alcohol and the effects which its consumption might lead to. Most parents who were concerned about the dangers of alcohol and the use of alcohol by their children held pre-existing concerns or attitudes.
Awareness
KAT raised children’s and parents’ awareness of issues relating to alcohol and some parents had thought about their own drinking practices, particularly how drinking alcohol in front of their children could influence them.
Intention
Evidence from participants suggested that KAT had only a small effect on intentions regarding future behaviour. These intentions were often stimulated by specific aspects of the programme such as the DVD or leaflets in the goody bag.
Behaviour
There was evidence from some parents and children at both schools that drinking behaviour of parents and other family members had changed as a result of KAT. The effect was not confined to those who had attended the fun evening, suggesting that KAT was able to influence communication within wider networks of family and friends.
IMPLICATIONS
The report highlights five main findings from the evaluation of KAT:
1. KAT has demonstrated promise as an alcohol misuse prevention intervention through its short term impact on knowledge acquisition and pro-social communication with family networks
2. The interaction between the programme’s core components (classroom activities, family fun evening and the programme DVD/goody bag) appear to have been integral to the impact on knowledge acquisition and communication processes that occurred within participating families
3. The timing of KAT (its delivery to children In primary school Years 5 and 6) is appropriate both because it precedes the onset of drinking (or regular drinking), and because it engages families whilst they are still a key attachment and influence in young people’s lives
4. KAT achieved high levels of engagement and acceptability among parents, and this included some families with problems/support needs in relation to alcohol
5. Engagement levels among parents were higher among mothers than fathers. The research was not able to explore the in-depth experiences of those parents/carers who did not or could not attend the KAT fun evening
The following five recommendations are made for the future development and evaluation of KAT:
1. Further research is needed to refine and develop the theoretical model of how KAT works, whether short term changes in knowledge, communication and behaviour are sustained over the longer term, and how these processes might reduce alcohol misuse
2. KAT needs to be delivered and evaluated in different school contexts to further test its underpinning model, and explore the acceptability and local adaptation of the programme within these settings
Future research needs to explore in more detail the reach of the programme (including the engagement of fathers), examine what barriers to attendance might exist and put in place strategies to minimise them
3. Future stages of implementation should clarify if KAT specifically aims to reach families with problems/support needs in relation to alcohol, or whether it is intended as a primary prevention intervention for general school populations
4. It is important to address the support needs of children whose attempts to discuss issues raised by KAT (particularly around parental drinking) are rejected or not received positively by their parents

Source: http://www.aerc.org.uk/insightPages/libraryIns0070.html Alcohol Insight number 70

Parents who try to teach responsible drinking by letting their teenagers have alcohol at home may be well intentioned, but they may also be wrong, according to a new study in the latest issue of the Journal of Studies on Alcohol and Drugs.

In a study of 428 Dutch families, researchers found that the more teenagers were allowed to drink at home, the more they drank outside of home as well. What’s more, teens who drank under their parents’ watch or on their own had an elevated risk of developing alcohol-related problems. Drinking problems included trouble with school work, missed school days and getting into fights with other people, among other issues.

The findings, say the researchers, put into question the advice of some experts who recommend that parents drink with their teenage children to teach them how to drink responsibly — with the aim of limiting their drinking outside of the home.

That advice is common in the Netherlands, where the study was conducted, but it is based more on experts’ reasoning than on scientific evidence, according to Dr. Haske van der Vorst, the lead researcher on the study.

“The idea is generally based on common sense,” says van der Vorst, of Radboud University Nijmegen in the Netherlands. “For example, the thinking is that if parents show good behavior — here, modest drinking — then the child will copy it. Another assumption is that parents can control their child’s drinking by drinking with the child.”

But the current findings suggest that is not the case.

Based on this and earlier studies, van der Vorst says, “I would advise parents to prohibit their child from drinking, in any setting or on any occasion.”

The study included 428 families with two children between the ages of 13 and 15. Parents and teens completed questionnaires on drinking habits at the outset and again one and two years later.

The researchers found that, in general, the more teens drank at home, the more they tended to drink elsewhere; the reverse was also true, with out-of-home drinking leading to more drinking at home. In addition, teens who drank more often, whether in or out of the home, tended to score higher on a measure of problem drinking two years later.

The findings, according to van der Vorst, suggest that teen drinking begets more drinking — and, in some cases, alcohol problems — regardless of where and with whom they drink.

“If parents want to reduce the risk that their child will become a heavy drinker or problem drinker in adolescence,” she says, “they should try to postpone the age at which their child starts drinking.”

Available at: http://www.jsad.com/jsad/link/71/105

Source: H. van der Vorst Journal of Studies on Alcohol and Drugs 71 (1), 105-114. Jan 2010

A Temple University psychologist argues that society would be better off using strict laws to prevent risky behaviors by adolescents rather than education programs, saying that teens’ brains are too immature to avoid risk-taking, USA Today reported April 5.
“We need to rethink our whole approach to preventing teen risk,” said researcher Laurence Steinberg, who drew his conclusions after reviewing a decade’s worth of research on the adolescent brain. “Adolescents are at an age where they do not have full capacity to control themselves. As adults, we need to do some of the controlling.”
Steinberg said society would be best served by raising the driving age, increasing cigarette prices, and enforcing underage-drinking laws than investing in prevention programs. “I don’t believe the problem behind teen risky behavior is a lack of knowledge,” he said. “The programs do a good job in teaching kids the facts. Education alone doesn’t work. It doesn’t seem to affect their behavior.”
“Kids will sign drug pledges. They really mean that, but when they get in a park on a Friday night with their friends, that pledge is nowhere to be found in their brain structure,” agreed psychologist Michael Bradley. “They’re missing the neurologic brakes that adults have.”
Isabel Sawhill, co-director of the Center on Children and Families at the Washington-based Brookings Institution, said the findings are “good research for policymakers to consider, but we shouldn’t infer from this research that all our past efforts have been ineffective. I’m not in favor of just doing education, but I’m also not in favor of not doing it, either. We need to do some of both.”

Source: Current Directions in Psychological Science. April 2007

My first appointment was with Dr Diana Fishbein, a Senior Fellow in behavioral neuroscience at the Research Triangle Institute (RTI) which is an international not-for-profit research organisation .

Diana is the Director of the Transdisciplinary Behavioural Science Program at RTI. In this role she focuses on bringing interdisciplinary teams of researchers together to try to answer some of the big questions that need to be asked in the behavioural sciences. Her overarching goal is to focus on the nexus between research and practice and to facilitate the “Translation of Research into Evidence Based Practice”. In fact RTI International organisational by line is Turning Knowledge into Practice.    

Diana’s personal research career has been in the area of criminology and drug abuse taking a prevention science approach.  She is particularly interested in why some young people respond well to a prevention approach while others don’t, and ultimately in determining “who responds to what treatment at what time point and why”?

To explore these questions she uses interdisciplinary methods and a developmental approach and sees the plasticity of neurobiological systems as one of the keys to finding the answer. Dr. Fishbein  pointed out that neuroplasticity enables neurobiological systems to be shaped by inputs from the environment and so can be altered for better or worse depending on the nature of these inputs. This is highly relevant to a prevention or early intervention approach and can guide the development of interventions. Research in this area is now beginning to focus on the mechanisms through which developmental risk factors impact on the developing systems and also on the type of interventions which have the most impact, how they are affecting neuroplastic change and when they are having the most effect.  

For instance there is evidence that the neurobiological functions underlying drug misuse and aggression are quite complex and include executive functioning, coping skills and affect regulation. The part of the brain associated with these functions (prefrontal-limbic brain networks) is not consolidated until early adulthood. Therefore is we can understand the type, effect and developmental timing of environmental impact on this brain function we may be able to plan intervention programs that alter negative impact and increase positive impact.  We may also need to tailor interventions to particular risk factors in the young person’s environment. Diana is confident this translational approach promises to eventually offer some direction for the design of effective interventions to prevent drug misuse and associated aggression.

This cutting-edge evidence-based research with the capacity to not only make a difference but to provide us with the scientific evidence to show how change has come about.  The message that again seems to be coming through to me is that one size is not likely to fit all. The other message is one that Professor Alan Hayes a member of the external advisory group for this project has written about in his chapter entitled Why early in life is not enough! (Hayes, 2007. In France, A & Homel, R (Eds) Pathways and crime prevention: Theory policies and practice  Willian (pps 202-225)

Dr Fishbein and I also talked about the need for parent and community involvement in interventions.  She also indicated to me that she and her organisation are very interested in innovative collaborative international research. Perhaps this is something to think about for the future.

Source: http://shapingbrains.wordpress.com  3^rd March 2010

The truth youth anti-smoking campaign has the power to save hundreds of thousands of lives and billions of dollars in smoking related health care costs and productivity losses, according to the Citizens’ Commission to Protect the Truth, a group composed of every former U.S. Secretary of Health, Education and Welfare and Health and Human Services with the exception of Michael Leavitt; every former U.S. Surgeon General; and every former Director of the Centers for Disease Control and Prevention.
A recent study published in the American Journal of Preventive Medicine indicated that the medical care costs averted by the truth® campaign – due to prevention of smoking – were far greater than the costs of the campaign itself and found that for every dollar invested in truth®, it is estimated that society saved over $6.80. The study focused on the period of 2000–2002. During this period of time, the truth® campaign has been credited with reducing the number of children and teen smokers by 300,000.
We believe that if the truth® campaign continues for another five years (2009-2014) with similar effectiveness, there will be up to 500,000 fewer youth smokers with savings of up to $9.0 billion in future medical costs.
The Commission based its analysis on the findings of the study presented in the May 2009 issue of the American Journal of Preventive Medicine, which found that the decrease in the number of youth who initiated smoking as a result of truth® during the period of 2000–2002 may result in averting up to $5.4 billion in future medical costs.
According to the U.S. Centers for Disease Control and Prevention, one-third of young smokers will die prematurely from smoking-related diseases. Since 80% of adult smokers began using tobacco products before the age of 18, the hundreds of thousands of children who opt not to smoke because of their exposure to truth® will almost certainly not become adult smokers.
“Ending smoking by American children and teens is crucial to the health and cost of healthcare to our nation. The truth® campaign provides a return on investment that would make the greediest corporate CEOs salivate. The truth® campaign is one of the most effective investments in the history of public health,” said Joseph A. Califano, Jr., Commission Chairman and former U.S. Secretary of Health, Education, and Welfare who started the national anti-smoking campaign in 1978. “truth® is the only national smoking prevention campaign not directed by the tobacco industry which exposes the tactics of the tobacco industry, the truth about addiction, and the health effects and social consequences of smoking.”
The American Legacy Foundation’s life-saving truth® campaign is the largest national youth smoking prevention campaign and an extraordinary public health story. The campaign is a national peer-to-peer intervention that works. In its first two years, truth® was responsible for 22% of the overall decline in youth smoking—a decrease which represents approximately 300,000 fewer smokers. Peer reviewed studies, both old and new, underscore that truth® can inoculate teens against tobacco addiction. The truth® campaign’s successes are unassailable.
Source : Citizens Commission to Protect the Truth April 19, 2009

Background: Prevention interventions that focus on the impact of social influences, making healthy choices, and promoting anti-substance abusing norms have proven effective in reducing adolescent drug use. The school-based drug abuse prevention program Life Skills Training (LST) teaches a variety of cognitive-behavioral skills for problem-solving and decisionmaking, resisting media influences, managing stress and anxiety, communicating effectively, developing healthy personal relationships, and asserting one’s rights. Researchers wanted to know if these strategies may also be successfully applied to combat adolescent delinquency, verbal and physical aggression, and fighting.

Study Design: Researchers introduced LST to 2,374 students in 20 New York City public and parochial schools, and established a comparable control group. Sample composition was 39 percent African-American, 33 percent Hispanic, 10 percent White; 55 percent economically disadvantaged; and 30 percent living in mother-only households.

What They Found: After 15 school-based sessions, delinquency and frequent fighting were significantly reduced across the entire intervention group.

Comments from the Authors: This study supports the idea that multiple problem behaviors may have common causes. It further suggests that the development of comprehensive, integrated school-based approaches to prevention may more efficiently target an array of related behaviors, thereby reducing the burden on resources and increasing the likelihood for adoption and implementation.

What’s Next: More research is needed to test the durability of the LST approach. It would also be useful to determine if these strategies can prevent more serious forms of violence, such as assault and homicide.

Publication: The study, led by Dr. Gilbert J. Botvin of the Department of Public Health at Weill Cornell University Medical College, was published in volume 7, pages 403-408 (2006) of Prevention Science.

Source: NIDA 27th Aug.2007

• Compared to 12- and 13-year olds who have frequent family dinners, those who have infrequent family dinners are six times likelier to use marijuana, four times likelier to use tobacco, and three times likelier to use alcohol.
• Compared to teens who attend religious services at least weekly, those who never attend services are more than twice as likely to try cigarettes, and twice as likely to try marijuana and alcohol.
• Compared to teens who have frequent family dinners, those who have infrequent family dinners are one and a half times likelier to report getting grades of C or lower in school. 

Source: www.casacolumbia.org   Sept.2009

As frequency of family dinners increases, reported drinking, smoking and drug use decreases.Compared to teens who have frequent family dinners (five to seven family dinners per week), those who have infrequent family dinners (fewer than three per week) are twice as likely to have used tobacco or marijuana, and more than one and a half times likelier to have used alcohol.

The relationship between the frequency of family dinners and substance use is especially strong among the youngest teens in the survey.

Compared to 12- and 13-year olds who have five to seven family dinners per week, those who have fewer than three family dinners per week are six times likelier to have used marijuana, four times likelier to have used tobacco, and three times likelier to have used alcohol.

Source: www.casacolumbia.org Sept.2009

A solid body of research has shown that raising the taxes and price of alcohol leads to a decrease in consumption by youth, and reduces alcohol-related deaths and illness. Increasing the total price of alcohol has also been shown to decrease drinking and driving among all age groups.The level of alcohol taxes and the rules for serving alcohol make a difference in underage and high-risk drinking. The taxes on beer, the drink of choice for the vast majority of underage drinkers, vary from $.02 per gallon in Wyoming to $1.07 per gallon in Alaska.

The five states with the highest beer taxes have significantly lower rates of teen binge drinking than the states with the lowest taxes.

Although raising alcohol taxes has proven to be effective, it is rarely used by states. According to the Center for Science in the Public Interest, most states’ alcohol taxes have not been raised in decades. With the effects of inflation taken into account, the current value of most state alcohol taxes is very low.

For example, in California alcohol taxes have fallen 49 percent in inflation-adjusted dollars since the last increase in 1991, according to the Marin Institute.

Some states that have raised alcohol taxes dedicate the proceeds to public health programs, including substance use treatment programs, prevention campaigns, and other public education efforts.

Source: www.Join Together.org Aug.2009

Twiggs County school system will receive a $62,724 federal grant to help students say no to gangs, according to a legislative news release    The grant from the Department of Justice will develop a Gang Resistance and Education Training program for Twiggs elementary and middle school students.
 Known as G.R.E.A.T, it’s a violence prevention curriculum that helps students develop values and practice behaviors to help them avoid destructive activities. It will help pay for a summer program and activities afterschool.
“This funding will go a long way to help ensure that Twiggs County has the resources necessary to help prevent young people from getting involved in dangerous activities,” Sen. Isakson said.
“G.R.E.A.T is an important resource for Georgia’s youth and I’m pleased to see Twiggs County receive this funding which will help keep our communities safe,” Chambliss said.Source: www.macon.com August 2008

Two Iowa State University researchers have given communities worldwide good reason to implement substance abuse prevention programs. They’re economically beneficial, with a nearly $10 return for every dollar invested in prevention.
Richard Spoth, director of the (PPSI) at Iowa State, and Max Guyll, ISU assistant professor of psychology, presented that message to substance abuse experts representing approximately 100 countries at a conference in Vienna, Austria, co-sponsored by the United Nations Office on Drugs and Crime and the World Health Organization back in December.
“We showed how prevention can be particularly economically beneficial,” Spoth said. “The presentation began by reviewing the evidence on the cost effectiveness and the return on the investment — or cost benefits — of prevention programs. I also did a second presentation on the scientific advances and positive outcomes of family-focused prevention, illustrated by our own research.”
The ISU researchers applied their own and national data to calculate both the cost effectiveness and cost benefit for two of PPSI’s intervention programs — Iowa Strengthening Families Program (ISFP), which works on the family level to prevent substance abuse; and the Life Skills Training Program (LST), which was designed for school-based implementation. Spoth defines cost effectiveness as the cost to achieve a particular outcome — such as the prevention of an alcohol use disorder — while the cost benefit assesses whether savings generated by prevention are greater than costs spent on prevention.
The longitudinal “Project Family” study recruited 667 families through 33 Iowa school districts. The researchers calculated that the ISFP intervention cost $12,459 per disorder prevented, but resulted in a $119,633 benefit to communities per alcohol disorder prevented — a $9.60 return on each dollar invested. The “Capable Families and Youth” trial recruited 679 families through 36 Iowa school districts. Researchers found that life skills training intervention cost $4,921 per methamphetamine use case prevented, but produced a $130,013 employer benefit per methamphetamine user prevented — a $9.98 return on each dollar invested.
“Effective and efficient prevention promises to save possibly billions of dollars per year, provided we can learn how to effectively implement it on a larger scale,” Spoth told the conference.
Iowa State was the only American university that had a presenter invited to speak on the topic of prevention. Spoth, who received a commendation from the director of the National Institute on Alcohol Abuse and Alcoholism last year for his prevention work, was also the only expert asked to present twice at the conference.
“I spoke with people there who were very interested in doing family-focused prevention programming, which is evidence-based, in their countries,” Spoth said. “Some of them are developing these vast infrastructures, devoting extensive resources. I received a number of requests where they wanted me to get involved in some way with a group that was working on a large scale implementation of prevention programming in their country.”
Spoth reports that his conference appearance generated requests from Chile, India, Indonesia, Senegal and a number of other countries for consulting assistance as they implement intervention programs — possibly modeled after the ones he’s successfully implemented through PPSI.
He’s also been asked to participate in the meetings by the International Narcotics Control Board, located in Vienna, to work with them to produce their annual report.”They evaluate international substance issues in depth,” Spoth said. “What they would want me to address is the state of the art in effective prevention worldwide.”
The complete ISU reports “Prevention’s Cost Effectiveness — Illustrative Economic Benefits of General Population Interventions,” and “Prevention of Substance-related Problems: Effectiveness of Family-focused Prevention” are available online at: http://www.ppsi.iastate.edu/press/vienna.htm.

Source www.newswise.com  Feb 2009

Marijuana use appears to have decreased among most European and North American adolescents between 2002 and 2006, and those who went out with friends on fewer evenings of the week were less likely to report using the drug, according to a report in the February issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
“Cannabis [marijuana] use among young people is a serious public health concern,” the authors write as background information in the article. Recent evidence links marijuana use to motor vehicle accidents, injuries, inflammatory and cancerous changes in the airways and mental health problems, including depression. Long-term detrimental effects include poor academic performance and failure to complete schooling, impeding development and hampering future career opportunities.
“One factor that may help explain why adolescents engage in cannabis use is association with cannabis-using peers, which can increase the availability of cannabis and socially influence use,” the authors write. To investigate this link and also trends in marijuana use over time, Emmanuel Kuntsche, Ph.D., of the Swiss Institute for the Prevention of Alcohol and Drugs Problems, Lausanne, and colleagues analyzed data from 93,297 15-year-old students who participated in the Health Behavior in School-Aged Children study. Participants in 31 countries (mostly in Europe and North America) were surveyed in 2002 and again in 2006 about marijuana use and the number of evenings per week they usually spend out with their friends, among other topics.
During the four-year study period, marijuana use decreased in most of the countries, with the most significant declines in England, Portugal, Switzerland, Slovenia and Canada. Increases were observed in Estonia, Lithuania, and Malta and among Russian girls. The number of evenings out with friends also declined in most countries during the same time period, although there was a wide range in averages, from about one evening per week for Portuguese girls to more than three evenings per week among boys and girls in the Ukraine, Russia, Scotland, Estonia and Spain.
“The more frequently adolescents reported going out with their friends in the evenings, the more likely they were to report using cannabis,” the authors write. “This link was consistent for boys and girls and across survey years. Across countries, changes in the mean [average] frequency of evenings spent out were strongly linked to changes in cannabis use.”
Besides a decline in evenings out with friends, potential reasons for the decline in marijuana use include prevention efforts, availability or changes in teen preferences. It is more difficult to pinpoint factors behind the decline in evenings out, the authors note. New forms of communication, such as e-mail and text messaging, may have replaced some face-to-face interactions, or that the high rate of marijuana use in 2002 may have increased parental concerns about substance use and made access to the drug and evenings out more difficult.
“This overview of trends in 31 countries and regions provides policy makers with important information on the prevalence and amount of change in cannabis use among boys and girls in their countries,” the authors write. “There is a great need to learn more about the nature of evenings out with friends and related factors that might explain changes in adolescent cannabis use over time. Because there are many benefits to adolescent social interaction, it is important to determine how best to foster it without unduly increasing exposure opportunities for cannabis use.”
(Arch Pediatr Adolesc Med. 2009;163[2]:119-125. Available pre-embargo to the media at www.jamamedia.org.)
________________________________________
Editorial: Reducing Social Time for Teens Not an Ideal Prevention Method
“What we have gained from this well-designed international study is further convincing evidence that unsupervised social time is a critical ingredient for cannabis use for many young people,” write John E. Schulenberg, Ph.D., and Patrick M. O’Malley, Ph.D., of the University of Michigan, Ann Arbor, in an accompanying editorial.
“This might lead some to suggest a simple intervention of reducing unsupervised time with friends by, for example, increasing structured time with friends, increasing school and work time or increasing alone time,” the authors write. “However, this strategy may have unintended consequences for many adolescents. An important part of adolescence is exploring and forming friendships, having bonding experiences and finding a safe haven with friends away from adult supervision.”
“Thus, rather than trying to reduce socializing with friends, a more complicated but possibly more successful approach to intervention would help young people find activities together that do not promote marijuana use,” they conclude.

Source: Arch Pediatr Adolesc Med. 2009;163[2]:183-184

All those T-shirts, hats and other items promoting alcoholic beverages that young people wear may be more than just a fashion statement.   Teens who own such merchandise are more likely to start drinking and become binge drinkers, a new study contends.
The Dartmouth scientists who did the research said this is the first study directly linking alcohol-branded merchandise to adolescent drinking and outcomes such as binge drinking that can result in illness and death. In addition, the data provide evidence that this merchandise promotes teen drinking and could be a basis for enacting policies to restrict this alcohol-marketing practice, the researchers said.
“About 3 million adolescents in the United States own alcohol-branded merchandise,” said lead researcher Dr. Auden C. McClure, a pediatrician at Dartmouth Hitchcock Medical Center in Hanover, N.H. “Ownership of these items is associated with susceptibility to alcohol use and binge drinking,” she added.
These items serve as a marker for adolescents who drink, McClure said. “But it is also a direct link with susceptibility and initiation to drinking,” she said. “You can’t say any longer that these items are just a marker of kids who drink.”

Source:Archives of Pediatrics & Adolescent Medicine.  arch 2009

A literature review
Results
The most extensive and consistent evidence relates to young people’s interaction with their
families. The key predictors of drug use are parental discipline, family cohesion and parental
monitoring. Some aspects of family structure such as large family size and low parental age
are linked to adolescent drug use. There is also consistent evidence linking peer drug use
and drug availability to adolescent drug use. There is extensive evidence on parental
substance use, although some studies report no association while others indicate that the
association is attenuated by strong family cohesion. Age is strongly associated with
prevalence of drug use among young people reflecting a range of factors including drug
availability, peer relationships and reduced parental monitoring. There is limited evidence
suggesting that genetic factors account for a significant proportion of the variance in liability to
use cannabis, however this interpretation has been criticised by other writers. There is a
similar level of evidence linking self-esteem and hedonism to drug use. The available
evidence indicates that higher levels of drug use are strongly associated with young people’s
reasons for using drugs after controlling for risk factors.
Categories where evidence linking specific factors is mixed include: mental health, Attention
Deficit Hyperactivity Disorder (ADHD), stimulant therapy, religious involvement, sport, health
educator interventions, school performance, early onset of substance use and socioeconomic
status. For some of these categories there is evidence of indirect effects; for
example, socio-economic status may influence parental monitoring which in turn influences
drug use. The review did not consider any studies relating to previously identified risk and
protective factors such as ethnicity or impulsivity.
For young drug users in treatment, psychosocial risk predicts drug abuse at treatment entry
but not follow up. In contrast, protective factors are of increased importance during recovery
The overall ratio of risk to protection may be more important than any individual factor. These
results, although supported by a relatively small body of research, support the concept of
resilience to drug use. According to this view resilience to drug use is enhanced by increasing
social skills, social attachments and material resources despite constant exposure to known
risk factors.
Whereas risk and resilience are, to a large extent, independent of individuals’ motives, there
is evidence that the latter are just as important as the former in determining drug use. Young
drug users consistently report getting intoxicated and relief from negative mood states as
reasons for their drug use. Qualitative research shows that the context in which young people
experience drugs is crucial for understanding how risk and protective factors operate in
relation to experimental and sustained drug use.
Risk factors have differential predictive values throughout adolescence. Some factors may
occur at birth (or before) while others occur at varying times throughout adolescence. Some
factors may persist for long periods of time while others are transitory. The distinction
between early and late onset risk factors is important as preventive measures need to focus
on particular age groups.
Conclusion
This review was pragmatic because it was time constrained and not all the studies identified
could be reviewed in detail. From the studies reviewed, the evidence relating to factors
associated with increased (or decreased) risk of drug use is described. Further analysis would
require a detailed assessment of individual studies, with clear specification of exposures (risk
and protective factors), outcomes (type and level of drug use) and study design (i.e. did
exposure precede the outcome).
Much of the current knowledge about risk and protective factors is not yet available in a form
that would permit the calculation of the effect of reducing exposure to risk (or enhancing
protective factors), even if was possible to modify the exposure. The evidence indicates that
risk and protective factors are context dependent and operate on people taking drugs for
disparate reasons. With these caveats, improving the general social environment of children
and supporting parents will probably be the most effective strategies for primary prevention of
drug use. Studies indicating that risk and resilience can be successfully altered include
interventions for parental monitoring and enhancement of social attachments and skills.
These interventions show promise but have rarely been implemented or evaluated in the UK.

Source:   Home Office OnLine report 05/07 Martin Frisher et al

From 2002 to 2007, there were decreases in the percentages of adolescents aged 12 to 17 reporting exposure to drug or alcohol use prevention messages through media sources (from 83.2 to 77.9 percent) and prevention programs outside of school (from 12.7 to 11.3 percent), but the percentage who had talked with their parents about the dangers of alcohol, drug, or tobacco use in the past year increased (from 58.1 to 59.6 percent)
   Combined data from 2002 to 2007 indicate that talking with a parent about the dangers of substance use decreased with age (61.6 percent of those aged 12 or 13, 59.5 percent of those aged 14 or 15, and 57.1 percent of those aged 16 or 17), whereas the percentage receiving prevention messages through media sources increased with age (77.0, 82.7, and 84.2 percent, respectively)
   In general, adolescents who reported having been exposed to substance use prevention messages in the past year were less likely than those who were not exposed to have used cigarettes, alcohol, and illicit drugs in the past month

Source:www.samhsa.gov

A family-based prevention program designed to help adolescents avoid substance use and other risky behavior proved especially effective for a group of young teens with a genetic risk factor contributing toward such behavior, according to a new study by researchers at the University of Georgia.

For two-and-a-half years, investigators monitored the progress of 11-year-olds enrolled in a family-centered prevention program called Strong African American Families (SAAF), and a comparison group. A DNA analysis showed some youths carried the short allele form of 5-HTTLPR. This fairly common genetic variation, found in over 40 percent of people, is known from previous studies to be associated with impulsivity, low self-control, binge drinking, and substance use.
The researchers found that adolescents with this gene who participated in the SAAF program were no more likely than their counterparts without the gene to have engaged in drinking, marijuana smoking, and sexual activity. Moreover, youths with the gene in the comparison group were twice as likely to have engaged in these risky behaviors as those in the prevention group.
The research team recruited 641 families in rural Georgia with similar demographic characteristics. They were divided randomly into two groups: 291 were assigned to a control group that received three mailings of health-related information, and 350 were assigned to the SAAF program, in which parents and children participated in seven consecutive weeks of two-hour prevention sessions. The parents learned about effective caregiving strategies that included monitoring, emotional support, family communication, and handling racial discrimination, which can contribute to substance abuse. The children were taught how to set and attain positive goals, deal with peer pressure and stress, and avoid risky activities.
Researchers conducted home visits with the families when the children were ages 11, 12, and 14 and collected data on parent-child relationships, peer relationships, youth goals for the future, and youth risk behavior. Two years later, the scientists collected DNA from saliva samples provided by the adolescents to determine whether they carried the short allele of 5HTTLPR. The results confirmed that the adolescents carrying this risk gene who were in the control group engaged in risky behaviors at a rate double that of their peers in the SAAF program.
“We found that the prevention program proved especially beneficial for children with a genetic risk factor tied to risky behaviors,” says the lead author, Gene H. Brody, Ph.D., Regents Professor and Director of the Center for Family Research at the University of Georgia. “The results emphasize the important role of parents, caregivers, and family-centered prevention programs in promoting healthy development during adolescence, especially when children have a biological makeup that may pose a challenge.”
Dr. Brody also notes that much of the protective influence of SAAF results from enhancing parenting practices. “The ability of effective parenting to override genetic predispositions to risky behaviors demonstrates the capacity of family-centered prevention programs to benefit developing adolescents,” he says. The study team, which included researchers from the University of Iowa and Vanderbilt University, concluded that the results validate the use of randomized, controlled prevention trials to test hypotheses about the ways in which genes and environments interact.

Source:: NIH/National Institute on Alcohol Abuse and Alcoholism (2009, May 20). Prevention Program Helps Teens Override A Gene Linked To Risky Behavior. ScienceDaily. Retrieved May 31, 2009, from http://www.sciencedaily.com¬ /releases/2009/05/090515083705.htm

The rates of nonmedical use of prescription drugs among adolescents and young adults in the United States are alarmingly high. Researchers funded in part by NIDA examined whether several universal drug abuse preventive interventions for middle school-age youth could reduce their future nonmedical use of prescription drugs. The interventions, which were administered to both middle school-aged children and their families, were tested in two randomized, controlled studies conducted in the rural Midwest
 The first study tested two different family-based interventions, the Preparing for the Drug Free Years (PDFY) program and the Iowa Strengthening Families Program (ISFP), which focus on teaching families about risk and protective factors for substance use.
 The second study compared the school-based Life Skills Training (LST) intervention program with the Strengthening Family Program for Parents and Youth 10–14 (SFP), a revised version of the family-based ISFP, plus the school-based LST programs.
Both studies followed participants until the age of 21 and also included control groups of students that did not receive any of the interventions being tested. Beginning in the 9th or 10th grade, students were asked about prescription drug abuse.
 Results from both studies showed that teens and young adults who had received the interventions in middle school reported less prescription drug abuse compared with participants who had not received the interventions. The magnitude of the difference depended on the specific intervention received, with the ISFP (in study 1) and SFP programs (in study 2) producing significant decreases in rates of prescription drug abuse. Whether these results can be generalized to other populations (such as nonrural or international populations) and whether the effects of the interventions persist into emerging adulthood years will need to be examined in further studies.
Source: Spoth R, Trudeau L, Shin C, Redmond C. Long-term effects of universal preventive interventions on prescription drug misuse. Addiction. 2008;103(7):1160–1168

Research Summary
Drivers ages 21 to 34 comprise a disproportionate share of fatal motor vehicle crashes in which at least one of the drivers was legally intoxicated (had a BAC of .08 or greater), according to data from the National Highway Traffic Safety Administration (NHTSA).
Although drivers ages 21 to 34 were involved in 31% of all fatal crashes in 2006, they were involved in 43% of all fatal crashes in which at least one driver was intoxicated.
On the other hand, drivers ages 45 or older were involved in 36% of all fatal crashes, but just 23% of drunk-driving fatal crashes.
These findings suggest that prevention efforts may be most effective if they focus on educating young adult drivers about the dangers of driving while intoxicated.
Source: , from The Center on Substance Abuse Research (CESAR) at the University of Maryland. October 1, 2007

A study suggests that school-based prevention programs begun in elementary school can significantly reduce problem behaviors in students. Fifth graders who previously participated in a comprehensive interactive school prevention program for one to four years were about half as likely to engage in substance abuse, violent behavior, or sexual activity as those who did not take part in the program. The study, supported by the National Institute on Drug Abuse (NIDA), a component of the National Institutes of Health, will appear in the August 2009 print issue of the American Journal of Public Health. The online version of the article is viewable today.

“This study provides compelling evidence that intervening with young children is a promising approach to preventing drug use and other problem behaviors,” said NIDA Director Dr. Nora Volkow. “The fact that an intervention beginning in the first grade produced a significant effect on children’s behavior in the fifth grade strengthens the case for initiating prevention programs in elementary school, before most children have begun to engage in problem behaviors.”

The study was conducted in 20 public elementary schools in Hawaii. Participating schools had below-average standardized test scores and diverse student populations with an average of 55 percent of students receiving free or reduced-price lunches.

The intervention tested was Positive Action (PA), a comprehensive K-12 social and emotional development program for enhancing behavior and academic achievement. Schools were randomly assigned from matched pairs to implement PA or not. The program consists of daily 15-20 minute interactive lessons focusing on such topics as responsible self-management, getting along with others, and self-improvement. At schools implementing the intervention, these lessons occupied a total of about one hour a week beginning in the first or second grade.

In fifth grade, 976 students (most aged 10 or 11) responded to a written questionnaire that asked about their use of substances, including tobacco, alcohol, and illicit drugs; involvement in violent behaviors, such as carrying a knife or threatening someone; and voluntary sexual activity. The total number of students reporting that they had engaged in any of these behaviors was small. Strikingly, however, students exposed to the PA program were about half as likely to report engaging in any of these behaviors as students not exposed to PA. Among students who were exposed to PA, those who had received the lessons for three or more years reported the lowest rates of experience with any of these problem behaviors.

“This study demonstrates that a comprehensive, school wide social and character development program can have a substantial impact on reducing problem behaviors of public health importance in elementary-school-age youth,”said Dr. Brian Flay of Oregon State University, the study’s principal investigator.

PA is an interactive program that integrates teacher/student contact and opportunities for the exchange of ideas as well as feedback and constructive criticism. The program is school wide and involves teachers and parents as well as students. It takes a positive, holistic approach to social and emotional development rather than focusing on the negative aspects of engaging in substance abuse and violence. Finally, at one hour a week, students’ exposure to the program was intensive. “These features likely account for the large effect observed,”concluded Dr. Flay.

Dr. Flay plans to conduct a follow-up study to determine whether the beneficial effects of the PA program on fifth graders are sustained, as the children grow older.
Source: CADCA Coalitions online June 25th 2009

NEW YORK (Reuters Health) – Watching a favorite movie star smoke appears to encourage teen girls to adopt the habit themselves, according to new findings released Tuesday.

Investigators found that girls who said their favorite celebrity was someone who had smoked in at least two recent movies were almost twice as likely to start smoking within the next three years as girls whose favorite stars did not smoke in films.

“Really, smoking in movies is just an effective form of marketing,” study author Dr. John Pierce told Reuters Health .

Pierce, based at the University of California in San Diego, added that it is also common for teens to copy their favorite stars’ clothing, hair and jewelry. Those habits are easy to alter as styles evolve, he said, but once teens become hooked on smoking, “that is something that’s very hard to change.”

Pierce noted that the tobacco industry has argued that it does not pay for actors to smoke on screen, and actors do it simply because it makes them feel more comfortable.

If that is the case, then one could argue that the stars themselves are responsible for encouraging teens to smoke, and should be held accountable for that, Pierce noted.

“If it’s the stars, and they’re liable, then they’d better watch out,” he said.

To investigate whether watching stars smoke on-screen influences teens to do the same, Pierce and his colleagues asked 3104 never-smokers between the ages of 12 and 15 to name their two favorite female stars and two favorite male movie stars.

The researchers reviewed the stars’ movies during the past 3 years, and counted them as smokers if they puffed during at least two films. They then re-interviewed teens three years later, to see how many had started smoking.

When Pierce and his team first contacted teens in 1996, the most popular stars among teen girls were Brad Pitt, Sandra Bullock and Leonardo DiCaprio. Favorite actors for boys were Pamela Anderson, Sandra Bullock and Demi Moore. More than 40 percent of girls and 30 percent of boys had favorite stars who smoked.

Favorite stars who did not smoke on-screen included Jim Carrey, Tom Hanks and Tom Cruise.

Although girls appeared to be influenced by the smoking habits of favorite stars, boys were not, the authors report in the American Journal of Public Health.

They note that research has shown that boys tend to prefer action movies, which tend to include less smoking by stars, while girls prefer more smoke-filled romances and dramas.

Pierce explained that his team also measured each child’s susceptibility to smoking — defined as being unwilling to rule out the option of future smoking. This removed the possibility that only those who were susceptible to smoking would have a favorite star who smoked on-screen, he said.

Dr. Stanton Glantz of the University of California in San Francisco, who was not an author of the paper, noted that research shows that the more teens see people smoke, the more likely they are to pick up the habit. The latest findings suggest that policymakers should strictly limit teens’ exposure to on-screen smoking, he said.

Restricting smoking to R-rated movies would apply “the same rules that Hollywood applies to saying the F-word,” Glantz said.

Merseyside’s first non-smoking pub has registered “record breaking-profits.” The Ring O’Bells in West Kirby barred smoking in June 2003.

Since then alcohol sales have risen 60 percent and food takings have doubled. The pub’s kitchen had to be refitted to cater for the demand.

Landlord Alan Jones said: “We lost some custom, which was a concern. But our profits have proved us right.”

Research conducted by the Harvard School of Public Health concludes that reducing marketing around college campuses would reduce binge drinking among college students, Reuters reported Sept. 12.

For the study, researchers went to alcohol-serving establishments near 118 U.S. college campuses to determine if there was a link between drinking habits and marketing promotions or advertising. Visits were made to 830 bars, restaurants, and nightclubs and 1,684 liquor stores and other retailers.

The researchers found that campuses with a high number of places either selling beer in volume packages or featuring frequent price promotions had the highest rates of binge drinking.

“It’s not just the advertising dollars. It’s the five-cent and 25-cent beers, it’s the extra pitcher of beer for a penny, it’s the $5 refillable cup. It’s not simply that these things make people drink, but that they make people drink much more,” said Henry Wechsler, lead researcher and director of Harvard’s college alcohol studies program.

The researchers concluded that binge drinking among college students could be limited by controlling the marketing of beer and other alcoholic beverages near campuses.

“You’re not going to make great headway with college binge drinking unless you address the issue of the alcohol environment that envelopes most colleges,” said Wechsler.

The study’s findings were met with criticism from the American Beverage Institute, a lobbying group that represents chain restaurants. The organization said alcohol problems on college campuses are a result of “abusers.”

“What they’re really looking for is a reduction of drinking among all Americans, including responsible adults,” said American Beverage Institute Executive Director John Doyle.

According to a new report, more teens first try marijuana in June and July than any other months of the year. To help parents prevent their teen from using marijuana this summer, the Office of National Drug Control Policy’s (ONDCP) National Youth Anti-Drug Media Campaign, the YMCA of the USA, and the American Camping Association kicked off this year’s “School’s Out” initiative.

The Media Campaign is offering new action-oriented advice and resources to help parents keep teens drug-free once school is out; a summer drug-free checklist, a summer calendar with suggested activities, and an interactive self-rating tool (Does Your Summer Plan Stand the Heat?). These resources are available on the Campaign’s Web site for parents at www.TheAntiDrug.com/SchoolsOut.

The 2003 Teens Partnership Attitude Tracking Study (PATS), released by the Partnership for a Drug-Free America (PDFA), says that more teens are recognizing the risks of marijuana and, as a result, may be less likely to start using the drug, according to a Feb. 25 news release from the Office of National Drug Control Policy.

The survey also found an increase in the number of teens who have seen or heard anti-drug advertisements since the National Youth Anti-Drug Media Campaign began in 1998.

According to the study, 52 percent of teens were exposed to anti-drug ads in 2003, compared with 32 percent in 1998. Furthermore, one in three teens in 2003 said they “learned a lot” about the risks of drugs from the ads, compared with one in five in 1998.

“The PATS survey reinforces earlier reports that showed an 11-percent drop in youth drug use … This research shows many understand the risks associated with marijuana use,” said John Walters, director of the ONDCP. “We hope this growing awareness will keep teens from using marijuana themselves and encourage them to take action when a friend is using.”

The survey also found that more teens are aware of the potential risks of using marijuana, such as getting in trouble with the law, losing their driver’s license, or not getting into a good college.

NEW YORK (Reuters Health) – Teens whose parents abuse alcohol or drugs may be prone to having negative or risk-taking personalities, which may help identify teens with a higher risk of substance abuse, researchers report.

The results of a study of more than 500 pairs of twins found that those with a parent dependent on alcohol were more likely than their peers to have a personality marked by irritability, aggression and mistrust. Teens whose parents abused drugs showed a propensity toward risk-taking, impulsive personalities.

Substance abuse disorders are known to run in families, and, similarly, research has shown that personality is strongly influenced by genetics. The new findings, published in the April issue of the American Journal of Psychiatry, suggest that personality traits may be useful in spotting which kids are at risk of substance abuse and in designing better prevention efforts.

For instance, lead study author Dr. Irene J. Elkins told Reuters Health that adolescents who are naturally risk-takers may be more likely to start smoking, but the common prevention message that smoking is bad for your health might not make much of an impression on kids with this type of personality.

Elkins, a researcher at the University of Minnesota in Minneapolis, said she is now studying whether personality can help predict which young people will develop substance abuse problems. If so, personality traits could be used in designing better prevention programs.

For the current study, the researchers used a standard questionnaire to assess personality traits among 17-year-old twins participating in the Minnesota Twin Family Study. The teenagers and their parents were also evaluated for alcohol and drug abuse. Most (97 percent) of the parents were Caucasian.

Elkins and her colleagues found that, on average, teens with a parent who abused alcohol scored higher on measures of “negative emotionality,” a tendency toward psychological distress, nervousness, distrust of others and aggression.

Those whose parents abused drugs scored lower on measures of “constraint,” meaning they were less likely than others to be cautious, “avoid thrills” or stick with traditional values. These patterns were similar for boys and girls.

Elkins noted that while all interventions aimed at keeping kids from drinking or using drugs are well-intentioned, they are not necessarily grounded in basic research. The hope, she explained, is that research on personality can help refine prevention programs to reach the kids who are most at risk.

Genetics may play a stronger role in behaviors like smoking and other drug use than previously believed, new research indicates. The Independent reported June 18 that researchers from Oxford University studied more than 20,000 people and found that a particular version of the human serotonin-transporter gene is strongly related to anxious personalities. People with this gene variant may be more likely to find social interaction stressful and use alcohol and other drugs to calm their anxiety. Further, scientists said a weaker link exists between the dopamine D4 receptor gene and extroverted personality types — the kinds of people who are novelty seekers and perhaps more likely to smoke, take drugs, gamble, or take other risks. “Our study suggests that there’s a genetic basis to certain kinds of personality trait, which may be important in influencing whether people take up habits like smoking or whether they can subsequently give them up,” said lead researcher Dr. Marcus Munafo. “Understanding genetic influences on personality is important if we are to design health campaigns that are effective for the widest possible range of people.”

The University of Colorado at Boulder, ranked among the top party schools in the country, will require incoming freshmen to take an Internet-based course about alcohol use and misuse.

“We are trying to provide a bottom-line common experience for all students,” said Robert Maust, principal investigator for the school’s A Matter of Degree program. “Then we will be able to say that you know at least that much.”

Maust said he is deciding between two Internet alcohol and drug education programs, “Alcohol EDU” and “My Student Body.” A final decision on which course the university will use will be announced shortly.

The course, required as of this fall, will be customized according to each student’s knowledge about alcohol use. Students will also be surveyed about personal perceptions of alcohol use at college and be given feedback and educational information based on their responses.

The course would take about one to two hours to complete.

A report by Georgetown University’s Center on Alcohol Marketing and Youth found a 39-percent increase in the number of alcohol ads aired on local and cable television in 2002 compared to the previous year. The report also concluded that a greater number of teens are being exposed to alcohol ads on television.   According to the report, there were 289,381 alcohol ads on television in 2002, with a significant increase in ads for distilled spirits and low-alcohol beverages. On a per-capita basis, the study found that more teens than adults saw 66,218 of the ads, a 30 percent increase over 2001. Television shows that attract a large teen audience, such as “Survivor,” “Fear Factor” and “That ’70s Show,” included alcohol ads.

“This dramatic increase in alcohol ads seen by our children in 2002 suggests the problem got worse,” said Jim O’Hara, executive director of the center. “The data demonstrate that the alcohol industry needs to make major changes in its advertising.”

The Distilled Spirits Council of the U.S. (DISCUS) disputed the findings. The industry contends that the “vast majority of alcohol ads are viewed by adults and that self-regulation is working.”

“To make further progress on underage drinking, we must focus on science-based solutions. Study after study shows that parents and other adults are the primary influence over a youth’s decision regarding drinking, not advertising,” said Peter Cressy, president of DISCUS.

New data indicates that youth in Washington are taking the advice offered in the anti-tobacco ads being run by the Washington State Department of Health. 

According to the latest report from Sedgwick Rd., the Seattle advertising agency that created the ads, 80 percent of Washington youth had seen the anti-smoking advertisements. Furthermore, 94 percent of those who had seen the ads said they gave them good reasons not to smoke. 

“The effectiveness of our advertising efforts lies in the extensive investigation we did with Washington state youth about what catches their attention most,” said Terry Reid, manager of the state Department of Health Tobacco Prevention and Control Program. “Our ads speak directly to youth who are at risk for smoking, with messages specifically designed to get their attention and give them the hard facts.” 

The ads are part of the state’s comprehensive Tobacco Prevention and Control Program, which began in July 2000. The campaign also includes radio, print, and Web-based ads, community outreach, support services, and school-based education programs. 

Since the start of the statewide campaign, the number of Washington 10th-graders who smoke has dropped by 40 percent. 

“We’re creating real and lasting change in Washington,” said Secretary of Health Mary Selecky. “Still, we have more work to do; about 55 kids start smoking every day in our state. Our new ad campaign will help us reach more youth so we can convince them to quit smoking or never start.” 

A study issued by the Substance Abuse and Mental Health Services Administration’s (SAMHSAs) Center for Substance Abuse Treatment (CSAT) this month found that drug-and alcohol-dependent women who are pregnant or have children significantly reduce their alcohol or drug use as well as criminal behaviour following residential substance abuse treatment. Treatment also produced improved birth outcomes for pregnant women. The study, 1993-2000 Residential Treatment Programs for Pregnant and Parenting Women, evaluated residential substance abuse treatment programs designed for pregnant women or women with infants or older children. The report examined 50 programs that provided on-site residential care for both parents and their children.

Among women in treatment, use of crack declined from 51 percent before treatment to 27 percent six months after treatment. Similar declines were noted in use of marijuana (from 48 percent before treatment to 15 percent after treatment); powder cocaine (34 percent to 9 percent); methamphetamine (21 percent to 6 percent); heroin (17 percent to 6 percent); and alcohol (65 percent to 25 percent). Over 60 percent of women reported being completely drug-and alcohol- free throughout the first six months following discharge from residential care. An additional 13 percent relapsed at some time after discharge but were completely alcohol-and drug-free in the past 30 days. Women who stayed in treatment longer than three months were more likely to remain alcohol-and drug-free than were those who left within the first three months of treatment (68 percent vs. 48 percent).

Criminal Outcomes

As compared to the 12 months prior to treatment, the percentage of clients arrested for alcohol or drug offenses (selling drugs, public intoxication, driving drunk, etc.) declined from 28 percent to 7 percent during the six months following discharge. A decline from 32 percent to 11 percent was seen in the percentage of clients arrested for non-substance offenses, such as shoplifting, burglary, prostitution or assault. Women who remained in treatment longer than three months were less likely to be arrested than were those who left treatment prior to three months – 9 percent vs. 20 percent.

Relationships And Parenting

The percentage of clients living with an alcohol-or drug-involved spouse or partner declined from 45 percent prior to treatment to 12 percent after, according to the report. The percentage of clients reporting that they and their family use drugs together declined from 26 percent to 4 percent.
Clients who had physical custody of one or more children increased from 54 percent before entering treatment to 75 percent after treatment. Clients who had children living in foster care declined from 28 percent before treatment to 19 percent after treatment.

A new study shows that women receive different types of benefits from prison-based addiction treatment programs and those located off prison grounds. Elizabeth Hall, project director of the Forever Free Substance Abuse Treatment Program Outcomes Study at the University of California, said the study found that women who received prison-based treatment initially did better on parole and with cutting drug use. On the other hand, women in the non-prison program fared better finding jobs. But a year later, when researchers conducted a review of study participants, they found that 35 percent of the prison group had used alcohol or other drugs during the month before the interview, compared with 8 percent of the non-prison group. Also, 75 percent of the prison group reported using alcohol or other drugs at some time during their parole period, compared with half of the non-prison group.

A new method designed to monitor drug consumption at dance venues may lead to more effective campaigns against drug use. Researchers analysed the contents of an amnesty bin at a London dance venue, into which visitors were required to discard illicit drugs and into which security staff placed substances found during searches. A total of 105 tablets and 79 powders in the bin were identified using a simple chemical test., later confirmed by more sophisticated analyses. A high proportion of the tablets contained MDMA (known as ecstasy), whereas the powders were predominantly amphetamine. Worryingly, nine tablets contained 4-MTA (known as flat liners). This drug is known to be highly toxic, having been implicated in four deaths in Britain and one in the Netherlands, say the authors. Unlike current methods of monitoring drugs in dance venues, this process does not rely on what users think they have bought, so regular analysis of the contents of the bins would reflect what is currently available on the streets, explain the authors. Accurate information on drug use would allow healthcare professionals to formulate better advice on avoiding injury through drug use and to design the most appropriate campaigns against drug use, they conclude.

 In  1988 the Harvard School of Public Health launched one of the best documented examples of a successful media effort to change public health behaviour: the designated driver campaign. The campaign, that was strongly supported by the leading broadcast networks, Hollywood studios, government agencies, non-profit groups and corporations, demonstrated how a new social concept, the designated driver, could be rapidly diffused through American society via mass communication.
The campaign broke new ground when television writers agreed to insert drunken-driving-prevention messages, including references to designated drivers, into the scripts of top-rated television programs. Networks also aired frequent public-service announcements during prime time that encouraged the use of designated drivers. Studies showed that this sustained media blitz contributed to a fundamental shift in social norms, in this case related to driving after drinking.

A new survey finds that unsupervised teens are four times more likely to be D students than teens supervised every day. The survey, After School for America’s Teens, released by YMCA of the USA, finds that 59 percent of teens are unsupervised after school at least one day in a typical week. And those teens are more likely to drink alcohol, smoke cigarettes and engage in sexual activity, nearly three times as likely to skip classes at school. They are also three times more likely to use marijuana or other drugs.
The survey of 500 teens 14-17 years of age reveals a strong interest in community and neighbourhood-based after school programs. Although many teenagers participate in after school programs, more than half of all teens (52 percent) wish there were more community or neighbourhood-based activities available. Some 62 percent of teens left alone during the week say they would likely participate in after school programs, while two in three teens (67 percent) expressed interest in programs that would improve their grades, develop leadership skills and involve them in the community.
Unsupervised teens are in the ‘Danger Zone’ the hours of 3 to 6 p.m. after school  when being unsupervised can lead to problems with alcohol, drugs, sexual activity and even crime. This danger cuts across race income and family structure, according to the University of Minnesota’s National Longitudinal Study of Adolescent Health, the largest-ever survey of American adolescents. Teens who are failing school and “hanging out” with friends are more likely to engage in at-risk behaviours.
The After School survey revealed that teens who do not engage in after school activities are five times more likely to be D students than those who do, while nearly eight in 10 teens (79 percent) who participate in after school programs are A or B students. Only half (52 percent) of teens who do not participate earn such high marks.

The arts, as an alternatives approach to substance abuse, offer tremendous opportunities for building resiliency in youth. Listed below are a few of the many protective factors enhanced by involvement in the arts, as well as, the results of several research studies that support the benefits of positive youth development activities.

Protective Factors:

Caring Relationships—The arts provide opportunities for young people to develop supportive relationships with caring adults who can sometimes reduce risk and improve resiliency.
Cognitive Competence—Involvement in the arts requires that young people develop critical thinking skills such as analysis and problem solving, so they can communicate those ideas to others using poetry, dance or other creative arts.
Social Skills—Participation in theater companies and other creative groups requires that young people learn to cooperate and work together to accomplish mutual goals.
Goal Setting—Involvement in the arts rewards long-term planning, practice, diligence and thinking ahead—the skills needed by young people to resist peer pressure to use drugs.
Connection to the Community—Through performing and exhibiting their artwork, young people begin to experience pride as they see themselves making valuable contributions to youth culture and to their communities.

Supporting Research:

An examination of outcome data of 127 studies found that alternative activities rated second to improving family relationships in terms of effectiveness in drug- related outcome categories.  An analysis of 143 adolescent drug prevention programs notes that alternative strategies are effective when they are intensively implemented and aimed at targeted populations, specifically youth in high-risk environments, who may not have adequate adult supervision or may not participate in a variety of constructive activities.

A program designed to increase awareness of the dangers of alcohol and drug use among African Americans, which incorporated a year-long arts program for youth, resulted in youth who were less likely to become involved in drug dealing than members of the control group.

The alternatives approach, which includes promoting creative or artistic endeavours, can make a positive difference in the lives of the children who participate in them. In addition, the alternatives approach sets forth a comprehensive prevention effort in the community that served to establish strong community norms against substance abuse.

A study on the effectiveness of the 7-year-old drug court in St. Louis, Mo., finds that the program’s benefits far outweigh its costs, the Associated Press reported Feb. 2.

The study by the independent Institute of Applied Research found that nonviolent drug offenders who are placed in treatment instead of prison generally earn more money and took less from the welfare system than those on probation.

The study compared the 219 individuals who were the program’s first graduates in 2001 with 219 people who pleaded guilty to drug charges during the same period and completed probation.

For each drug-court graduate the cost to taxpayers was $7,793, which was $1,449 more than those on probation. However, during the two years after drug court, each graduate cost the city $2,615 less than those on probation. The savings were realized in higher wages and related taxes paid, as well as lower costs for health care and mental-health services.

“What you learn is that drug courts, which involve treatments for all the individuals and real support — along with sanctions when they fail — are a more cost-effective method of dealing with drug problems than either probation or prison,” said Tony Loman, the lead researcher.

The St. Louis drug court allows addicted individuals who have been arrested to voluntarily enrol in the program. Participants are required to submit to periodic drug and alcohol testing, appear in court during scheduled times, find and keep jobs, and enrol in drug and alcohol treatment. Those who successfully complete the program have their charges dropped.

Outside a Bogotá dance club called Pipeline, a bouncer frisks a young businessman, comes up with a small bag of cocaine, and casually returns it to the owner. He pockets it with a grin and swaggers into the maze of flashing lights and techno beats. But this laid-back approach may not last much longer. A decade after Colombia legalized possession of 20 grams of marijuana and one gram of cocaine and heroin for private consumption, President Alvaro Uribe wants to restore total prohibition. The reason: The world’s largest cocaine producer has become a consumer nation with an addiction problem, according to experts, the government and drug users themselves.

The 1994 Constitutional Court ruling for legalization was aimed at forcing the government to find more effective methods than law-enforcement for combating drug abuse, such as education programs, says Sen. Carlos Gaviria, the former justice who wrote the decision.  But he complains that successive governments never invested enough time and money in the battle. Meanwhile, drug use has increased by 40 percent in the past 10 years, says Dr. Camilo Uribe, a toxicologist and the president’s adviser on drug matters. No comprehensive study of domestic consumption has been carried out since 1996, but a 2001 survey by the government’s National Narcotics Office found that nine of every 100 Colombian city-dwellers aged 12 to 25 regularly use drugs.

Camilo Uribe (no relation to the president) blames legalization for part of the increase, saying it made drugs more acceptable in a society that traditionally frowned upon them as a source of corruption and violence. “The court decision sent the completely wrong message, that it’s OK to do drugs,” he says. The push for criminalization marks a change from a few years ago, when liberal legislators were making the headlines by pushing to relax the laws even further. They sought to decriminalize drug trading, claiming the U.S.-driven war on growers and producers was getting nowhere. But that initiative withered for lack of public support, and Uribe’s election in 2002 buried it.

Uribe’s presidency has been characterized by sternness on all fronts, the fight against rebels, corruption in politics, and drug use. But his attempt to criminalize drug use by referendum last year was killed by the Constitutional Court before the vote could take place. The court said prohibiting drug use would violate the constitutional right to free choice. So the president is seeking a constitutional amendment, but it’s unclear whether he can get Congress to approve the change. Among the smartly dressed crowd at the Pipeline club, the cocaine sniffers say recriminalization would probably push up prices from their rock-bottom level of $3-$4 a gram, compared with $75-$100 in the United States. “Right now it’s cheaper than buying a beer,” a 33-year-old bank executive, who gives his name only as Guillermo, says after snorting a line of cocaine in the restroom.

Guillermo says outlawing drug use probably wouldn’t change his habits much, except to make him more discreet. He agrees that legalization increased drug use, but also blames the explosion of bars featuring techno and trance music, which often prove more popular than traditional salsa fiestas. Jennifer Cubides, chief psychologist at a juvenile detention center where many drug peddlers are incarcerated, is desperate to see tougher laws. Her office at the Hogares Claret prison overlooks one of Bogotá’s most notorious streets, nicknamed “El Bronx,” where dealers, pimps and prostitutes lurk in doorways and addicts loll lifelessly atop piles of broken cardboard boxes. To Cubides’ despair, the police can’t or won’t do much about it. The sale of drugs remains illegal, but suspected dealers can only be arrested if caught with more than the legal limit. “They know exactly what their rights are,” Cubides says. “The 1994 law was the worst thing that could have happened.”

Some 400,000 cannabis smokers live in the Netherlands, where they can openly buy and smoke the drug, to the ire of neighboring countries. “We are developing a system whereby people not registered in the Netherlands will not be allowed into coffee shops,” Justice Ministry spokesman Ivo Hommes said. The number of coffee shops has been cut to 754 nationwide in 2003 from 1,200 in 1997, according to the latest figures from the Netherlands Trimbos institute for addiction studies. The government also hopes to stub out the illegal growing of hemp plants and sale of soft drugs by criminal groups.

The Camden County Board of Education in Georgia has proposed a student drug testing policy, but fears that a law being considered by Congress would force school officials to involve law enforcement rather than get students into treatment, the The proposed drug testing policy would require any student participating in extracurricular activities or requesting a parking pass to first undergo a drug test. Students who test positive would attend counseling sessions and further drug testing, but would not be subject to additional penalties unless they tested positive more than once.

Under the proposed policy, results from the drug tests would not be placed in the student’s academic record, turned over to law enforcement, or kept later than one year after the student’s graduation or 18th birthday.

However, under the Defending America’s Most Vulnerable Act, currently being considered by Congress, school officials would be required to report student drug use to enforcement officials. The Board of Education cited this potential, undesired consequence as a reason not to adopt the proposed drug testing policy, which aims to prevent and treat student drug use, not to provide criminal evidence that would ruin students’ lives.

Hollywood might be bad for your health, a new study says.

A team of medical researchers has found plenty of sex but only one reference to condoms among the top-grossing films of the past two decades, concluding that blockbuster movies paint a worryingly consequence-free view of sex and drug use.

Australian researchers who studied 87 of the biggest box-office hits since 1983 found they contained no depictions of unwanted pregnancy or sexually transmitted disease. Drug use also tended to be portrayed “without negative consequences,” they reported in a study published Monday in the Journal of the Royal Society of Medicine.

“The social norm being presented is concerning, given the HIV and illicit drug pandemics in developing and industrialized countries,” said Dr. Hasantha Gunasekera of the School of Public Health at the University of Sydney, the study’s lead author.

The researchers studied a September 2003 list of the 200 most successful movies of all time as ranked by the Internet Movie Database on the basis of world box-office takings. They excluded animated features, films with G and PG ratings, and movies released or set before the start of the AIDS pandemic in 1983.

Of the 87 movies remaining, 28 contained sex scenes — a total of 53 scenes in all.

Only one film — the 1990 romance Pretty Woman, in which Julia Roberts plays a prostitute — contained a “suggestion of condom use, which was the only reference to any form of birth control.”

“There were no depictions of important consequences of unprotected sex such as unwanted pregnancies, HIV or other STDs,” they added.

The sexiest film — in quantity, if not quality — was the 2001 comedy American Pie 2, which contained seven episodes of unprotected sex in which the “only consequences were social embarrassment.”

The 1992 thriller Basic Instinct had six sex scenes, no birth control and no “public health consequences” — although “other consequences” included death by ice pick.

Suave super-spy James Bond also was rapped for his promiscuity. The 2002 Bond adventure Die Another Day contained three episodes of sex — “all new partners, no condoms, no birth control, no consequences at all” — but at least no drug use.

Eight per cent of the films studied contained depictions of marijuana use, and seven per cent other non-injected drugs, the researchers said.

Just over half the marijuana scenes – 52% – showed use of the drug in a positive light. In the other 48%  of cases it was depicted in a neutral light with no negative consequences.

Characters smoked tobacco in 68% of the films and got drunk in 32%.

Only a quarter of the movies – including spooky drama The Sixth Sense and Tom Hanks survival adventure Cast Away – were entirely free of behaviour such as unprotected sex, drug use, smoking and drinking, the researchers said.

“The most popular movies of the last two decades often show normative depictions of negative health behaviours,” the authors concluded. “The motion picture industry should be encouraged to depict safer sex practices and the real consequences of unprotected sex and illicit drug use.”

Gunasekera said “there is convincing evidence that the entertainment media influences behaviour.”

But some experts said the issue was more complex than the study suggested.

“I don’t think you can pinpoint Hollywood as responsible for sexual immorality in the post-AIDS era,” said Paul Grainge of the Institute of Film and Television Studies at the University of Nottingham.

“Hollywood responds to social mores as well as creates them.”

San Francisco Mayor Gavin Newsom called for a moratorium Monday on opening medical marijuana clubs in the city after learning that one plans to open on the ground floor of a city-funded welfare hotel.

Medical marijuana is a pathetic sham, but don’t say that too loudly in San Francisco. While lots of leftist politicians there seem to agree that pot clubs like the “Happy Days Herbal Relief Center” are a good idea to distribute “medicine,” there is a growing consensus that they need to be regulated.

Why? Well, for instance:

The medical marijuana club that grabbed Newsom’s attention was the Holistic Center, which plans to open Friday on the ground floor of the All- Star Hotel on 16th Street in the Mission District. The hotel is among a dozen that serve welfare tenants under the city’s Care Not Cash program and is home to some recovering drug addicts and substance abusers.

“That obviously raised some concern, not just from the community, not just from our Departments of Human Services, but from the residents within the building themselves, who appropriately said, ‘Hey, I’m just trying to get away from drugs and alcohol, and here you have a pot club downstairs,’ ” Newsom said. “It was at that moment that our office started looking at a way we could amend all of our contracts with the Department of Human Services to restrict the … use of medicinal marijuana clubs in (Care Not Cash) facilities.”

According to Matier and Ross, the clubs are growing like crazy, and “many of the neighbours aren’t happy.”

“There are 44 McDonald’s in all of Manhattan — more than any location in the world — and we have 37 marijuana dispensaries in San Francisco,” fumes Dogpatch Neighbourhood Association President Susan Eslick, who just learned of plans for a new dope dealership down the street from her, at the corner of Third and 20th streets.

“If these are for health,” Eslick added, “then we must have a huge epidemic.”

While unprincipled libertarians and others usually say that legalizing pot will make it harder for kids to buy (heh, like alcohol?), in reality:

Police confirm the clubs are a real magnet for kids . . .According to Hettrich, it’s not uncommon for one kid with a card to purchase an ounce or so of weed — then turn around and sell enough of it to his friends to support his own habit.

So now the government will have to come in and enact more regulations, entangling itself even further in the drug dealing business. Since, as the article also says, the pot club owners are making a killing selling the drug, it’s probably only a matter of time before someone starts arguing that the state should run things to cut costs for all the . . . errrr . . . sick people.

I visited one of these places in Los Angeles once, in an attempt to do some interviews for a video on marijuana. A spokesman told me that lots of their customers were grandmas, successful businessman, soccer moms and other mainstream types who just happened to be sick. He said that he and the staff refused to be interviewed for fear of how they would be made to look.

I was not allowed inside, but I watched people come and go for a while. Oddly enough, I didn’t see a single soccer mom. I did see a lot of 25-40 year old men who, to put it bluntly, looked like your stereotypical stoner.

In the USA primary care nurses have successfully delivered a school-based intervention to prevent under-age drinking based on a brief (average 20 minutes) one-to-one consultation with each pupil. Parents of nearly 90% of sixth grade (age 11–12) pupils at two innercity schools agreed to their children entering the study. One school was for local pupils, at the other 40% of pupils were bussed in from the suburbs. Within each school pupils were randomly assigned to the STARS for Families programme or to act as controls. In the first year the programme consisted of a nurse consultation plus postcards mailed to parents with an alcohol prevention message to discuss with their children. Next year there was a follow-up consultation and four parent-child homework tasks incorporating a ‘contract’ returned to the school which committed the child not to drink and designated a parent to remind them of that pledge. Postcards and homework were endorsed by the lead researcher and a local paediatrician. Control pupils simply read alcohol health promotion and prevention booklets at school.

Then about 14 years old, 78% of the pupils surveyed at baseline were re-surveyed a year after the intervention had ended. All alcohol use measures were lower among STARS for Families pupils, most noticeably at the bussed-in school where intervention pupils were less likely to drink (11% versus 21%), significantly less likely to intend to drink soon (5% versus 18%), and were assessed as at significantly less risk of drinking. The same trends were seen at the local school but only a reduced risk of drinking attained statistical significance. However, at this school there had been significant alcohol use reductions after the first year of the programme.

In context The main puzzle is why significant long-term effects were not seen at the local school. The probable explanation is a combination of the number of pupils who did not complete follow-up surveys and the fact that control and intervention families more often mixed together in the same neighbourhood, potentially spreading any preventive impact to control pupils. Also, an attempt to tailor the intervention to individual risk and protective factors may have overcomplicated it. Earlier studies with short follow-ups minimising attrition, which reduced ‘contamination’ by not involving parents, and which used simpler interventions, reported substantial (but not always statistically significant) intervention effects in local schools in the same area. One also established that primary care nurses produced outcomes as good as or better than those from family doctors. The entire package was much more extensive than the nurse consultations. Home-based activities successfully stimulated parent-child communication about drinking so were potentially an active ingredient, as were the research surveys which provided the data enabling consultations and postcards to be tailored to the pupil.

Practice implications Advantages of the approach are that it does not occupy classroom time and that it is simple and cheap enough for widespread dissemination. It also releases teachers from the bind of objectively teaching about substance use while trying to prevent it, and pupils seem more likely to discuss drug use openly with someone who does not have the disciplinary responsibilities of a teacher. The intervention could be implemented by school counsellors or school nurses, who in Britain are being encouraged to extend their public health role. It can be targeted at at-risk pupils yet avoids dealing with them as a group (perhaps reinforcing deviance) or stigmatising them – they would be ‘Just seeing the nurse’. Alternatively, in institutions with a high risk profile it could be applied across the board. The best format for the sessions and how far they need to be tailored to the pupil are unclear, but quite simple interventions with follow-up sessions seem effective, at least with respect to drinking. Postcards and take-home lessons which involve parents may augment schoolbased activities but are not essential.

Featured studies Werch C.B. et al. “One-year follow-up results of the STARS for Families alcohol prevention program.” Health Education Research: 2003, 18(1), p. 74-87. Copies: apply Alcohol Concern. Contacts Chudley Werch, Center for Research on Substance Use, 4567 St Johns Bluff Road South, Jacksonville, Florida 32224-2645, USA, cwerch@unf.edu

The reusable plastic sleeve features an image of the Marlboro Man playing a guitar; World Health Organization policy advisor Judith Mackay called the product a “cynical attempt” to “reintroduce some glamour back into the sale of cigarettes.”

“It’s absolutely against the spirit of the law, which is to do away with imagery that makes these packets more attractive to young people,” she said in comments that were echoed by Wan Wai-lee, executive director of the Hong Kong Council on Smoking and Health.

A Hong Kong spokesperson for Philip Morris said the sleeves were not meant to be reused, adding: “It’s something that we do to offer our consumers more choice.”

At least 188,000 fewer New Yorkers were smoking two years after the city banned indoor smoking and hiked cigarette taxes, according to the city health department.

An annual city survey found that 18.4 percent of adult New Yorkers smoked in 2004, down from 19.2 percent in 2003 and 21.6 percent in 2002.

The smoking tax hike took effect in 2002; the indoor-smoking ban went into place in 2003. In the decade prior to the laws, the city’s smoking rate had remained relatively unchanged.

The dropoff was especially pronounced among young women: smoking among females ages 18 to 24 fell 40.5 percent from 2002 to 2004.

The city also gives out free nicotine patches to those trying to quit.

HealthDay News reported Oct. 27 that states spent an increasing amount of money on TV antismoking campaigns between 1999 and 2002 — funded by the 1998 nationwide tobacco settlement — but spending fell 28 percent between 2002 and 2003 as states diverted the money to cover budget deficits. Researchers said the shift could be part of the reason why youth smoking declines leveled off between 2002 and 2004, after falling steadily since 1997.

“It does seem that the more [states] spend on tobacco-control programs, the greater the impact,” said David Nelson of the Center for Disease Control and Prevention’s (CDC) Office on Smoking and Health. “States need to support anti-tobacco activities. One of the key components is a media presence.”

“This is an inevitable result of the cuts to state tobacco-prevention programs that we’ve see over the last several years,” said Danny McGoldrick of the Campaign for Tobacco-Free Kids. “States never did a good job of allocating their tobacco-settlement dollars and their tobacco tax dollars to programs to reduce tobacco use. They’ve done even a worse job in the past few years.”

McGoldrick said states could make a real difference if they spent even 10 percent of their tobacco-settlement funds on youth smoking prevention.

A new study reveals that only 17 percent of graduates of Georgia’s drug treatment courts are convicted of further crimes, compared to the national recidivism rate of 48 percent among those who go through traditional courts, reported on

The study results were among many positive remarks given during a Drug and DUI Court Conference held on June 22 in Marietta, sponsored by the Judicial Council of Georgia and attended by nearly 200 judges and court officials.

Repeat drug offenders who land in drug courts in Georgia undergo rigorous substance abuse treatment, vocational counseling, and random drug testing to avoid jail time. “It’s the hardest work most of our participants have ever done,” said Cobb County Superior Court Judge George Kreeger, head of the Georgia drug court committee.

These drug courts also save money by requiring participants to contribute to court costs, said Kreeger. “We collect about $2,400 a year [from each offender], that’s almost all the cost of the treatment component,” he said.

The growing acceptance of alternatives to incarceration can be attributed to the rising use of methamphetamine in the state, officials said. Since 1994, 33 counties in Georgia have established drug courts.

“The problem is that what we have traditionally done doesn’t work,” said West Huddleston, director of the National Drug Court Institute, during the conference. “The drug court seeks to solve the problem of recidivism by breaking the cycle of abuse, crime, prison and return to addiction by restoring the participants to health.”

Objectives. This study examined whether adolescents’ recall of antidrug advertising is associated with a decreased probability of using illicit drugs and, given drug use, a reduced volume of use.

Methods. A behavioral economic model of influences on drug consumption was developed with survey data from a nationally representative sample of adolescents to determine the incremental impact of antidrug advertising.

Results. The findings provided evidence that recall of antidrug advertising was associated with a lower probability of marijuana and cocaine/crack use. Recall of such advertising was not associated with the decision of how much marijuana or cocaine/crack to use. Results suggest that individuals predisposed to try marijuana are also predisposed to try cocaine/crack.

Conclusions. The present results provide support for the effectiveness of antidrug advertising programs

Lauren G. Block, PhD, Vicki G. Morwitz, PhD, William P. Putsis, Jr, PhD and Subrata K. Sen, PhD

Lauren G. Block is with the Department of Marketing, Baruch College, New York City. Vicki G. Morwitz is with the Department of Marketing, New York University, New York City. William P. Putsis Jr is with the Department of Marketing, London Business School, London, England. Subrata K. Sen is with the Department of Marketing, Yale University, New Haven, Conn.

Correspondence: Requests for reprints should be sent to William P. Putsis Jr, London Business School, Regent’s Park, London NW1 4SA, United Kingdom (e-mail: bputsis@london.edu

Source: August 2002, Vol 92, No. 8 | American Journal of Public Health 1346-1351 © 2002 American Public Health Association

Study: Preventing Youths From Smoking Even Once May Be VitalMay 25, 2006 (WebMD) A new study shows that 11-year-olds who smoke just one cigarette are more likely to become regular smokers by the time they’re 14 years old.

“It may be that preventing children from trying even one cigarette is an important goal, and prevention efforts could usefully be focused at the earliest ages,” write University College London’s Jennifer Fidler, Ph.D., and colleagues.

Fidler’s team also writes that one-time smoking may have a “sleeper effect,” or a period in which youths who have smoked one cigarette may be particularly vulnerable to becoming regular smokers.

The study comes on the heels of a CDC report showing that, worldwide, nearly two in 10 students aged 15-17 years report currently using a tobacco product (9 percent are cigarette smokers; 11 percent use other tobacco products). Those figures are published in the CDC’s Morbidity and Mortality Weekly Report.

Young Novice Smokers

Fidler and colleagues studied more than 5,800 students from 36 London schools.

The study started when the students were 11 years old and ended when they were 16. The group was diverse in terms of ethnicity and income.

Every year, the students completed surveys about whether they had ever smoked and, if so, how often they smoked. They also provided saliva samples that were tested for cotinine, a chemical marker of nicotine.

The students didn’t have to participate in any of those tests. About a third had complete data for all five years; Fidler’s team focused on those 2,041 students.

When those students were 11 years old, 206 reported having smoked just one cigarette. They were twice as likely to start smoking regularly by age 14 than their peers who reported never smoking cigarettes at age 11.

‘Sleeper’ Effect

“Our results show that progression from experimenting with one cigarette (being a ‘one-time trier’) to current smoking can take up to three years,” write Fidler and colleagues.

“However, we have also shown that, between trying an early cigarette and regular smoking uptake, there may be a protracted period of dormancy when no reported smoking occurs,” they continue.

The researchers suggest that that dormancy “may be termed a ‘sleeper effect,’ a personal propensity or vulnerability to smoke that may not become manifest without additional triggers.”

The reason for that effect isn’t clear, note Fidler and colleagues. They suggest three possible explanations:

• One cigarette may set the stage, biologically, for vulnerability to smoking.

• Smoking a first cigarette may break down social barriers to smoking.

• Personality traits, in certain situations, may nudge one-time smokers towards regular smoking.

Study’s Limits

The researchers note some limits to their study.

• Only adolescents took part, so the data doesn’t show if the findings apply to adults.

• The students may not have reported their smoking habits accurately. However, Fidler’s team notes that previous studies have shown that adolescents are generally reliable in reporting their smoking habits.

• Fidler’s team also isn’t sure that the findings apply to other groups of students, though they point out that their group was socially and ethnically diverse.

• Finally, the study doesn’t look at younger kids. It’s possible that the “sleeper” period might start earlier than age 11.

Further studies of younger children and young adults would help clarify how some youths progress from one-time smokers to regular smokers, note Fidler and colleagues.

“Previous studies established that alcoholism runs in families, but this research has given us the most extensive catalogue yet of the genetic variations that may contribute to the hereditary nature of this disease,” says NIDA Director Dr. Nora D. Volkow. “We now have new tools that will allow us to better understand the physiological foundation of addiction.”

The study can be viewed online and will be published in the December 2006 issue of the American Journal of Medical Genetics Part B (Neuropsychiatric Genetics).

“This is an important contribution to studies of the genetics of alcoholism and co-occurring substance use disorders,” adds Dr. Ting-Kai Li, director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA). “The findings will open many new avenues of research into common factors in genetic vulnerability and common mechanisms of disease.”

NIDA researchers found genetic variations clustered around 51 defined chromosomal regions that may play roles in alcohol addiction. The candidate genes are involved in many key activities, including cell-to-cell communication, control of protein synthesis, regulation of development, and cell-to-cell interactions. For example, one gene implicated in this study — the AIP1 gene — is a known disease-related gene expressed primarily in the brain, where it helps brain cells set up and maintain contacts with the appropriate neighboring cells. Many of the nominated genes have been previously identified in other addiction research, providing support to the idea that common genetic variants are involved in human vulnerability to substance abuse.

The scientists, led by Dr. George Uhl, included Ms. Catherine Johnson, Ms. Donna Walther, Dr. Tomas Drgon, and Dr. Qing-Rong Liu. Their team developed, validated, and applied a new genetic platform that allowed them to generate the equivalent of more than 29 million individual genotypes and to analyze 104,268 genetic variations from unrelated alcohol-dependent and control individuals. The scientists used DNA samples that were collected by investigators of the Collaborative Study on the Genetics of Alcoholism (COGA), a study funded by NIAAA that included Dr. Howard Edenberg, Dr. Tatiana Foroud, and Dr. John Rice, who are coauthors of the paper. These samples had been analyzed previously to look for genetic associations to alcoholism, but the resolution and coverage achieved in the present study are unprecedented.

Dr. Volkow said finding ways to identify who is most physiologically vulnerable to addiction ‘will be a tremendous step towards more effective prevention and treatment approaches.’

The term ‘genome’ refers to the total genetic information of a particular organism. The normal human genome consists of about 3 billion base pairs of DNA in each set of chromosomes from one parent.

For more information, visit the NIDA home page at www.drugabuse.gov

Of the 15,540 pubs, hotels, bars and restaurants inspected by councils, 99.4 per cent were complying with the ban.

Since the bill came into force in March, just three fixed penalty notices have been issued to premises that have broken it.

“A smoke-free Scotland is looking forward to a healthier future,” said Scottish health minister Andy Kerr.

“A future where Scots live longer, families stay together longer and our young people are fitter and better prepared to make the most of their ambitions.

“It is a future that we can all look forward to and Scotland should be proud that it’s leading the way in the UK.”

Almost three quarters of people interviewed said that they believed that the ban was successful.

The results follow a Cancer Research UK study which revealed that 24 per cent of people said that they were more likely to go out to smoke-free bars and restaurants.

A further 45 per cent said that they would be going out the same amount as before the ban and just ten per cent said that they would be going out less.

A similar ban is to be introduced in the UK next year and Wales is considering opting-in to the legislation.

The FAN Club involved the parents of youth participating in the Boys and Girls Clubs of America’s SMART Moves program and the SMART Leaders booster program. Participants included parents of 11 to 13-year-old boys and girls of various ethnic groups. The club was designed to strengthen families and promote family bonding, which has been shown to increase children’s resistance to drug use. Parents in the FAN Club received stress management support and participated in educational and enrichment activities, parental leadership activities, and regularly scheduled group social activities.

After their parents participated in the FAN Club, children showed a greater ability to refuse alcohol, marijuana, and cigarettes. They also learned of the health consequences and prevalence of substance use.

The Dare To Be You program included preschoolers, ages 2 to 5, and their families, teachers, and related community members in four ethnically diverse areas in Colorado. Parents participated in a 24-hour educational curriculum where trained facilitators taught them responsibility, personal efficacy, self-esteem, communication and social skills, problem solving and decision-making skills, and child development and home-management strategies. Facilitators also provided them with booster sessions and monthly family group meetings and participated in periodic community events for ongoing support. The children were enrolled in a 20-hour educational program focusing on communications, responsibility, self-esteem, and problem solving.
Dare To Be You showed a dramatic improvement in the parents’ sense of competence, satisfaction with – and positive attitude about – being a parent, and use of nurturing family management strategies. There were substantial decreases in the parents’ use of harsh punishment, and significant increases in the children’s developmental levels compared with non-participant peers.

CDP is a comprehensive school-based program designed to reduce risk and bolster protective factors related to substance use. Implemented in five school districts across the country, CDP staff transformed 12 elementary schools into “caring communities” where the students’ desires to learn were nurtured, supportive relationships were cultivated, and commitments to social values were promoted.

The program was successful in its efforts to decrease substance use (alcohol use decreased by 11 percent, marijuana use by 2 percent, and tobacco use by 8 percent). CDP also helped motivate students to learn and to increase their enjoyment of school, as well as assisting students with skills in resolving conflicts, which ultimately increased their sense of social competence.

Across Ages is a Philadelphia-based program targeted primarily at African American middle school children (white, Asian, and Hispanic children composed a minority of the program’s participants). Adult mentors were paired with students, providing them with positive, nurturing role models. In addition, youth participated in classroom-based activities to develop life skills, and performed community services in area nursing homes. Parents were encouraged to become involved and meet their children’s mentors.

Across Ages improved school attendance and strengthened children’s bonding to significant adults and to the community. Evaluations of the program showed an increased knowledge about – and negative attitudes toward – alcohol and tobacco use and helped enhance students’ ability to respond appropriately to situations involving drug use.

A rap contest methodology for smoking prevention was tested with sixth and seventh grade students in a predominantly minority public school district. Contests were held after initial assemblies in which students heard anti-smoking rap messages from same-age and older peers on audio and videotape. Pretesting and posttesting (N = 268) indicated high preference ratings for most aspects of the intervention. Analyses of variance revealed no differences across races on any of the dependent measures. However, smaller assemblies were more effective than larger ones in enhancing attitudes against smoking and obtaining more positive contest evaluations and predictions about smoking behavior. A rap contest method therefore may be effective against the initiation of smoking by disadvantaged children in sixth and seventh grades because it is highly acceptable and perceived as culturally relevant. This effectiveness may be better demonstrated in a single classroom environment rather than larger assemblies.

The following five studies have examined the effects of the ‘harm reduction’ policy in the Netherlands on drug use.
The Dutch Drug Policy: A Physicians Commentary – K F Gunning MD, 1993
Conclusions: The availability and sale of cannabis in Dutch coffee shops has been associated with an increase in its social acceptability and use among adolescents as a soft’ drug. The ‘harm reduction’ Dutch policy of containing heroin addiction through distribution of free needles and syringes and methadone distribution has not prevented the spread of heroin addiction nor has it curtailed drug-related crime.
Drug Reform: The Dutch Experience – Richard H. Schwartz, 1993
Conclusions: The Dutch policy has been associated with a progressive increase in cannabis use among 15 – 19 year olds.  Between 1984 and 1988 the use of cannabis increased by almost 100% among upper high school students in the Netherlands. The policy of ‘harm reduction’ has not prevented a steady and significant rise in drug addiction (cannabis, cocaine and opiates) among 15 – 19 year olds and young adults.
(Source for full reports: Cannabis: Physiopathology, Epidemiology, Detection” Nahas & Latour CRC Press. London 1993)

Survey from Dutch Primary Schools:
Use of drugs by this age group had increased from 7% in 1992 to 11% four years later. 2.5% smoke cannabis more than ten times each month. Alcohol use increased among the 12- 18 year olds, with 52% reporting that they used alcohol regularly – a 10% increase on 1992 figures. Smoking also increased in the same period. 2% of those surveyed reported regular use of Ecstasy, 1% used cocaine. The use of heroin in this age group had not increased – 200 of the 3,000 surveyed had used heroin.
(Source: Trimbos Institute. Netherlands. 1996 – Survey of 10,000 youngsters, 3,000 were pupils from primary schools.
Dutch People Dislike Drugs Policy and are Opposed to Legalization.
A poll carried out by the Erasmus University in Rotterdam found that most Dutch people reject the use of drugs, dislike the liberal drugs policy and oppose any moves toward legalisation.
According to the survey 82% think the use of drugs is fundamentally wrong, 61% said all drugs should be prohibited and over 75% disagreed with the policy of arresting addicts only if they caused public nuisance.
In 1995 ‘Telepanel’, a bureau with close links to the University of Amsterdam, presented results from a poll involving 1,930 people where almost three quarters wanted tougher measures against those who deal in and use drugs. 73% thought that the Netherlands showed too much tolerance towards drug abusers and 56% thought that the country’s reputation abroad was bad due to its drugs policy.(Source: Hassela Nordic Network Press Release Nov. 91995)

In the fall of 1994, a survey was conducted on the use of alcohol and drugs and on gambling among members of the Dutch parliament. The survey indicated that almost two-thirds of the representatives sampled supported legalization of marijuana. A smaller majority (57 percent) was in favor of reducing the number of coffee shops selling marijuana. At least a quarter of the members of parliament had used marijuana themselves at one time or other. Alcohol consumption could be said to be “excessive” or “very excessive” for nearly 10 percent of the members of parliament. In general, the nature and extent of the parliamentarians’ substance use was comparable to that in the Dutch general population.

Research has shown that the most vulnerable years for initiating drug abuse are between the ages of 12 and 20. During this period, substance abuse has been shown to be associated with antisocial and dysfunctional behaviors, including truancy, academic failure, criminal behavior, and suicide or suicidal behaviors (Hawkins et al. 1987, pp. 81-131; Kumpfer 1987, PP. 1-72; Eggert and Nicholas 1992; Eggert and Herting 1993; Powell-Cope and Eggert 1994, pp. 23-51). Many research studies have shown that a significant precursor of substance abuse among youth is association with antisocial and substance-using peers. Lack of school bonding, as manifested by poor school achievement, truancy, alienation from school, and few extracurricular school-based activities also are factors associated with involvement with such friends. Therefore, youth who are poorly bonded to school are an obvious group to target for indicated prevention programs to help them connect with peers who are positive role models and teachers within the school setting (Huba et al. 1984a, pp. 11-23; Huba et al. 1984b, pp. 111-116; Newcomb and Bentler 1986; Eggert et al. 1990; Eggert and Herting 1991; Kumpfer et al. 1991; Eggert et al. 1994a, 1994b, 1994c).
Once youth have begun to use drugs, universal and selective prevention programs become less effective in dissuading them from continued use because these programs target the general population, most of whose members are not involved in drug abuse. Therefore, indicated prevention activities, as well as treatment programs are needed to curb continued drug abuse and reduce further substance abuse risks. Consequently, beyond the widely embraced prevention mission of educators, school and health professionals must become more aggressive in reaching out to youth who are at risk and intervening to reduce the prevalence of drug abuse and its adverse consequences.
Drug abuse problems affect persons of all ages and backgrounds, regardless of their risk factors. But research has shown that not all individuals with the same risk factors develop substance abuse problems. Genetic, family, peer and psychosocial, biological, and community factors also have been shown to influence an individual’s risk of becoming involved with substance abuse (Dupont 1989; Eggert and Herting 1993; Powell-Cope and Eggert 1994).
A risk factor is an association between some characteristic or attribute of an individual, group, or environment and an increased probability of certain disorders or disease-related phenomena (Berman and Jobes 1991). Clearly defined risk factors help prevention practitioners assess, identify, and treat at-risk individuals. Risk factors for substance abuse comprise an array of traits or characteristics that have been shown to increase the likelihood that a person will become involved in substance abuse.

The number of risk factors, however, may be offset by protective factors (Eggert et al. 1994a). It is important that a determination of risk for drug abuse assesses both risk and protective factors (Dupont 1989; Eggert et al. 1994c.)
The spectrum of risk factor characteristics or traits that render individuals vulnerable to substance abuse is presented in Table 1 (below). The elements included in this table are based on a review of the available literature by Hawkins and colleagues (1992a) and recent empirical research evidence (Powell-Cope and Eggert 1994; Thompson et al. 1994). For each risk factor an example is presented to describe the kinds of circumstances that contribute to the risk.

• Attributes of temperament such as self-esteem, feelings of autonomy and control, and a view of life as predictable and basically positive;

• Family cohesion and warmth and the absence of family discord and neglect; and

• Availability and utilization of external supports and resources (Berman and Jobes 1991; Eggert et al. 1994c; Powell-Cope and Eggert 1994).

For example, a youth may live in a neighborhood characterized by high crime rates and community disorganization but have a positive and supportive relationship with a parent, teacher, or peer who promotes abstinence from drug abuse. Thus, when the youth’s individual risk for drug abuse is assessed, both the risk and protective factors must be considered.

Prevention program strategies that are used to increase  protective  factors are presented in Table 2 (opposite). For each program strategy presented, an example describes the particular focus and expected goal of the program (Hawkins et al. 1992a).
 
 
Table 1
 Risk Factors for Substance Abuse

Table 2
Strategies to increase Protective Factors

Indicated prevention programs focus on the school, family, and community domains when targeting individuals at highest risk for drug abuse. Typically, these are stand-alone programs that are offered within community agencies or school settings. Researchers believe that regardless of the particular focus of the prevention approach used in reaching at-risk youth (school, family, or community), there are some basic requirements for developing effective indicated prevention programs. For example, Goplerud (1991) has suggested that prevention practitioners:

• Design prevention activities that target the major risk factors of the individuals. Because each youth is different and has different risk factor vulnerabilities, no single prevention approach will be effective for all.
• Begin with the use of the prevention approach that will be the least intrusive but will be capable of ameliorating the problem.
• Establish consistent rules, responsibilities, policies, and practices for the prevention program.
• Work to develop trust and credibility for the prevention effort through positive actions.
• Assume that an individual’s problem with alcohol and/or drugs is not his or her only problem but merely a symptom of other stressors.
Because of an increasing dropout rate, schools are beginning to reach out to youth who are at risk in an effort to keep them in school and away from the kinds of problems associated with substance abuse. Therefore, school-based indicated prevention programs usually address several risk factors simultaneously, such as low self-esteem, academic failure, and depression. One such indicated prevention approach is the Student Assistance Program (SAP), similar to employee assistance programs, available in some schools. SAPs usually provide an assessment, crisis hotline, monitoring of a student’s performance (e.g., tardiness, absences, grades, discipline problems, demerits, and suspensions), family contacts, support groups or group counseling, and referral to outside agencies, if needed.
A number of useful research-based guidelines are available to help teachers and counselors increase protective factors among youth (Eggert et al. 1994a; Powell-Cope and Eggert 1994). These guidelines stress the importance of:

• Helping youth develop an increased sense of responsibility for their own success;
• Helping youth identify their skills and talents;
• Motivating youth to dedicate their lives to helping society rather than feeling their only purpose in life is to be consumers;
• Providing youth with realistic appraisals and feedback;
• Stressing multicultural competence;
• Encouraging youth to value education and skills training;
• Increasing cooperative solutions to problems rather than competitive or aggressive solutions; and
•  Increasing a sense among youth of responsibility for others and caring for others.

A long-term study looking at the PRIDE prevention programme (for youth and parents) over five years found that there had been a continuous decrease in the use of all substances by almost all age groups. One example was that cannabis use by 16 – 17 years old had decreased from 45% to 30% among youths who participated in the programme. [Adams, R., “The PRIDE Survey,” Western Kentucky University, 1989].

In an assessment of 42 schools that participated in parent education and organisation, the findings showed that prevalence rates for cigarettes, alcohol and marijuana were significantly lower at the one year follow-up study. The net increase in drug use prevalence in schools receiving prevention programming was half that of other schools. [Pentz, Dwyer, et al., 1989].

When families are included in school programmes, risk factors can be reduced and early signs of problems can be reversed. One study has shown that three months of targeted family problem-solving training reduced drug use and a correlate factor (school failure) by the end of a 16 month follow-up, while control group families which did not get the training remained the same. [Biy, 1986]. (Quoted in Life Education International Fact Sheet. 1999).

A study of six schools examining the effects of drug prevention lessons for children to complete at home with parents showed that the children reported significantly less perceived peer use of alcohol, tobacco and marijuana, as well as significantly less peer pressure susceptibility to experiment with cigarettes. Mothers reported significantly more recent and frequent communication with their children about refusing drugs and, along with fathers, significantly greater discussions on how to resist peer pressure to use alcohol, tobacco and marijuana. Fathers also reported significantly greater motivation to help their children avoid drug use. [Werch, C.E; et al. Effects of a Take-home Drug Prevention Program on Drug-Related Communication and Beliefs of Parents and Children;” Journal of School Health: 61 (8): 346-350; ~1991].
In general, from existing studies on prevention programmes for parents, it has been found that those assessing children have shown reductions in their use of tobacco and alcohol. [Bry, National Institute on Drug Abuse; 1983].

Parent training can help reduce children’s behaviours that are precursors of drug use and increase positive behaviours such as school achievement, social skills and family involvement. [StouthamerLoeber, 1986].

Prevention Practices: Effective substance abuse prevention programs rarely use one prevention strategy exclusively. Programs typically contain a range of prevention approaches and strategies which may include one or more of the following:
1.   factual information about drugs, drug use, media literacy, related crime, and health information;
2.   life skills training, including resistance skills training and social and personal skills development;
3.   alternative activities to drug use, such as sports, dance, and theater;
4.   exercises to increase self-perception and confidence;
5.   family development, including parent training and advocacy;
6.   individual and peer group counseling;
7.   student, school, and community management practices;
8.   stress management;
9.   spiritual and cultural enhancement; and
10. antidrug/anticrime advertisements and media messages.

While there may not be a simple solution for preventing Alcohol and Other Drug (AOD) use, there is consensus among professionals in the prevention field that multicomponent programs are likely to produce the most positive effects for the greatest number of participants.  The following list includes 9 drug abuse and related crime prevention program elements that have been proven effective by the prevention research literature:

• Peer programs and multimodal approaches, particularly those with skill-building and peer program components, are effective in preventing alcohol and other drug (AOD) use (Bangert-Drowns, 1988; Tobler, 1986);

• Programs emphasizing life and peer refusal skills impact attitudes toward AODs and AOD use (Botvin, Schinke, Epstein, and Diaz, 1994; Flay, 1985; Hurd et al., 1980; Johnson et al., 1990; McAlister, Perry, Killen, Slinkdard, and Maccoby, 1980; Murray, Johnson, Luepker, and Mittelmark, 1984; Perry et al., 1983);

• Life skills training approach has been shown to impact an individual’s behavior up to 6 years after the intervention, provided the program is properly implemented and booster sessions are administered in subsequent years (Botvin, Baker, Dusenbury, Botvin, and Diaz, 1995);

• Parenting skills development and increasing parent-child attachment are effective strategies in preventing substance use among young people (Andrews et al., 1993; Barrera, Li, and Chassin, 1993; Brook, 1993; Byram and Flay, 1984; Dielman, Butchart, and Shope, 1991; Ensminger, Brown, and Kellam, 1982; Hamburg, Kraemer, and Jahnke, 1975; Hundleby and Mercer, 1987; Podell, 1992);

• Strategies to change parental attitudes toward AOD and parental AOD use impact child AOD attitudes and use (Andrews et al., 1993; Barrera et al., 1993; Weinberg, Dielman, Mandell, and Shope, 1994);

• Academic mentoring and tutoring strategies are effective in reducing and preventing AOD use (Crum, Heizer, and Anthony, 1993; Thomas and Hsiu, 1993; Wiebusch, 1994);

• Early prevention interventions targeting AOD attitude formation are effective in reducing and preventing AOD use (Grube and Wallack, 1994; McGee and Stanton, 1993; Pfeffer, 1993; Towberman and McDonald, 1993; Whittaker, 1993);

• Anti-AOD advertising is effective in changing both attitudes and use among children (Grube and Wallach, 1994; Van Reek, Knibble, and van Iwaarden, 1993; Zastowony, Adams, Black, Lawson, and Wilder, 1993); and

• Tax and increased price policies for alcohol are related to reduced consumption among adolescents (Lockhart, Beck, and Summons, 1993; Nettles and Pleck, 1993).

Additional Resources: For information on substance abuse prevention contact: National Clearinghouse for Alcohol and Drug Information P0 Box 2345 Rockville, MD 20847-2345 (800) 729-6686 (800) 487-4889 TDD www.health.org

Data from the past 20 years show that prevention has succeeded in substantially reducing the incidence and prevalence of illicit drug use. Successful substance abuse prevention also leads to reductions in traffic fatalities, violence, unwanted pregnancy, child abuse, sexually transmitted diseases, HIV/AIDS, injuries, cancer, heart disease and lost productivity.

Substance Abuse Prevention can be shown to be effective. In 1979, 25 million Americans used an illegal drug during the preceding month. (SAMHSA National Household Survey)  In 1995, 12.8 million Americans used an illegal drug in the past month, a decrease of nearly 50 percent.   In the 1980s, complete abstinence from drugs was claimed by fewer than one in thirteen high-school seniors. (NIDA–Monitoring the Future Survey)  In 1995 nearly one out of five seniors reported complete abstinence, an increase of nearly 250 percent.  Examples of Prevention Findings from CSAP national cross-site evaluations, CSAP grantee evaluations, and other programs.

FINDING:
Prevention programs can encourage change in youth behavior patterns which are indicative of eventual substance abuse.

•  Cornell University researchers in a study of 6,000 students in NY State found that the odds of drinking, smoking, and using marijuana were 40% lower among students who participated in a school-based substance abuse program in grades 7-9 than among their counterparts who did not.
• Forty-two schools in Kansas City, MO reported less student use of alcohol, tobacco, and marijuana than control sites as a result of Project Star, a prevention program.
• In Nashville, the proportion of students who achieved perfect attendance for 20-day attendance periods increased from 27% to 60% as a result of a CSAP-funded community partnership school incentive prevention program.

FINDING:
Substance abuse prevention programs can improve parenting skills and family relationships.

• A CSAP-funded study at CO State University found significant and enduring enhancement of successful parenting skills including: increased parental satisfaction, decreased harsh punishments for children, increased positive attitudes towards parenting, and increased appropriate control techniques.

FINDING:
Drug abuse prevention programs are effective in changing individual characteristics which are predictive of later substance abuse.

•  In Oakland, CA and other sites across the country, the Child Development Project found significant decreases in incidents of weapons possession and gang fighting among program participants in comparison to control groups.

FINDING:
Substance abuse prevention programs reduce delinquent behaviors among youth which are frequently associated with substance abuse and drug-related crime.

•  The Mexican-American Unity Council found significantly fewer conduct problems, less hyperactive behavior, and reduced passivity among children participating in a CSAP-funded prevention program. A similar study in Denver, CO replicated these results.
• The Safe Streets Prevention Partnership in Tacoma, WA has been instrumental in closing 600 drug selling locations since 1990 and in reducing crime by more than 40%.
• The Miami Coalition Community Partnership program has spurred Dade County community officials to demolish more than 2000 crack houses. Crime in the area has been reduced 24% and annual drug use has decreased by more than 40%.

FINDING:
The transmission of generic life skills is associated with short-term reductions in substance abuse among adolescents.

•  
  • In DE, the Diamond Deliveries program which targets pregnant adolescent alcohol and drug users resulted in a 60% lower incidence of low-birth-weight babies and significantly lower neonatal costs than a matched control group.
  • CSAP’s High Risk Youth projects confirm that prevention efforts incorporating “life skills” such as problem-solving, decision-making, resistance against adverse peer influences, and social and communication skills are associated with reduced incidence of substance abuse among adolescents.

What is preventive education for adolescents or children?
One of the most popular forms of ATOD (Alcohol, Tobacco and Other Drugs)prevention is preventive education for adolescents or children. Youth in classrooms or other community settings are presented with preventive lessons by a teacher, preventionist, trained police officer, or other authority. Often, trained teen volunteers may co-present a lesson. Lesson content may include ATOD information, life skills, or other components. (Note: Preventive education is just one way that schools play a prevention role. See the U.S. Dept. of Education’s list of “Characteristics of a Safe, Disciplined, and Drug-Free School,” in Appendix E of this Best Practices Handbook.)

Why does preventive education work?
Different kinds of curricula are based on different premises. Some seek to remedy a lack of drug information. Some seek to develop decision-making and resistance skills. Some seek to help adolescents counter pro-drug social influence as the youth establish their attitudes about ATOD. Research indicates that only some of these premises are valid.

How effective is preventive education for adolescents or children?
Preventionists have long been aware that preventive education alone is inferior to a more comprehensive approach that includes a focus on parents and community. Even so, preventive education as a sole approach has been one of the most heavily researched approaches to ATOD prevention. As a result of cumulative research, particularly in the 1980s and early 1990s, the evolving consensus of researchers in the field is that:

1. 1.      Given the correct curriculum, implementation support, and teaching approach, preventive education can   have a significant positive effect in terms of delaying or preventing youth ATOD use.
2. 2. Most currently used preventive education materials are NOT among the effective ones. But, they continue to be used due to political support, low cost, or other factors.

What else does research tell us about preventive education?

For adolescent education, two key research sources are Tobler and Stratton (1997) and Hansen (1996). Following earlier (1986 and 1992) meta-analysis studies of drug prevention programs, researcher Nancy S. Tobler conducted a meta-analysis of 120 experimental or quasi-experimental school-based adolescent drug prevention programs (5th-12th grade) that evaluated success on self-reported drug use measures. Each program was classified as either interactive (included guided discussion among students) or non-interactive (included only a lecture and discussion with the class facilitator).
Tobler found a tremendous difference in effectiveness, with non-interactive programs having little impact but the interactive programs having a substantial impact. Surprisingly, this impact on drug use occurred even when the average program length was only 10 contact hours.

Content categories of the various programs also played a role in effectiveness. Programs that focused only on intrapersonal skills such as decision-making, goal setting, and values clarification were ineffective. Effective programs may have had some intrapersonal skills, but included a strong interpersonal skill component focused on dealing with peer influence. Even with this content, programs delivered in a non-interactive way were substantially less effective, and frequently ineffective.

Another attribute, program size, was unexpectedly found to play a significant role in effectiveness. ‘Small” interactive programs did much better than “large” interactive programs, even though the latter did better than small non-interactive programs. The Tobler article does not define “small” and “large”, but a sub-analysis with “extremely large programs” may be used to infer a cutoff of about 1,000 students between the two categories.

Tobler’s meta-analysis used self-reported drug use as the sole measure of effectiveness, but “mediating variables” including knowledge and attitudes were also measured. An interesting point about the pattern of results on these measures is that interactive and non-interactive programs were approximately equal in producing knowledge gain, but interactive programs were superior in changing attitudes and decreasing use.

William Hansen’s summary of work in progress indicates that the three most powerful curricular elements in ATOD prevention are:

1. Normative Beliefs. Youth tend to greatly overestimate the percent of peers who use drugs. When given actual numbers, they apparently feel less deviant in their non-use.

2. Life Style Compatibility. In spite of hearing about the negative effects of drugs, many adolescents don’t necessarily see any threat by drug use to their desired lifestyle. When these connections are explicitly made, it has an impact.

3. Commitment. Opportunities for adolescents to make a personal, public commitment to avoiding ATOD use can lead to lower use rates.

For preventive education of younger (elementary school) children, the National Structured Evaluation indicates that a “Psychosocial Skill” approach is best. The approach is congruent with a “youth development” model, emphasizing affective, social, and other skills. It includes no didactic ATOD education. Examples of beneficial life skills for prevention include resistance skills, assertiveness, social problem solving, and decision-making.

Shock tactics are far more likely to convince people to avoid binge drinking than long-term health education, new research shows.
Sinister advertisements warning young women that they may not get home safely if they allow themselves to get too drunk are far more likely to be effective than campaigns warning them of potential heart or liver disease, according to a survey by the Portman Group, which is funded by the drinks industry.
The equivalent for young men might be advertisements informing them how much more likely they are to get into a fight or to be involved in committing a crime when drunk.
The survey, by MORI, found that 39% of people think shock tactics would work better than education campaigns, which were supported by 21%.  Among under-25’s, support for shock tactics rose to 44%.
The study showed that binge drinking is rife among under-25’s, with 17% – representing one million young people – admitting that they regularly drank to get drunk.  That compares with 5% of all adults.    Alexandra Frean

Two brief family-focused drug abuse prevention programs have produced long-term reductions in substance abuse among adolescents in rural Iowa public schools. The programs may offer communities a practical approach to effective family-based drug abuse prevention.
The longer of the two programs reduced the proportion of students who used any marijuana, tobacco, or alcohol in grades 6 through 10 as well as students’ current use of alcohol and tobacco. The shorter program decreased alcohol use among 10th-graders significantly, along with reducing lifetime substance use behaviors.
“The study demonstrates that brief family interventions can reduce drug use among young people during the high-risk years when they are making the transition from childhood to adolescence,” says Dr. Richard Spoth. Reducing the number of children who begin substance use during these years may have important public health benefits because early initial use is associated with higher rates of substance dependence in later adolescence and young adulthood.
A total of 667 families of sixth-graders were recruited for the study. The children’s schools were randomly assigned to either a five-session program called Preparing for the Drug Free Years (PDFY), a seven-session Iowa Strengthening Families Program (ISFP), or a control group.    programs were designed for families with young adolescents.  The ISFP was asive  several racial and ethnic groups.
The fact that the adapted programs achieved very positive results indicates they can be whittled down and still maintain their effectiveness,” says Dr. Elizabeth Robertson.
The programs were delivered in weekly evening sessions to participating families at the schools.  Parents in PDFY attended four sessions and were joined by their children for a final joint session. In the relatively more intensive ISFP, parents and children attended both separate and joint sessions for 6 weeks and a final joint session. The weekly PDFY and ISFP sessions sought to improve how parents and children functioned individually and as a family in a variety of situations.  Both programs taught skills such as effective parenting, appropriate management of family conflicts, and how to resist peer pressure. The development of such skills has been linked to delayed onset or reduction of substance abuse.
Four years after 6th-grade students had received the programs, the researchers interviewed them and found that significantly lower percentages of ISFP than control 10th-graders had ever initiated any of five substance abuse behaviors. Specifically lower percentages of ISFP students than controls had begun to use alcohol, cigarettes, or marijuana; had ever used alcohol without parental permission; or had become drunk. The proportion of new marijuana users in the control group was 2.4 times greater than it was among ISFP youths. Similarly, the proportion of controls who had been drunk or smoked cigarettes were 1.7 and 1.5 times greater than they were among ISFP youths. Participants in the PDFY program also showed lower rates of initiation of all five substance use behaviors than controls, but only the differences in lifetime drunkenness and marijuana use approached statistical significance. Nevertheless, the rates of new marijuana use and ever getting drunk were 1.5 and 1.2 times greater for controls than they were for PDFY youths.
Among those 10th-graders in the three groups who had begun to use alcohol, tobacco, or marijuana, the study found lower proportions of PDFY and ISFP students than controls had used alcohol and tobacco in the preceding month and marijuana during the preceding year. For example, frequency of past-month alcohol use among PDFY and ISFP students was about two-thirds that of controls. Among ISFP students, past-month cigarette use was approximately half that of control group students.
“Developmental timing is an important factor in the long-term effects of these interventions,” Dr. Richard Spoth of Iowa University says. “Intervening at this time in the sixth grade when kids are experimenting with substances probably contributes greatly to the positive effects,” he says. “The careful design of the interventions with their theory-based focus on parenting and family interactions also is important,” he adds.
The critical element affected by both programs is the parent component, says NIDA’s Dr. Robertson. “When you provide parents with information about what to expect of children at that age, what is typical and what is not, and how to deal with some of the problems, you are shaping how parents relate to their children. Changing the family context can have a long-lasting effect because you are positively influencing the day-to-day environment of the child over a long period of time” she says.

Data from the past 20 years show that prevention has succeeded in substantially reducing the incidence and prevalence of illicit drug use. Successful substance abuse prevention also leads to reductions in traffic fatalities, violence, unwanted pregnancy, child abuse, sexually transmitted diseases, HIV/AIDS, injuries, cancer, heart disease and lost productivity.

Substance Abuse Prevention can be shown to be effective. In 1979, 25 million Americans used an illegal drug during the preceding month. (SAMHSA National Household Survey) In 1995, 12.8 million Americans used an illegal drug in the past month, a decrease of nearly 50 percent. In the 1980s, complete abstinence from drugs was claimed by fewer than one in thirteen high-school seniors. (NIDA–Monitoring the Future Survey) In 1995 nearly one out of five seniors reported complete abstinence, an increase of nearly 250 percent. Examples of Prevention Findings from CSAP national cross-site evaluations, CSAP grantee evaluations, and other programs.

FINDING:
Prevention programs can encourage change in youth behavior patterns which are indicative of eventual substance abuse.

Cornell University researchers in a study of 6,000 students in NY State found that the odds of drinking, smoking, and using marijuana were 40% lower among students who participated in a school-based substance abuse program in grades 7-9 than among their counterparts who did not.
Forty-two schools in Kansas City, MO reported less student use of alcohol, tobacco, and marijuana than control sites as a result of Project Star, a prevention program.
In Nashville, the proportion of students who achieved perfect attendance for 20-day attendance periods increased from 27% to 60% as a result of a CSAP-funded community partnership school incentive prevention program.
FINDING:
Substance abuse prevention programs can improve parenting skills and family relationships.
A CSAP-funded study at CO State University found significant and enduring enhancement of successful parenting skills including: increased parental satisfaction, decreased harsh punishments for children, increased positive attitudes towards parenting, and increased appropriate control techniques.
FINDING:
Drug abuse prevention programs are effective in changing individual characteristics which are predictive of later substance abuse.
In Oakland, CA and other sites across the country, the Child Development Project found significant decreases in incidents of weapons possession and gang fighting among program participants in comparison to control groups.
FINDING:
Substance abuse prevention programs reduce delinquent behaviors among youth which are frequently associated with substance abuse and drug-related crime.
The Mexican-American Unity Council found significantly fewer conduct problems, less hyperactive behavior, and reduced passivity among children participating in a CSAP-funded prevention program. A similar study in Denver, CO replicated these results.
The Safe Streets Prevention Partnership in Tacoma, WA has been instrumental in closing 600 drug selling locations since 1990 and in reducing crime by more than 40%.
The Miami Coalition Community Partnership program has spurred Dade County community officials to demolish more than 2000 crack houses. Crime in the area has been reduced 24% and annual drug use has decreased by more than 40%.
FINDING:
The transmission of generic life skills is associated with short-term reductions in substance abuse among adolescents.
In DE, the Diamond Deliveries program which targets pregnant adolescent alcohol and drug users resulted in a 60% lower incidence of low-birth-weight babies and significantly lower neonatal costs than a matched control group.
CSAP’s High Risk Youth projects confirm that prevention efforts incorporating “life skills” such as problem-solving, decision-making, resistance against adverse peer influences, and social and communication skills are associated with reduced incidence of substance abuse among adolescents.
Source: CSAP (Center for Substance Abuse Prevention) – www.health.org – Apr/1999

A St. Louis study finds that drug courts and addiction treatment are far more cost-effective than probation over the long run, Alcoholism & Drug Abuse Weekly reported March 8.

The study by the Institute of Applied Research focused on the city’s adult felony drug court. Researchers concluded that drug court costs about $1,449 per offender more up front than probation, but end up saving taxpayers $7,707 within four years of discharge.

“The drug-court client pays for his drug-court experience within about 3.5 years by avoiding costs [such as reinvolvement with the criminal-justice system] and paying taxes,” said Jeffrey N. Kushner, the city’s drug-court administrator.

The complete report is available on the Institute of Applied Research website.

Distributing nearly 3 million needles a year to drug addicts, Vancouver, Canada boasts the largest needle exchange program in North America. The program was established in 1988– 16 years ago– to prevent the spread of HIV and hepatitis C (HCV). A new study finds that co-infection with these two deadly viruses is “shocking” with 16% of study participants co-infected at the beginning of the study and 15% more becoming co-infected over the course of the study. The researchers note it took a median of 3 years for seroconversion to secondary infection.

NEW YORK (Reuters Health) Jun 28 – Coinfection with Hepatitis C virus (HCV) and HIV is prevalent in a “shocking” number of young injection drug users, according to Canadian researchers.

In the June 1st issue of the Journal of Acquired Immunodeficiency Syndromes, Dr. Carl L. Miller of the University of British Columbia, Vancouver and colleagues note that they sought to determine the incidence of such coinfections and to compare the socioeconomic characteristics of those infected.

The researchers used data from the Vancouver Injection Drug Users Study to identify 479 subjects aged 29 years or less. At baseline, 78 (16%) were coinfected and a further 45 (15%) became so over the course of the study.

Baseline infection was independently associated with factors including being female, being of aboriginal ancestry, being older and with the number of years of injecting.

Borrowing needles and injecting cocaine more than once a day were both among the factors associated with the time to secondary infection seroconversion. Having recently attended a methadone maintenance program was protective.

Across the categories of coinfected, monoinfected and HIV and HCV negative injection drug users, say the investigators, there were “clear trends for increasing proportions” of women, aboriginals, daily cocaine users and inhabitants of Vancouver’s 10-block injection drug use epicenter.

The researchers, who note that it took a median of 3 years for seroconversion to secondary infection, conclude that “appropriate public health interventions should be implemented immediately.”

The number of admissions to substance abuse treatment for adolescents ages 12 to 17 increased again in 2002, continuing a ten-year trend. These data were released today in the “Treatment Episode Data Set: National Admissions to Substance Abuse Treatment Services 1992-2002″ by the Substance Abuse and Mental Health Services Administration (SAMHSA).

The new data show that the number of adolescents ages 12 to 17 admitted to substance abuse treatment increased 65 percent between 1992 and 2002. In 1992, adolescents represented 6 percent of all treatment admissions. By 2002, this proportion had grown to 9 percent. This report expands upon data published in May in the “Treatment Episode Data Set (TEDS) Highlights 2002.”

The increase in substance abuse treatment admissions among 12 to 17 year olds was largely due to the increase in the number of admissions in this age group that reported marijuana as their primary drug of abuse. Between 1992 and 2002, the number of adolescent treatment admissions for primary marijuana abuse increased 350 percent. In 1992, 23 percent of all adolescent admissions were for primary marijuana abuse. By 2002, 63 percent of adolescent admissions reported marijuana as their primary drug.

“The youthfulness of people admitted for marijuana use shows that we need to work harder to get the message out that marijuana is a dangerous, addictive substance, SAMHSA Administrator Charles Curie said. All Americans must begin to confront drug use and drug users honestly and directly. We must discourage our youngsters from using drugs and provide those in need an opportunity for recovery by encouraging them to enter and remain in drug treatment.”

Forty-eight percent of all adolescent treatment admissions in 2002 involved the use of both alcohol and marijuana. Admissions involving these two substances increased by 86 percent between 1992 and 2002.

In 2002, more than half (53 percent) of adolescent admissions were referred to treatment through the criminal justice system. Seventeen percent were self- or individual referrals, and 11 percent were referred through schools.

The TEDS report provides detailed data on admissions to substance abuse treatment for all age groups. The 2002 data show that polydrug abuse (abuse of more than one substance) was more common among TEDS admissions than was the abuse of a single substance. Polydrug abuse was reported by 55 percent of all admissions for substance abuse treatment in 2002. Alcohol, marijuana and cocaine were the most commonly reported secondary substances. For marijuana and cocaine, more admissions reported these as secondary substances than as primary substances.

This new report provides information on the demographic and substance abuse characteristics of the 1.9 million annual admissions to treatment for abuse of alcohol and drugs in facilities that report to individual state administrative data systems. The report also includes data by state and state rates.

ATLANTA — Twenty-five years after the first AIDS cases jolted the world, scientists think they soon may have a pill that people could take to keep from getting the virus that causes the global killer.

Two drugs already used to treat HIV infection have shown such promise at preventing it in monkeys that officials last week said they would expand early tests in healthy high-risk men and women around the world.

“This is the first thing I’ve seen at this point that I think really could have a prevention impact,” said Thomas Folks, a federal scientist since the earliest days of AIDS. “If it works, it could be distributed quickly and could blunt the epidemic.”

Condoms and counselling alone have not been enough HIV spreads to 10 people every minute, 5 million every year. A vaccine remains the best hope but none is in sight. If larger tests show the drugs work, they could be given to people at highest risk of HIV from gay men in American cities to women in Africa who catch the virus from their partners.

People like Matthew Bell, a 32-year-old hotel manager in San Francisco who volunteered for a safety study of one of the drugs. “As much as I want to make the right choices all of the time, that’s not the reality of it,” he said of practicing safe sex. “If I thought there was a fallback parachute, a preventative, I would definitely want to add that.”

Some fear that this could make things worse. “I’ve had people make comments to me, ‘Aren’t you just making the world safer for unsafe sex?’” said Dr. Lynn Paxton, team leader for the project at the Centers for Disease Control and Prevention.

The drugs would only be given to people along with counseling and condoms, and regular testing to make sure they haven’t become infected. Health officials also think the strategy has potential for more people than just gay men, though they don’t intend to give it “to housewives in Peoria,” as Paxton puts it. Some uninfected gay men already are getting the drugs from friends with AIDS or doctors willing to prescribe them to patients who admit not using condoms. This kind of use could lead to drug resistance and is one reason officials are rushing to expand studies.

“We need information about whether this approach is safe and effective” before recommending it, said Dr. Susan Buchbinder, who leads one study in San Francisco.

The drugs are tenofovir (Viread) and emtricitabine, or FTC (Emtriva), sold in combination as Truvada by Gilead Sciences Inc., a California company best known for inventing Tamiflu, a drug showing promise against bird flu.

Unlike vaccines, which work through the immune system the very thing HIV destroys, AIDS drugs simply keep the virus from reproducing. They already are used to prevent infection in health care workers accidentally exposed to HIV, and in babies whose pregnant mothers receive them. Taking them daily or weekly before exposure to the virus the time frame isn’t known yet may keep it from taking hold, just as taking malaria drugs in advance can prevent that disease when someone is bitten by an infected mosquito, scientists believe.

Monkeys suggest they are right. Specifically, six macaques were given the drugs and then challenged with a deadly combination of monkey and human AIDS viruses, administered in rectal doses to imitate how the germ spreads in gay men. Despite 14 weekly blasts of the virus, none of the monkeys became infected. All but one of another group of monkeys that didn’t get the drugs did, typically after two exposures.

“Seeing complete protection is very promising,” and something never before achieved in HIV prevention experiments, said Walid Heneine, a CDC scientist working on the study.

What happened next, when scientists quit giving the drugs, was equally exciting.

“We wanted to see, was the drug holding the virus down so we didn’t detect it,” or was it truly preventing infection, said Folks, head of the CDC’s HIV research lab. It turned out to be the latter. “We’re now four months following the animals with no drug, no virus. They’re uninfected and healthy.” Years of previous monkey studies using tenofovir alone had shown partial protection. The scientists thought to add the second drug, FTC, when Gilead’s combination pill, Truvada, came on the market last year.

The results, announced at a scientific meeting last month in Denver, so electrified the field that private and government funders alike have been looking at ways to expand human testing. “This is an approach we’ve considered for a long, long time,” but didn’t try sooner because AIDS drugs had side effects and risks unacceptable for uninfected people, said Dr. Mary Fanning, director of prevention research at the National Institute of Allergy and Infectious Diseases.

Tenofovir changed that when it came on the market in 2001. It is potent, safe, stays in the bloodstream long enough that it can be taken just once a day, doesn’t interact with other medicines or birth control pills, and spurs less drug resistance than other AIDS medications. The CDC last year launched $19 million worth of studies of it in drug users in Thailand, heterosexual men and women in Botswana, and gay men in Atlanta and San Francisco. A third U.S. city, not yet identified, will be added, CDC announced last week.

Because of the exciting new monkey results, the Botswana study now will be switched to the drug combination; the others are well under way with tenofovir alone. Farthest along is a study of 400 heterosexual women in Ghana by Family Health Initiative. The Bill & Melinda Gates Foundation funded it and others in Cambodia, Nigeria, Cameroon and Malawi, but the rest were doomed by rumours, including fears that scientists wanted to deliberately expose people to HIV or that study participants who got infected might not have access to treatment. In other cases, activists demanded better health care or clean needles for drug users as a condition for allowing the studies to proceed.

Such problems are “part of the HIV prevention landscape” in many foreign countries, said Dr. Helene Gayle, who formerly oversaw AIDS research for the Gates Foundation. Expense also could limit use of the drugs. Gilead donated them for the studies and sells them in poor countries at cost _ 57 cents a pill for tenofovir and 87 cents for Truvada, the combination drug. That’s more than the cost of condoms, available for pennies and donated by the truckload in Africa, but often unused. In the United States, wholesale costs are $417 for a month of tenofovir and $650 for Truvada. Still, health officials are hopeful the drugs could fill an important gap.

The National Institutes of Health is starting a tenofovir study in 1,400 gay men in Peru. Private and government funders are considering others. Tenofovir also is being tested in microbicide gels that women could use vaginally to try to prevent catching HIV. “If you’re in an area where there’s a really high HIV incidence, something that’s even 40 percent effective could have a huge impact,” Paxton said. And in the Atlanta labs where Heneine, Folks and others are still minding the monkeys, “the level of enthusiasm is pretty high,” Heneine said. “This is very promising. For us to be involved in a potential solution to the big HIV crisis and pandemic is very exciting.”
Source:www.chron.com March 2006

In 2004, the 28 High Intensity Drug Trafficking Areas (HIDTA) implemented a Performance Management Process (PMP) to measure their performance, identify the outcomes of their efforts, and improve the efficiency and effectiveness of their initiatives. The National High Intensity Drug Trafficking Area Program 2004 Annual Report highlights the initial results of the PMP, including two of sixteen performance measures developed—the number of Drug Trafficking Organizations (DTOs) disrupted or dismantled and the return on investment (ROI).

In 2004, the HIDTA Program received a law enforcement budget of $176,835,426. In that same year, HIDTA initiatives disrupted.or dismantled 3,538 DTOs and seized more than $10.5 billion in drugs and nearly $500 million in assets from DTOs.

Thus, every $1 invested in the HIDTA program yielded an estimated $63 in drugs and assets removed from the market.
SOURCE: Adapted by CESAR from National HIDTA Directors Association, National High Intensity Drug Trafficking Area Program 2004 Annual Report, 2006.
For more information, contact Erin Artigiani at CESAR aterin@cesar.umd.edu

Administered by Kentucky’s Council on Prevention and Education, CLC worked with five church communities to identify and recruit 11- to 15-year-olds. Over 131 ethnically diverse youths and their families living in rural, suburban, and inner-city areas in Kentucky participated in the program. CLC provided youths with 15 hours of training and parents/caregivers received 55 hours of training on substance abuse issues, communication skills, refusal skills, and family issues. CLC also provided referral services to families that required intervention or other social services. Evaluators found that both parents and children had increased involvement with the church community and an increase in resiliency as they learned about alcohol and drug issues. Youths increasingly declined drug and alcohol use and some inexperienced with drug use delayed initial experimentation with drugs. Participants also increasingly consulted community services for resolving family and personal problems and reported greater communication and bonding between parents and children.

Of course, it is difficult to categorise a group of children as to whether they have ever tried drugs; most groups that prevention workers see probably have a mixture of experiences. This, however, still requires the use of prevention strategies. Information and messages on “safer drug use” are not appropriate for children who have never experimented with drugs, nor does it do a service for children who have experimented or are using drugs on a more regular basis. There are no easy answers in prevention to help children who are using drugs, as the roots of drug taking behaviour are multiple and may involve family, social and environmental causes, as well as individual issues. Intervention, including the prevention message, is a helpful and healthier method to help these children. To tell children about “safe” ways to use legal or illegal drugs, however, not only harms them, but also harms society. The implications of this approach have major effects on families, crime rates (including driving under the influence of substances), the medical and legal systems.
It is known from research that if people think it is “normal” to use drugs, use will increase. If society wants to decrease drug use, then it must be socially unacceptable to use drugs. (Johnson, University of Michigan, 1991). Research has shown that increases in perceived risks and disapproval contribute substantially to the decline in actual use. It appears that large proportions of young people do pay attention to new information about drugs, especially risks and consequences. Such information, presented in a realistic and credible fashion, plays a vital part in reducing the demand for a drug (National Institute on Drug Abuse. USA. 1991).

In conclusion, there are currently many problems caused by drug use. The overuse and misuse of legal substances (alcohol, cigarettes, and prescriptions) also have an effect on society. Prevention initiatives regarding these substances are finally being seen as important by most levels of society. Ongoing programmes, training, and social policy help spread prevention of drug use throughout communities, with the proven benefits of increasingly healthy individuals and society.

Source: Life Education International 1997 updated 1999

Prevention is a pro-active range of strategies designed to create and maintain healthy lifestyles. The view of health is a holistic one, including physical, mental, spiritual and social health.
Prevention theory and practice have developed through evaluative research and reflect what is shown to work. To be effective, prevention needs to involve communities (including families, schools, churches) and its systems (e.g. political, police, media). The range of prevention strategies includes providing awareness (for example, media campaigns); information and education about achieving and/or maintaining health including personal and social consequences; a range of alternative healthy activities (e.g. sports, dance, art); and a context of health-promoting social policy. Together, these strategies create social norms in which individuals can develop to their full potential.

Most drug prevention programmes define primary prevention as preventing the onset of drug use before experimentation starts (essentially done at an early age, such as 4-5, and often not addressing drug issues straight away, instead discussing the body, care of it and other health issues). Secondary prevention is done with an older group, who may be experimenting with drug use or who may be at risk – a situation many children will now face. Its aim is to stop the progression of experimentation or more regular drug use. Drug use is not a “normal part of development” for young people. It is something that stunts development. Drug use has harmful effects on people, physically, emotionally, spiritually and socially. Using this model, the third component is treatment, when a person has a drug problem and wants to stop using. People in treatment also need a form of prevention, in this case, defined as relapse prevention, which involves a range of personal and social skills to avoid drug use.

Strategies:
The most effective prevention programmes cover a wide range of issues and skills. These include information on the body and health; decision making, problem solving and stress reduction; communication skills; friendship, peer pressure and how to resist it; alternatives to drug use; identity and self esteem; and drug information (including illegal and legal substances) – all delivered in a developmentally and ethnically appropriate manner. In programmes for children (at schools, youth groups, etc.), a child-centered approach that creates a forum for children to discuss their issues and concerns should be used. Other types of prevention programmes include parent and peer education, as well as training programmes for teachers, health and youth workers. Professional training is an effective and efficient way to increase the amount of prevention work in communities.

Documents the harm to young people from marijuana use. The Denver-area teenagers studied were in delinquency/substance abtise treatment and most were dependent on marijuana, although most reported behavior problems predated, and were not initially caused by, drug use. Most of the dependent youth had let marijuana control their lives, interfering with school, home, and work situations and with driving. Three-quarters of the dependent young people spent much time in getting, using or recovering from the effects of marijuana. Two-thirds had given up important activities to use or acquire marijuana. Most of these dependent children experienced withdrawal symptoms when they tried to quit marijuana. Among other findings of this study:

Marijuana is a strong reinforcer of itself, propelling further use.
Among the dependent youth, even moderate marijuana use commonly led to dependence. For those who had used marijuana at least 6 times, 83% developed dependence.
Progression in marijuana use was significantly more rapid than for alcohol.
An anti-drug prevention organization recently compiled an extensive bibliography of studies showing marijuana’s harm. This is available from DNE/Strategic Intelligence upon request.
Aside from the harm caused by marijuana directly, its role as a “gateway drug” has been well established. Marijuana use is of particular concern because, for some, it is a forerunner of use of other drugs with their attendant problems. Documentation of the association of marijuana with abuse of more serious drugs was reported in the June 1997 Bulletin. One study showed that the earlier a person starts using marijuana, the more likely it is that they will at least experiment with other drugs. This is shown in the graph below and suggests that the longer marijuana use can be prevented, the better the chance for a drug-free life.
Risk of using other drugs varies directly with how young a person is when they start using marijuana

Source:Recent research conducted at the University of Colorado and published in Drug and Alcohol Dependence
How Marijuana Use Relates to Other Drug Use
(Based on Federal Drug Use Figures)

The risk for developing substance dependence is increased in the prison milieu, due to stress factors, to the availability of drugs, and to an over-representation of persons dependent on drugs among the prison population. Recent overviews on projects for primary prevention against substance abuse in European countries are summarized and some evaluation results are discussed (especially prevention programs in the school milieu and in community settings). The main messages are that knowledge and attitudes can be improved, but, with unreliable impact on consumption behavior, short programs are not effective and most programs cannot adequately reach those who are most in need for them. These messages have to be considered when it comes to prevention in the prison milieu. The specific prevention goals for prison populations are identified, and selected strategies mentioned (including control measures, therapeutic measures, and harm reduction measures). Evaluation of such prevention strategies and programs is rare; a few examples are given. More pilot projects are recommended, focusing on relapse prevention for those already dependent, adequate networking with after-care and other agencies outside, and active participation by inmates in order to improve compliance with the program.

Source: Uchtenhagen, A. International Journal of Drug Policy 8(1):56-61, 1997
Availability: Reprints are available from the publisher

In a study of 6,000 high school students in New York State, Cornell University researchers found that the odds of drinking, smoking, and using marijuana were 40 percent lower among students who had participated in a school-based substance abuse prevention program in grades 7-9 than among students who had not. In 1995 near1y one out of five seniors reported complete abstinence from drugs. This represents an increase of almost 250 percent since 1980. Also in 1995, 12.8 million Americans used an illegal drug within the past month. A decrease of nearly 50 percent since 1979.

Source: Substance Abuse and Mental Health Services Administration: Prevention Works!
The 1997 National Household Survey on Drug Abuse found that the rates of use of marijuana, psychotherapeutics, cocaine, hallucinogens, and inhalants in the total population age 12 and older did not change between 1996 and 1997.
Source: White House Drug Policy Website

This article reports the results of a study of substance use, measured by self-reports and hair test results, and delinquency among arrested youths entering a service intervention program. The results highlight important relationships between their alcohol and drug use and involvement in delinquency in the year prior to their interviews. The research and service implications of these findings are discussed.

Source: Dembo R.; Pacheco, K.; Schmeidler J.; Fisher, L.; Cooper, S. Journal of Child & Adolescent Substance Abuse 6(2):1-25, 1997
Availability: The Haworth Press, Inc., 10 Alice Street, Binghamton, NY 13904-1580

Implications for preventing drug-related behavior among youths

The rise in drug-related behavior (DRB) among youths represents a major public health concern. The interaction of DRB and other risk factors predicting delinquency and disease among youths has led to more interest in the implications for using persuasive communication in the mass media for drug prevention. Advancements in communications technology offer promising alternatives for delivering drug prevention on a large scale. The efficacy of anti-drug public service announcements (PSAs) for preventing DRB among youths is discussed.

Source: Davis. N. Journal of Child & Adolescent Substance Abuse 6(2):49-56, 1997
Availability: Haworth Press. 10 Alice Street, Binghamton, NY 13904

In a workshop at the August 1997 10th Annual National Prevention Network (NPN) Research Conference, in Philadelphia, Nancy Chase and Fred Garcia defined the kinds of media reaching today’s youth. These include such obvious sources as television and movies and the Internet, as well as message delivery vehicles not always looked at as media, such as T-shirts, video games, and the lyrics of popular music. DHHS Secretary Donna Shalala responds to the question of why so many of today’s kids engage in substance abuse by pointing out that “…young people are bombarded with mixed messages about drugs, alcohol, and tobacco from the environment…” The reach and impact of media in the environment is growing daily. While the NPN members on hand were familiar with the issue generally, they were impressed by a collection of recent videotaped clips of commercials and news programs shown during the workshop. They also learned that the American Psychological Association estimates that the typical child sees about 10,000 acts of violence each year on television. And the workshop leaders pointed out that these same youth are exposed to music that “glamorizes illicit drug use, underage drinking, and violence.” A surprisingly long and varied list of products depicts the marijuana leaf, often with a pro-marijuana message.

Faced with the challenge of countering such powerful forces, media literacy offers opportunities to strengthen and add to other prevention efforts: Media campaigns and other prevention strategies are important steps in reducing substance abuse among adolescents. It is simply not possible to reach all young people with compelling and frequent enough messages about the dangers of alcohol, tobacco, and illicit drugs. Dollar for dollar, substance abuse prevention forces can never hope to match, much less outspend, corporate marketing in the media. But media literacy may adjust the balance in favor of prevention at relatively small cost by helping young people “analyze, evaluate, and understand the direct and subtle themes of a media message.”

To be media literate, in the workshop’s words, “is to understand that the message was produced by someone with an agenda to sell, persuade, or change attitudes or behaviors.” Thus, “media literacy is the skill to ‘deconstruct’ the message and understand the messenger’s motives.” In theory the idea of letting someone else pay to produce a message, which, through media literacy can become an effective prevention teaching tool, is bound to be appealing. But how well does it work? Garcia and Chase cited a 1996 study that found that students who have acquired media literacy skills will counter-argue alcohol ads months or years after exposure.

At the University of Washington, Erica Weintraub Austin reported that third graders had immediate as well as delayed effects from viewing and discussing a videotape about television advertising and looking at alcohol ads. The workshop presenters conclude from this and other studies that “teachers of media literacy may indeed be inoculating students against the appeals of sophisticated alcohol and tobacco advertising.” Garcia and Chase also emphasize that media literacy is not media bashing, but treats media as a tool that can be used, misused, and abused. Nor, they told the gathering of State prevention directors, is media literacy a silver bullet. But the media industries need to be seen as a part of the solution toward healthier, safer communities. And media literacy is a prevention strategy to address both public health and public safety concerns. It’s also an excellent alternative activity for youth, since it is involving, engaging and compelling.

Source: Workshop in Aug-1997 – 10th Annual National Prevention Network Research Conference – Philadelphia USA – Reported in Prevention Pipeline Nov/Dec 1997

A universal program, the Seattle project is a school-based intervention for grades one through six that seeks to reduce shared childhood risks for delinquency and drug abuse by enhancing protective factors. The multicomponent intervention trains elementary school teachers to use active classroom management, interactive teaching strategies, and cooperative learning in their classrooms. At the same time, as children progress from grades one through six, their parents are provided a training session called ‘How To Help Your Child Succeed in School’, a family management skills training curriculum called ‘Catch ‘Em Being Good’, and the ‘Preparing for the Drug-Free Years’ curriculum. The interventions are designed to enhance opportunities, skills, and rewards for children’s prosocial involvement in both school and family settings, thereby increasing their bonds to school and family and commitment to the norm of not using drugs. Long-term results indicate positive outcomes for students who participated in the program: reductions in antisocial behaviour, improved academic skills, greater commitment to school, reduced levels of alienation and better bonding to prosocial others, less misbehavior in school, and fewer incidents of drug use in school.

Source: Hawkins et al. 1992

Strengthening Families is a selective multicomponent, family-focused program that provides prevention programming for 6-10-year-old children of substance abusers. The program began as an effort to help substance-abusing parents improve their parenting skills and reduce their children’s risk factors. The program has been culturally modified and found effective (through independent evaluation) with African-American, Asian/Pacific Islander, and Hispanic families. The Strengthening Families program contains three elements: a parent training program, a children‘s skills training program, and a family skills training program. In each of the 14 weekly sessions, parents and children are trained separately in the first hour. During the second hour, parents and children come together in the family skills training portion. Afterward, the families share dinner and a film or other entertainment. Parent training improves parenting skills and reduces substance abuse by parents. Children‘s skills training decreases children’s negative behaviors and increases their socially acceptable behaviors through work with a program therapist. Family skills training improves the family environment by involving both generations in learning and practising their new behaviors. This intervention approach has been evaluated in a variety of settings and with several racial and ethnic groups. The primary outcomes of the program include reductions in family conflict, improvement in family communication and organization, and reductions in youth conduct disorders, aggressiveness, and substance abuse.

Source: Kumpfer et al. 1996

AAPT is a universal classroom program designed for fifth grade students, with booster sessions conducted in the seventh grade. It includes two primary strategies. Resistance skills training is designed to give children the social and behavioral skills they need to refuse explicit drug offers. Normative education is specifically designed to combat the influences of passive social pressure and social modeling effects. It focuses on correcting erroneous perceptions about the prevalence and acceptability of substance use and on establishing conservative group norms. In the research design, the students received either information about consequences of drug use only, resistance skills only, or resistance skills training in combination with normative education. Results showed that the combination of resistance skills training and normative education prevented drug use; resistance skills training alone was not sufficient.

Source: Donaldson et al. 1994

The follow-up results of a six-year study by the Institute for Prevention Research at Cornell University Medical College provide important new evidence that drug abuse prevention programs conducted in school classrooms work. In a large-scale study involving nearly 6,000 students from 58 schools in New York state, students who received a skills-based prevention program in junior high school were found to have significantly lower odds of smoking, drinking, and using marijuana at the end of high school. This is the first scientifically rigorous study to show conclusively that a school-based drug abuse prevention program can produce meaningful reductions in drug use lasting over the critical junior and senior high school years.

The study was conducted by researchers at Cornell University Medical College’s Institute for Prevention Research with funding from the National Institute on Drug Abuse. The research team was led by Dr. Gilbert J. Botvin, professor public health and psychiatry. Schools were first grouped according to their rates of drug use and then randomly assigned to either receive the prevention program or to serve as controls. The prevention program, called Life Skills Training, taught students self-management skills and general social skills as well as information and skills for resisting pro-drug use influences. Students received the prevention program during the 7th, 8th, and 9th grades. Final follow-up data were collected at the end of the 12th grade.

Students receiving the prevention program had less tobacco, alcohol, and drug use at the end of the study than control students who did not receive the prevention program. The odds of smoking, drinking immoderately, or using marijuana were significantly lower for the students who received the prevention program during grades seven, eight, and nine. For these students, the odds of smoking, drinking, or using marijuana were up to 40 percent lower than for controls. Not surprisingly, the prevention program was less effective for students whose teachers taught only part of the program. On the other hand the strongest prevention effects were found for students who received at least 60 per cent of the drug abuse prevention program.

In addition to assessing the long-term impact of the prevention program on the use of individual substances, the effectiveness of the program was also assessed in terms of polydrug use (defined as the use of two or more drugs by the same individual.) A criticism of previous prevention studies is that they have only demonstrated an impact on relatively low levels of drug involvement – for example, the occasional use of cigarettes. This study directly deals with this issue by looking at the impact of the prevention program on the regular (weekly or more) use of cigarettes, alcohol, and marijuana. The odds of using all three substances on a regular basis were up to 60 percent lower for the students who received the prevention program than for controls.

Two forms of the prevention program were tested. One involved providing teachers conducting the program with special training and feedback by project staff. The other gave teachers a videotaped version of the training and no feedback. All teachers assigned to teach the prevention program were given a teacher’s manual and student guides for each year of the program. The teacher’s manual contained 12 units designed to be taught in 15 class periods. Each unit included an overall goal and specific student objectives as well as detailed lesson plans spelling out the material that should be covered with step-by-step instructions. The student guide contained information related to each of the program units and classroom activities along with workbook assignments intended to supplement classroom material.

Teachers in the schools assigned to receive training and feedback attended a one-day workshop that taught them about the causes of drug abuse and the reasons for using this particular prevention method. They were also taught how each of the classroom sessions should be conducted. During the time they were teaching the prevention program, members of the project staff periodically watched the teachers conducting the program in the classroom and whenever necessary gave them feedback and advice on how to teach the prevention program more effectively. The teachers in the other group received the same prevention materials and videotapes for each year of the program offering the same material as the training workshops. Although teachers in this group were also periodically observed while teaching the prevention program, they did not receive any feedback or advice.

Both prevention groups had significantly lower odds of using drugs by the end of the study. However, when results were examined with respect to the most serious patterns of drug use – using two or three drugs once a week or more – as expected, the prevention program was more effective for the students whose teachers received the training workshop and ongoing support from the Cornell researchers.

The results of this study have several practical implications for developing more effective drug abuse prevention programs:

Prevention programs should contain components that make students aware of the actual rates of drug use and the fact that only a small percentage of adolescents use drugs in order to correct the misperception that “everybody’s doing it.”

Prevention programs should teach skills for resisting pro-drug use social influences.
They should also teach a variety of general life skills for helping adolescents deal with the challenges of adolescent life. These include self-improvement skills such as goal-setting and self-reinforcement, skills for making decisions and solving problems, skills for thinking critically and analyzing media messages, skills for coping with anxiety, skills for communicating effectively, skills for meeting people and making friends, and general assertiveness skills.

Even if a prevention program previously found to be effective is being taught, it will only be effective if it is properly implemented. Because there are many competing demands on the school schedule, it is sometimes difficult to teach drug abuse prevention programs in their entirety. However, this and other studies show that there is a direct relationship between how much of the prevention program is implemented and its effectiveness. If prevention programs are only partially implemented, they are not likely to reduce drug use or drug use risk. Similarly, changing a prevention program known to be effective by modifying program components or adding new ones that have not yet been tested can render the prevention program ineffective.

Drug abuse prevention programs must be taught over a prolonged period of time. Prevention programs that are only one year long or do not contain two or more years of booster sessions are not likely to produce lasting reductions in a drug use. In fact, evaluations of prevention programs not including booster sessions have shown that initial reductions in drug use decrease after about a year and disappear totally after about two or three years.

In order to have maximum effectiveness, training and support from prevention experts should be obtained whenever possible.

The prevention program tested in the Cornell study was effective whether teachers received a formal training workshop and ongoing consultation and support or only received a training videotape. However, with respect to more serious drug use, it was most effective when teachers received formal training and periodic consultation and support.

Researchers have been searching for effective prevention programs for more than two decades now. The goal of a prevention program that could actually produce measurable reductions in drug use behavior has been elusive. Prevention approaches that relied on teaching factual information about the dangers of drug use have consistently been shown to be ineffective, as have a variety of other prevention approaches. Prevention programs that teach students how to resist social influences to use drugs have produced short-term reductions in cigarette smoking and, to a lesser extent, alcohol and marijuana use. Several long-term follow-up studies have raised questions about the ability of these approaches to pro duce lasting reductions in drug use.

The results of the Cornell study provide important new information that prevention works. The right kind of program, when properly implemented with junior high school students and with four years of booster sessions, can produce prevention effects that last at least until the end of high school. A prevention program that teaches general skills for dealing with life as well as skills and information for resisting social influences to use drugs can significantly reduce the chances that junior high school students will experiment with drugs. It can also reduce the likelihood that these same students will develop more serious patterns of drug use by the end of high school . With this study, it is clear that drug abuse prevention has come of age.

Source: Western Center News – June 1994 – Western Regional Center for Drug-Free Schools and Communities – published in ‘The Challenge’ vol. 6 No.1.

The long term effectiveness of DARE was assessed by contrasting drug use and other DARE related attitudinal variables among 356 12th grade students who received the program in 6th grade with 264 others who did not receive it. There was a significant relationship between earlier participation in DARE and less use of illegal, more deviant drugs (e.g. inhalants, cocaine and LSD). This effect was significant for males. Long term effects of DARE that were not perceptible after 3 years appeared among the males after six years when they were senior in high school. A possible explanation for this ‘sleeper effect’ is that the effectiveness of DARE was ‘suppressed’ until after the follow-up in 9th grade. This effect may not have arisen for the young women due at least partially to the fact that so few of them in either the DARE or control condition were using these hard drugs.

Richard L. Dukes et. al., University of Colorado, 1996.

Introduction
Several reviews of the substance abuse prevention literature have concluded that social-influence-based prevention programmes can significantly delay the onset of tobacco, alcohol, and other drug use and slow the rate of increase in substance use prevalence among entire populations of early adolescents. Less is known about the capacity of these and other primary prevention programmes to effect decreases in substance use. This is an important question, since some youth have already begun to experiment with drugs by the time that usual primary prevention programmes have reached them. Youth exhibiting early drug use relative to their peers are considered at higher risk for later drug use and abuse. The few studies that have investigated the effect of primary prevention programmes on those who have already begun using tobacco or other drugs have yielded equivocal results and have not systematically evaluated maintenance of decreases in use. The purpose of this study was to evaluate the secondary prevention effects of a primary prevention programme in reducing cigarette, alcohol, and marijuana use among baseline users.

Abstract
Objectives. This study investigated the secondary prevention effects of a substance abuse primary prevention programme.
Methods. Logistic regression analyses were conducted on 4 waves of follow-up data from sixth- and seventh-grade baseline users of cigarettes, alcohol, and marijuana taking part in a school-based programme in Indianapolis.
Results. The programme demonstrated significant reductions in cigarette use at the initial follow-up (6 months) and alcohol use at the first 2 follow-ups (up to 1.5 years). Models considering repeated measures also showed effects on all 3 substances.
Conclusions
Primary prevention programmes are able to reach and influence high-risk adolescents in a non-stigmatizing manner.
Discussion
Primary prevention programmes have been criticized for affecting future occasional users but not youth at the highest risk for drug abuse (e.g., current users). In this study, we reported 3.5-year follow-up effects of a primary prevention programme in decreasing drug use among adolescents who were users at either sixth or seventh grade. With a very conservative criterion to define decreased use, the results indicate that the programme did effect reductions in use, especially cigarette and alcohol use. These secondary prevention effects were significant for cigarette users at the 6-month follow-up and marginally significant at the 2.5-year follow-up. Effects were also found among baseline alcohol users through the 1.5-year follow-up. Consistent with other prevention studies, the effect sizes were small for cigarettes (range: .05-.31) and alcohol (range: .08-.24) and medium for marijuana (range: .38-.58). Although no significant effects were detected among baseline marijuana users, it is important to note that the programme group consistently demonstrated greater reductions in all 3 substances across all follow-ups, except marijuana at the 3.5-year follow-up. When the secular trend was also considered, the Midwestern Prevention Project consistently showed significant secondary prevention effects on cigarette, alcohol, and marijuana use.

There are several methodological limitations to this study. For example, a possible threat to the validity of the findings was the reliance on self-reported drug use. However, extensive research conducted on the validity of self-reported smoking dispels this concern, especially if a bogus pipeline activity is built into the procedures for data collection, as was done in the present study. Another possible limitation is that measurements were limited to a fixed point in time (previous month) from year to year, thus leaving open the possibility that the last reported use level may have been an under-estimate of actual normal use patterns. However, given that this study was fully randomized, the programme and control groups should have been equal in regard to their validity estimates of the point prevalence of drug use measured.

This research suggests that social-influence-based primary prevention programmes can have an impact on not only students who are nonusers at baseline but also those who have begun to use drugs. The advantage of such a primary prevention programme is that it may reach and affect a ‘silent’, not-yet-identified, high-risk population of early drug users in a nonstigmatizing , nonlabeling fashion at an age when youth are more easily persuaded (treating the young users, in effect, like nonusers contemplating use).

Source: Chih-Ping Chou, PhD, et al. American Journal of Public Health, June 1998, Vol.88, No6

The present study investigated the reasons university students have for not drinking on those occasions when they choose not to drink and whether those reasons differ with students’ differing levels of alcohol consumption. Volunteer participants for the study were students (158 males, 245 females) from a mid-South State University. These students anonymously answered questions about the quantity and frequency of their alcohol consumption, and on this basis, four alcohol consumption level groups were formed (80.4 percent of the sample) in addition to abstainers (19.6 percent of the sample). Each student also responded to the question, “on those occasions when you DO NOT drink (or drink very little), what is the MAIN reason you make that decision?”

A chi-square test of independence indicated that reason for not drinking was significantly related to alcohol consumption level group, and separate chi-square tests for goodness-of-fit revealed distinctly different reasons given for not drinking depending on the group’s alcohol consumption level. Light drinkers endorsed religious-moral reasons significantly more often than the other groups, moderate drinkers chose safety reasons, while heavy drinkers indicated expense as their main reason for not drinking. The results of this unique study can help shape social and legislative policies for alcohol abuse prevention and intervention by indicating strategies that target the beliefs of the various alcohol consumption levels.

Source: Slicker. EK. Journal of Alcohol and Drug Education 42(2):83-102, 1997

Mentoring can best be described by the classic example of the Big Brother/Big Sister Program. In the Big Brother/Big Sister Program, an adult volunteer mentor commits to developing a supportive relationship with a youth who is between 6 and 16 years old. Although older youth can mentor younger ones, mentoring programs most typically rely on adult mentors. Informal mentoring may happen as part of any youth/adult interaction, but mentoring programs seek to purposefully structure mentor/mentee relationships to maximize success. Mentoring may be a component of treatment or intervention, but mentoring for prevention involves youth who have not experienced significant ATOD problems. Often the youth chosen to participate are considered to be “at-risk” due to having limited access to their parents.

Mentoring is strongly rooted in resiliency theory and research. The goal is to “bond” each youth (via a caring, enjoyable relationship) to a positive role model who gives the youth encouragement and support for healthy activities and development.  Key studies of eight Big Brother / Big Sister programs by an organization called ‘Public/Private Ventures’ in the early 1990’s differentiated successful ‘developmental’ mentor/mentee relationships from less effective ‘prescriptive” relationships. In the less effective ‘prescriptive” relationships, adults sought to guide or direct youth, apparently leading to alienation in those youth rather than the success of the developmental, supportive relationships. (Mentors need to strike a balance between a non-prescriptive approach and the identifying of behaviours which need to be observed, and a [brotherly] discussion of these boundaries). These studies found very substantial effects toward decreased likelihood of mentored youth initiating alcohol or other drug use, in comparison to a control group.  Bonnie Benard (1996) summarizes research-based characteristics of effective mentoring relationships as follows:
 

• Relationships have sufficient intensity and duration (regular weekly contacts, three-four hours per meeting. longer than one year in duration, etc.)
• Sustained relationships are those in which the mentor sees him/herself as a friend: not as a teacher or preacher. Success is based on the mentors belief that he or she is there to meet the developmental needs of youth—to provide supports and opportunities the youth does not otherwise have.
• Mentors center their involvement and expectations on developing a reliable trusting relationship and expand the scope of their efforts as the relationship strengthens.
• Mentors place top priority on having the relationship enjoyable and fun to both partners, listen non-judgmentally, look for the youth’s interests and strengths, and incorporate the youth into the decision-making process around their activities.
• From a resiliency perspective, mentors provide the three protective factors of a caring relationship that conveys positive expectations and respect, and that provides ongoing opportunities for participation and contribution, and see risks existing in the environment, not in the youth.
• Relationships are fundamentally based on the belief that the development of a caring, trusting, respectful reciprocal relationship is a key to reducing risks, enhancing protection, and promoting positive youth development in any system.

The following list includes elements of an effective mentoring program. In any community based prevention, one can better assist those involved in the implementation  of mentoring programs by promoting these elements:
 

• Encourage quality relationships. Support efforts to build on research-based findings associated with successful mentoring relationships.
• Screen mentors. Use thorough volunteer screening methods that filter out adults who are unlikely to make a lasting commitments or might pose a safety risk to the youth.
• Train mentors. Conduct mentor training that promotes caring relationships, conveying a  deep belief in a youth’s innate resilience. Train on communication and limit-setting skills, tips on relationship-building, and recommendations on the best way to interact with a young person.
• Make careful matches. Ensure a good match between the youth and mentor expectations and program goals. Conduct interviews with mentors that explain the type and depth of a mentoring relationship and commitment expectations. Consider youth preferences, their family, and the volunteer, as well as use a professional case manager to analyze which volunteer would work best with which youth.
• Establish structure and a process. Build a program structure and process, supervised by case managers/youth workers. Ensure that case managers supervise each match through quality contact with the parent/guardian, volunteer, and youth in an ongoing/consistent manner and provides help as needed. Use staff to provide “back-up” stability and continuity in a mentoring relationship, especially so that youth are not left alone if their mentor leaves.
• Create a communication process. Ensure that a communication and feedback loop is established for youth and adults to discuss needs, progress, and problems.
• Support social activities/ATOD-free events. Support the relationship and activities of youth and adults by providing community-based activities and events that are ATOD-free. Be a resource/volunteer in activities and educational programs.
• Meet mentor needs. Respond to a mentor’s needs, as well as the youth’s needs to support the mentoring relationship.
• Involve families. Communicate clear expectations about family involvement in the mentoring program. Build in opportunities for the families of the youth and adult to become involved in activities.

Youth Results Mapping may forever alter the way that prevention programs are evaluated, according to Barry M. Kibel, Ph.D., a senior research Scientist at Pacific Institute for Research and Evaluation, Chapel Hill, NC, and the principal investigator for CSAP-funded High-Risk Youth Grants in Cincinnati and Atlanta. This approach promises to be cheaper, more efficient, and able to develop a comprehensive program evaluation as much as five times sooner than traditional methods.
“There is a major paradigm shift underway in the prevention yield from a problem solving-deficit model to the asset-buiIding model,” said Dr. Kibel, at the 1997 CSAP High-Risk Grantee Conference last summer.
Under a problem-solving-deficit model most kids who had problems are thought to have problems for the same reasons. and programs were designed to keep them out of trouble.
“The new approach emphasizes the uniqueness of every youth, adult and community—and builds on these strengths,” says Dr. Kibel. It requires that a program  be “reinvented  as  you  go along.”
“The new asset-building approach can be best evaluated by anecdotes,” says Dr. Kibel. “In using anecdotes and complex stories that describe the specific success of a specific individual in a program, the new model emphasizes that everyone is different.”
Dr. Kibel explains that there are two types of anecdotal stories. The simple and causal story is where a baby gets a flu shot and does not get the flu—cause and effect. In the prevention field, unlike the baby and the flu shot, all programs have complex, synchronistic stories where many outside factors beyond the program factors beyond the program influence the outcome of each individual.
An example of a complex story in the prevention  field  would  be  an  18-year-old Hispanic woman with a drinking problem, who has not completed high school, and enters a community center program. As the result of bonding with one of the counselors, and obtaining direction from one of her former teachers who lives in the neighborhood, the young woman has significantly reduced alcohol consumption and is working on a high school equivalency diploma. This is a complex story of a client engaged in “healing and transformation,” in which the community center has provided part of the outcome, along with outside factors such as the teacher and the client has made a contribution to her own positive outcome and future.
This anecdotal story, unlike the simple cause-effect story, emphasizes the uniqueness of each client and the importance of otherwise hard to-measure outside influences on client outcomes
This new paradigm in the evaluation of prevention programs, known as Results Mapping, is only 2 years old. According to Dr. Kibel, Results Mapping is a system for relating anecdotal information in a structured format. It is a scientific process because there are rules and conventions for recording and scoring anecdotal information.

A Growing Approach
Results Mapping is a growing approach to evaluation of programs in the prevention field.
‘At least 25 percent of the alcohol and drug prevention field have made the shift, but evaluation and plan-fling tools have not kept up with the shift,” says Dr. Kibel.
Who is using Results Mapping as an alternative to the old model of evaluation? The States of Connecticut and Colorado now use Results Mapping in evaluating all of their alcohol and drug abuse prevention programs. At the local level, programs in Tennessee, California, Arizona, Florida, Illinois, Texas, and New York are using Results Mapping. CSAP is funding programs in Ohio and Georgia that are being evaluated by Results Mapping.
And   why  are   State   and   Federal  prevention
programs using Results Mapping evaluation? This model for evaluation is much cheaper, according to Dr. Kibel, and it is a form of empowerment evaluation.
Results Mapping places the formulation of program data back into the hands of the program directors and staff. There is less dependency on an outside or consultant evaluator. Unlike other more impersonal forms of evaluation, Results Mapping allows clients to become an active part of the evaluation process. Program staff members are encouraged to sit down with clients and write down what the client has to say about their experiences with a specific prevention program.
“The methodology of Results Mapping is not incompatible with outcome-based funding approaches. In fact, the opposite is true. The way we score the anecdotal information provides the best possible information regarding how well a program is doing in moving its target population toward difficult to reach, long-term outcomes,” says Dr. Kibel.
For a 5-year prevention program, it could take 5 to 6 years to see any comprehensive evaluations. With Results Mapping, results could be seen from the same 5-year program in 6 months.
Dr. Kibel emphasizes that Results Mapping is a very scientific process. When there is concern that a handful of stories provide a distorted or highly exaggerated accounting of the accomplishments of a program, there are answers in making a valid and scientific program evaluation.
“Programs need to provide more stories-enough for a comprehensive picture of program accomplishments to emerge. Programs need to score and rank their stories, much as judges rate athletic performances, based on the contribution these represent to clients,” he added.
According to Dr. Kibel, because Results Mapping can provide timely evaluations, as often as every 6 months, it has the potential of becoming an important new tool and resource for prevention program directors and staff Results Mapping is a new evaluation methodology that may become a cornerstone in future prevention programs throughout the country.

Prevention Pipeline     Nov/Dec 1997

Adolescent Alcohol and Marijuana Treatment

After declining in the 1980s, tobacco, alcohol, and marijuana use among adolescents has been on the rise again in the 1990s. Marijuana and alcohol use are highly intertwined, according to data from the National Household Survey on Drug Abuse (NHSDA; OAS, 19%). While 60 percent of adolescents aged 12-17 were not actively using in the last year, 24 percent were using alcohol, 15 percent were using both alcohol and marijuana, and 1 percent were using  marijuana only; moreover, 2 out of 3 weekly adolescent users were using both alcohol and marijuana (McGeary, Dennis, French, .& Titus, 1998). As one might expect, the frequency of’ substance use increased with age and  grade in school, and was slightly higher among males. Contrary to stereotypes, frequent use was less likely among minorities and more likely among those who were employed. Further, there are no significant differences in the patterns of’ alcohol or marijuana use among adolescents in terms of’ their welfare status, income, or the metropolitan status of’ their community.
Over time, generations have been defined by peaks in the use of alcohol, opioids cocaine, and then crack. Among adolescents in the 1990s, the defining drug has clearly become and continues to be marijuana. In fact, among 12-17 year olds, marijuana is now the primary substance of abuse among adolescents entering treatment (QAS, 1997).
High rates of marijuana and alcohol use among adolescents are related to many earlier problems. Relative to non-users, adolescents who reported weekly marijuana and alcohol use are about four times more likely to report past year behavior problems related to attention deficit hyperactivity disorders, conduct disorder or delinquency (57 percent vs. 4 percent), dropping out of school (25 percent vs. 6 percent), being involved in a major light (47 percent vs. 11 percent) and being involved in one or more illegal activities during the past year (69 percent vs. 17 percent) (McGeary, Dennis, French, & Titus, 1998). Moreover, they were 8 to 23 times more likely during the past year to have the  following:

•  
  • Committed a theft       (33% vs. 4%)
  • Damaged property      (31% vs. 3%)
  • Shoplifted                  (41% vs. 4%)
  • Been on probation      (16% vs. 1%)
  • Been arrested             (23% vs. 1%)
  • Sold drugs                  (31% vs. 0%)

In terms of health care, adolescents who used marijuana and alcohol weekly were also twice as likely to have been to the emergency room during the past year (33 percent vs. 17 percent). In fact, marijuana is now the primary substance mentioned in both adolescent emergency room admissions and autopsies (OAS, 1995).
Adolescent substance use is likely to have a long—term impact on both the individual and on society. The table below uses data on adults from the National Household Survey on Drug Abuse to look at their probability of having one or more symptoms (Sx) of tobacco, alcohol, and/or marijuana disorders based on their age of first use. Relative to people who started using over the age of 18, those adolescents who started using under time age of 15 are more likely to report major problems related to their use as adults about twice as often for  tobacco (26 percent vs. 13 percent), four times as often for alcohol (27 percent vs. 7 percent) and about six times as often for marijuana (24 percent vs. 4 percent (Dennis, McGeary, French, & Hamilton, 1998). Conversely, among adults reporting one or more substance disorder symptoms in time National Household Survey on Drug Abuse, over 85 percent started using under the age of 18 — with about 40 percent starting under the age of 15.  Despite the rise in substance use, range of related problems, and potential for long-term consequences, few adolescents have ever been in treatment. While 14 percent of adolescents reported one or more past year alcohol disorder symptoms, 8 percent reported one or more cannabis disorder symptoms and 4 percent reported other substance disorder symptoms — only 1 percent reported ever having been to a substance abuse treatment program (McGeary, Dennis, French & Titus, 1998).

While substance use is often a chronic condition, treatment (toes help. Long-term studies of adult substance abuse treatment show that about 25-85 percent of adults recover after a given treatment episode and tend to stay better; that those who relapse tend to deteriorate without further re-intervention; and that each time there is a re-intervention, another proportion tend to be moved into the recovery column (Simpson & Savage, 1980). While information is still emerging about adolescent treatment effectiveness, there is considerable tension between efforts to develop short-term, cost-effective treatments and findings that 50 percent or more adolescents relapse to marijuana or alcohol use within the first 3 months after discharge (Brown & Vik, 1994; Brown, Vik, & Creamer, 1989; Catalano, Hawkins, Wells, Miller, & Brewer, 1991; Kennedy & Minami, 1993). There are, however, several promising options for improving treatment effectiveness by focusing on motivational enhancement, relapse prevention, problem solving, coping strategies, case management, family support, family therapy, and working with the adolescents concerned others to change their environments (Azrin, et al., 1994; Brown, et al, 1994; Graham et al., 1996; Kadden et al., 1989; Liddle et al., 1995).

The Substance Abuse and Mental Health Services Administration (SAMHSA) has recognized the need for further study of adolescent treatment. As part of the Department of Health and Human Services Secretary’s Youth Initiative, the Center for Substance Abuse Treatment h as embarked on a major randomized field experiment to directly evaluate live of the most promising models of adolescent outpatient treatment and hopes to have the main findings by the fall of 2000 (Dennis, Babor, Diamond, Donaldson, S.Godley, Tims, 1998 or see www.chestnut.org/cyt Substance use among adolescents is at a new high and related to a multitude of problems for the public health system, government, society, and America’s families. While the Federal and State governments are and should continue to increase their prevention efforts to   reduce   use  among  the  next  generations,  the substantial numbers of adolescents in the current generation are already using and need more formal treatment. 11 Unfortunately, they are not likely to get it under the current system. Government leadership is needed to head off the likely long-term consequences of this problem for both the health of these individuals and for the nation.

Alcohol and drugs deaths in Scotland are twice the UK average
New report finds carrying of knives a key factor
DRINK PROBLEM: research suggests killings and suicides are linked to alcohol and drugs
Alcohol and drug abuse is pushing Scots to kill or take their own lives almost twice as often as people in other parts of Britain, a report revealed today.
Researchers found there were 500 killings in Scotland over five years and 5,000 suicides over six years.  Both these figures are almost double those in England and Wales.The culprits were normally young men attacking other young men, they said, and the carrying of knives was a key factor.Scientists also found the North-South divide was highest among teenagers .  The findings were revealed in a Scottish Government-commissioned report, Lessons for Mental Health Care in Scotland, carried out at the University of Manchester.
Scientists looked at all suicides and homicides in the population north of the border, as well as those committed by people who had sought help from mental health services. Homicide rates in Scotland were 2.12 per 100,000 people compared to 1.23 per 100,000 in England and Wales.  And suicide rates in Scotland were 18.7 per 100,000 of the population, compared to 10.2 per 100,000 in England and Wales.  Rates for suicide and killing among the mentally ill were also found to be higher in Scotland.
A total of 12% of killers and 28% of those who took their own lives had mental health problems.
Research director Professor Louis Appleby said the number of killings and suicides linked to alcohol and drug misuse was “striking”.  He said: “Alcohol and drug misuse runs through these findings and it appears to be a major contributor to risk in mental health care and broader society. The findings suggest alcohol and drugs lie behind Scotland’s high rates of suicide and homicide.”
Referring to the high homicide figure, Prof Appleby said: “National homicide rates are high because of particularly high rates in certain areas of the country, namely Glasgow and Clyde and Argyll.”  In Scotland, as across Britain, homicide is a crime committed primarily by young men against young men, the report said.   Alcohol and drugs had often been taken and the weapon was usually a knife or another sharp object.
Prof Appleby said politicians should focus on drugs and alcohol and the carrying of knives, rather than mental health, when seeking to tackle the problem.   He said: “Drugs and knives are a dangerous mix, so policy response to these deaths should focus on alcohol and drug abuse in young people and on the carrying of knives by young men.  The rise in homicide rates in recent years is the result of an increase in killings by young people, mainly men under 25 years, but most are not mentally ill.  A public health approach to homicide would target alcohol and drug use before mental health illness.”
Of 1,373 suicides among the mentally ill studied, there was a history of alcohol misuse in 57% of cases and drug abuse in 38%.  Of 58 killings looked at among the mentally ill, more than 70% were committed by people with alcohol problems and around 77% had drug problems.
The report also made a string of recommendations.  These included improving mental health services for young people, removal of ligature points from hospital wards and tightening up security on wards.
Source:The Press & Journal : 16/06/2008
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