Prevention and Intervention

Drug-related deaths are rising and are a major concern to councils and our health partners. Deaths have increased sharply over the past five years and are now at their highest levels since records began.

Any death related to the misuse of drugs is a tragedy and we know that reversing this worrying trend is not going to be easy. Public health budgets are being increasingly stretched. But there are plenty of examples of councils which are succeeding – and you can read about some of them in this publication (available on linked site)

Source: August 2017

A. Benjamin Srivastava, MD
Mark S. Gold, MD

The opioid epidemic is the most important and most serious public health crisis today. The effects are reported in overdose deaths but are also starkly evident in declines in sense of well-being and general health coupled with increasing all-cause mortality, particularly among the middle-aged white population. As exceptionally well described by Rummans et al in this issue of Mayo Clinic Proceedings, the cause of the epidemic is multifactorial, including an overinterpretation of a now infamous New England Journal of Medicine letter describing addiction as a rare occurrence in hospitalized patients treated with opioids, initiatives from the Joint Commission directed toward patient satisfaction and the labeling of pain as the “5th vital sign,” the advent of extended-release oxycodone (OxyContin), an aggressive marketing campaign from Purdue Pharma L.P., and the influx of heroin and fentanyl derivatives.

To date, most initiatives directed toward fighting the opioid initiatives, and the focus of the discussion from Rummans et al, have targeted the “supply side” of the equation. These measures include restricting prescriptions, physician drug monitoring programs, and other regulatory actions. Indeed, although opioid prescriptions have decreased from peak levels, the prevalence of opioid misuse and use disorder remains extremely prevalent (nearly 5%). Further, fatal drug overdoses, to which opioids contribute to a considerable degree, continue to increase, with 63,000 in 2016 alone. Thus, although prescription supply and access are necessary and important, we need to address the problem as a whole. To this point, for example, the ease of importation and synthesis of very cheap and powerful alternatives (eg, fentanyl and heroin) and the lucrative US marketplace have contributed to the replacement pharmacy sales and diversion with widespread street-level distribution of these illicit opioids; opioid-addicted people readily switch to these illicit opioids.

A complementary and necessary approach is to target the “demand” side of opioid use, namely, implementation of preventive measures, educating physicians, requiring physician continuing education for opioid prescribing licensure, and addressing why patients use opioids in the first place. Indeed, prevention of initiation of use is the only 100% safeguard against addiction; however, millions of patients remain addicted, and they need comprehensive, rather than perfunctory, treatment. Rummans and colleagues are absolutely correct in their delineation of the unwitting consequences of a focus on pain, given that a perceived undertreatment of pain fueled the opioid epidemic in the first place. They are correct to point out how effective pain evaluation and treatment are much more than prescribing and should routinely include psychotherapy, interventional procedures, and nonopioid therapies. In addition, we have described the crossroads between pain and addiction as well as successful strategies to manage patients with both chronic pain syndromes and addiction.

Rummans and colleagues also mention much needed dissemination of medication-assisted treatment (MAT; eg, methadone and buprenorphine) and the opioid overdose medication naloxone, and we agree with both of these measures. However, in addressing the demand side of the opioid epidemic, the focus must be much more comprehensive. Viewing opioid addiction as a stand-alone disease without consideration of other substance use or comorbid psychiatric pathology provides only a limited perspective. Rather, dual disorders are the rule and not the exception, and thus addiction evaluation and treatment should also specifically focus on psychiatric symptomatology and comorbidity. Epidemiological evidence indicates that over 50% of individuals with opioid use disorder meet criteria for concurrent major depressive disorder.Recent evidence from Cicero and Ellis indicates that the majority of opioid-addicted individuals seeking treatment indicate that their reasons for use are for purposes of “self-medication” and relief of psychiatric distress. To expand on this concept, we have suggested that drugs, by targeting the nucleus accumbens, alter motivation and reinforcement circuits and change brain reward thresholds; this change results in profound dysphoria and anhedonia, which, in turn, lead to further drug use.

Obviously, then, opioid addiction treatment should focus on diagnosing and assessing psychiatric comorbidity and monitoring of affective states and other depressive symptoms. However, a bigger problem might be the pretreatment phase, considering that, as Rummans et al note, only 10% of patients with opioid use disorder receive any treatment at all. Resources have principally been devoted to mitigating the effects of acute opioid toxicity both before and during intervention in the emergency department. A principal means of medical stabilization has been overdose reversal with the μ-opioid receptor antagonist naloxone, and efforts have been largely focused on dissemination of this agent. However, while increased naloxone use among the lay public, first responders, and medical personnel has been successful in reducing deaths, recidivism is high and increased naloxone use has not affected the problem as a whole. Generally, when patients present to the emergency department, clinical experience dictates that opioid overdoses are considered accidental until proven otherwise, which, after stabilization, allows the physician to discharge the medically stable patient, the hospital to collect reimbursement, and the pharmaceutical company to raise prices (eg, naloxone prices increased by 400% from 2014 to 2016, for autoinjection formulations).

In addition to the substantial costs associated with repeated naloxone administration and emergency department visits, recidivism is inextricably linked with another problem—the reason for overdose in the first place is not addressed. As mentioned earlier in this editorial, depression prevalence is high in patients with opioid use disorders. Strikingly, using nationwide data from US poison control centers, West et al found that over 65% of opioid overdoses reported were indeed suicide attempts, and of completed overdoses, the percent of those characterized as suicides climbed to 75%. Thus, an “inconvenient truth” may be that many of these opioid overdoses presenting to emergency departments may be unrecognized suicide attempts and that many of the over 66,000 deaths may indeed be completed suicides. Thus, comprehensive evaluation and treatment become even more relevant.

Clearly, more thorough evaluations in emergency departments with comprehensive risk assessments are needed, especially given that these patients may be guarded about suicidal ideation in the first place. Indeed, efforts to initiate buprenorphine in the emergency department, which independently is being investigated for its therapeutic effects on suicidal ideation, have spread; however, while abstinence outcomes are favorable at 30 days, the therapeutic benefit seems to disappear at both 6 months and 1 year. This failure of opioid reversal treatment is important, especially given that at 1 year, 15% of patients rescued with naloxone had died. Additionally, lack of psychiatric services and overcrowding at many emergency departments may preclude a comprehensive evaluation; however, target screening of all high-risk patients may identify patients with even hidden suicidal ideation and allow for appropriate triage.

Most addiction treatment today is centered around time-limited settings without adequate follow-up. Although MAT is an important addition to treatment for opioid addicts, it is generally not sufficient for long-term sobriety given (1) the relatively high rates of immediate and short-term treatment discontinuation and (2) that patients rarely are using just opioids. In fact, regarding long-term outcomes, methadone may be the only MAT treatment that demonstrates superior abstinence rates, safety, opioid overdose prevention, and treatment retention. We recommend that future studies include random assignment to different treatment modalities, assessing abstinence with urine testing and other modalities, psychosocial outcomes, and overall level of functioning for 5 years.

In terms of treatment, we suggest a continuing care approach, viewing addiction as a chronic, relapsing disease, but higher quality data are needed. For example, in most states, physicians with substance use disorders who are referred for treatment indeed undergo evaluation and detoxification, but they are also monitored for 5 years with frequent drug testing, contingency management, evaluation and treatment of comorbid psychiatric issues, and mutual support groups. Outcomes are generally superior, with 5-year abstinence and return to work rates approaching 80%. Notably, most of these programs do not allow MAT, yet opioid-addicted physicians do as well in the structured, supportive, long-term care model as physicians addicted to other substances. Obviously, the threat of professional license sanctions may impel physicians to comply with treatment, but many of the aforementioned strategies including contingency management, long-term follow-up, comprehensive psychiatric evaluation, and mutual support have demonstrable evidence for addiction treatment in general.

More resources need to be devoted to addressing the opioid epidemic, particularly on the prevention and also the demand side. Access to treatment is important, but more investment is needed in improving treatment including implementing 5-year comprehensive care programs. Thus, we recommend that future studies involve random assignment to different treatment groups, focusing on urine drug test–confirmed abstinence, psychosocial outcomes, and overall functioning. Additionally, advances in neuroscience may allow for the development of novel therapeutics targeting specific neurocircuitry involved in reward and motivation (ie, moving beyond the single receptor targets). A parallel can be drawn to the AIDS epidemic, in which massive basic science investments yielded novel effective therapies, which have now become standard of care and one of the world’s great public health successes. Resources focused on these interventions and reinvigorating drug education and prevention may prove fruitful in addressing this devastating epidemic. Further, lessons from this epidemic may help us move beyond a specific “one drug, one approach” so that for future epidemics, irrespective of the drug involved, we would already have in place a generalizable framework that utilizes the full repertoire of responses and resources.

VIENNA: The United Nations Commission on Narcotic has unanimously adopted Pakistan’s resolution on strengthening efforts to prevent drug abuse in educational settings.

The resolution was adopted during the commission’s sixty first regular session in Vienna. The resolution drew attention of the Commission towards the common challenges of drug abuse among children and youth in schools colleges and universities.

It underscored the need for enhancing efforts including policy interventions and comprehensive drug prevention programmes to protect children and youth from the scourge of illicit drugs and to make educational institutions free from drug abuse.

The resolution emphasized upon the important role of educational institutions in promoting healthy lifestyles among young people and calls for close coordination among law enforcement agencies, educational centres and health authorities at domestic level.

It reflected political commitment of the global community to promote international cooperation through exchange of experiences and good practices and technical assistance to address drug abuse in educational institutions. Pakistan’s initiative to table this resolution was widely appreciated.

Source:  March 2018

The United States is confronting a public health crisis of rising adult drug addiction, most visibly documented by an unprecedented number of opioid overdose deaths. Most of these overdose deaths are not from the use of a single substance – opioids – but rather are underreported polysubstance deaths. This is happening in the context of a swelling national interest in legalizing marijuana use for recreational and/or medical use. As these two epic drug policy developments roil the nation, there is an opportunity to embrace a powerful initiative. Ninety percent of all adult substance use disorders trace back to origins in adolescence.a New prevention efforts are needed that inform young people, the age group most at-risk for the onset of substance use problems, of the dangerous minefield of substance use that could have a profound negative impact on their future plans and dreams.


The adolescent brain is uniquely vulnerable to developing substance use disorders because it is actively and rapidly developing until about age 25. This biological fact means that the earlier substance use is initiated the more likely an individual is to develop addiction. Preventing or delaying all adolescent substance use reduces the risk of developing later addiction.

Nationally representative data from the National Survey on Drug Use and Health shows that alcohol, tobacco and marijuana are by far the most widely used drugs among teens. This is no surprise because of the legal status of these entry level, or gateway, drugs for adultsb and because of their wide availability. Importantly, among American teens age 12 to 17, the use of any one of these three substances is highly correlated with the use of the other two and with the use of other illegal drugs. Similarly for youth, not using any one substance is highly correlated with not using the other two or other illegal drugs.

For example, as shown in Figure 1, teen marijuana users compared to their non-marijuana using peers, are 8.9 times more likely to report smoking cigarettes, 5.6, 7.9 and 15.8 times more likely to report using alcohol, binge drink, and drink heavily, respectively, and 9.9 times more likely to report using other illicit drugs, including opioids. There are similar data for youth who use any alcohol or any cigarettes showing that youth who do not use those drugs are unlikely to use the other two drugs. Together, these data show how closely linked is the use by youth of all three of these commonly used drugs.

aAmong Americans age 12 and older who meet criteria for substance use disorders specified in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). bMarijuana remains illegal under federal law but is legal in some states for recreational use the legal age is 21, and in some states for medical use, the legal age is 18. Nationally the legal age for tobacco products is 18 and for alcohol it is 21.

Figure 1. Past Month Use of Other Drugs, if Marijuana is Used, Ages 12-17

These findings show that prevention messaging targeting youth must address all of these three substances specifically. Most current prevention efforts are specific to individual substances or kinds and amounts of use of individual drugs (e.g., cigarette smoking, binge drinking, drunk driving, etc.), all of which have value, but miss a vital broader prevention message. What is needed, based on these new data showing the linkage of all drug use by youth, is a comprehensive drug prevention message: One Choice: no use of any alcohol, nicotine, marijuana or other drugs for youth under age 21 for reasons of health. This no use prevention message provides clarity for young people, parents, physicians, educators, communities and for policymakers. It is not intended to replace public health prevention messages on specific substances, but enhances them with a clear focus on youth.

Some claim adolescent use of alcohol, cigarettes and marijuana is inevitable, a goal of no use of any drug as unrealistic and that the appropriate goal of youth prevention is to prevent the progression of experimentation to later heavy use or problem-generating use. These opinions are misleading and reflect a poor understanding of neurodevelopment that underpins drug use. Teens are driven to seek new and exciting behaviors which can include substance use if the culture makes them available and promotes them. This need not be the case. New data in Figure 2 (below) show over the last four decades, the percentage of American high school seniors who do not use any alcohol, cigarettes, marijuana or other drugs has increased steadily. In 2014, 52% of high school seniors had not used any alcohol, cigarettes, marijuana or other drugs in the past month and 26% had not used any alcohol, cigarettes, marijuana or other drugs in their lifetimes. Clearly making the choice of no use of any substances is indeed possible – and growing.


Key lessons for the future of youth prevention can be learned from the past. Substance use peaked among high school seniors in 1978 when 72% used alcohol, 37% used cigarettes, and 37% used marijuana in the past month. These figures have since dropped significantly (see Figure 3 below). In 2016, 33% of high school seniors used alcohol, 10% used cigarettes and 22% used marijuana in the past month. This impressive public health achievement is largely unrecognized.

Although the use of all substances has declined over the last four decades, their use has not fallen uniformly. The prevalence of alcohol use, illicit drug use and marijuana use took similar trajectories, declining from 1978 to 1992. During this time a grassroots effort known as the Parents’ Movement changed the nation’s thinking about youth marijuana use with the result that youth drug use declined a remarkable 63%. Rates of adolescent alcohol use have continued to decline dramatically as have rates of adolescent cigarette use. Campaigns and corresponding policies focused on reducing alcohol use by teens seem to have made an impact on adolescent drinking behavior. The impressive decline in youth tobacco use has largely been influenced by the Tobacco Master Settlement Agreement which provided funding to anti-smoking advocacy groups and the highly-respected Truth media campaign. The good news from these long-term trends is that alcohol and tobacco use by adolescents now are at historic lows.

It is regrettable but understandable that youth marijuana use, as well as use of the other drugs, has risen since 1991 and now has plateaued. The divergence of marijuana trends from those for alcohol and cigarettes began around the time of the collapse of the Parents’ Movement and the birth of a massive, increasingly well-funded marijuana industry promoting marijuana use. Shifting national attitudes to favor legalizing marijuana sale and use for adults both for medical and for recreational use now are at their highest level and contribute to the use by adolescents. Although overall the national rate of marijuana use for Americans age 12 and older has declined since the late seventies, a greater segment of marijuana users are heavy users (see Figure 4). Notably, from 1992 to 2014, the number of daily or near-daily marijuana uses increased 772%. This trend is particularly ominous considering the breathtaking increase in the potency of today’s marijuana compared to the product consumed in earlier decades. These two factors – higher potency products and more daily use – plus the greater social tolerance of marijuana use make the current marijuana scene far more threatening than was the case four decades ago.

Figure 4. Millions of Americans Reporting Marijuana Use, by Number of Days of Use Reported in the Past Month

Through the Parents’ Movement, the nation united in its opposition to adolescent marijuana use, driving down the use of all youth drug use. Now is the time for a new movement backed by all concerned citizens to call for One Choice: no use of any alcohol, nicotine, marijuana or other drugs for youth under age 21 for reasons of health. This campaign would not be a second iteration of the earlier “Just Say No” campaign. This new no-use message focuses on all of the big three drugs together, not singly and only in certain circumstances such as driving.

We are at a bitterly contentious time in US drug policy, with front page headlines and back page articles about the impact of the rising death rate from opioids, the human impact of these deaths and the addiction itself. At the same time there are frequent heated debates about legalizing adult marijuana and other drug use. Opposing youth substance use as a separate issue is supported by new scientific evidence about the vulnerability of the adolescent brain and is noncontroversial. Even the Drug Policy Alliance, a leading pro-marijuana legalization organization, states “the safest path for teens is to avoid drugs, including alcohol, cigarettes, and prescription drugs outside of a doctor’s recommendations.”

This rare commonality of opinion in an otherwise perfect storm of disagreement provides an opportunity to protect adolescent health and thereby reduce future adult addiction. Young people who do not use substances in their teens are much less likely to use them or other drugs in later decades. The nation is searching for policies to reduce the burden of addiction on our nation’s families, communities and health systems, as well as how to save lives from opioid and other drug overdoses. Now is precisely the time to unite in developing strong, clear public health prevention efforts based on the steady, sound message of no use of any alcohol, nicotine, marijuana or other drugs for youth under age 21 for reasons of health.

Robert L. DuPont, MD, President, Institute for Behavior and Health, Inc.

Source:  February 2018

There will never be fundamental change in west Belfast’s drug problem without addressing the poverty and conflict legacies affecting it, a new report has found.

Launched on Monday, the West Belfast Community Drugs Panel’s report examined all aspects of drugs misuse in the area and provided a series of recommendations.

The panel was set up in October last year in reaction to a spate of drug-related deaths in the west of the city and is made up of representatives from several government departments, including the Belfast Trust and the Public Health Agency.

Families in the area affected by drugs, including bereaved parents, were also invited to give their views through community representatives on the panel, which was chaired by Noel Rooney, former head of the Probation Board for NI.

Funding for the report was provided by the Belfast Policing and Community Safety Partnership, which is made up of councillors and representatives from statutory agencies.

The report found significant issues relating to drugs misuse in west Belfast, many related to chronic under-funding by successive governments and the lack of a coherent, multi-agency strategy to deal with the problem.

It also identified significant contributing factors relating to the area’s social housing provision.

Several of the root causes detailed in the report, however, are generational and systemic.

“The West Belfast drugs issue is directly related to the area being affected by systemic poverty and the legacy of the NI Conflict and, unfortunately, this looks set to worsen over time,” the report reads.

“There will never be a fundamental change for west Belfast without addressing the poverty and conflict legacies.”

Elsewhere, the panel found addiction to prescription medications to be disproportionately high in the area.

“Evidence shows the level of prescribing medication in west Belfast is higher than in most other parts of Belfast, the north of Ireland and Great Britain,” the document states.

The report recommends several measures that public agencies could take to try and tackle the problem, including:

– An anti-poverty plan aligned with appropriate, long-term funding (10-15 year minimum)

– A multi-layered education strategy with a focus on early intervention

– A co-designed pilot social housing model, specifically for the area

– A zero-tolerance drugs policy from the PSNI, with a stronger focus on small level dealing

In addition, the report includes a ‘What We Heard’ section summarising key information providing to the panel by members of the public, community representatives and others.

“Criminal gangs, some claiming to have paramilitary connections, are controlling the supply of cocaine and heroin in some streets to children as young as 12-years-old,” the report reads.

“They decide what to provide and how much it will cost local people.”

Prescription medications being reported as being currently misused in west Belfast include: Tramadol, an opiate-based painkiller, and Fentanyl, a tranquiliser 100 times stronger than heroin.

It is now in the hands of government agencies to decide which, if any, of the report’s recommendations they might adopt.

Source:   11th June 2018


Submitted by Livia Edegger

Strengthening Families Programme, a family-focused prevention programme used in 26 countries around the world, was found to be nine times more effective than individually-targeted programmes and yielded a $10 return for every dollar spent on it. The programme, designed for youth and their families, aims to improve parent-child interactions, parenting skills and strengthen young people’s social and problem-solving skills.

Submitted by Andy Travis 

Those who first used alcohol at or before the age of 14 were nearly four times more likely to meet the criteria for past year alcohol abuse or dependence than those who started using alcohol between the ages of 18 and 20 (16.5% vs. 4.4%) and more than six times more likely than those who started using alcohol at or after age 21 (16.5% vs. 2.5%).

These findings illustrate the need for alcohol education and prevention efforts as early as middle school.

Percentage of Adults (Ages 21 or Older) Who Abused or Were Dependent on Alcohol in the Past Year, by Age of First Alcohol Use, 2009.


Similarly, adults who first started using marijuana at or before the age of 14 are most likely to have abused or been dependent on illicit drugs in the past year. Adults who first used marijuana at age 14 or younger were six times more likely to meet the criteria for past year illicit drug abuse or dependence than those who first used marijuana when they were 18 or older (12.6% vs. 2.1%) and almost twice as likely as those who started between the ages of 15 and 17 (12.6% vs. 6.6%).

Percentage of Adults (Ages 21 or Older) Who Abused or Were Dependent on Illicit Drugs in the Past Year, by Age of First Marijuana Use, 2009.


• Adults Who Initiate Alcohol Use Before Age 21 More Likely to Abuse or Become Dependent on Alcohol(link is external) – CESAR FAX, University of Maryland, USA.
• Early Marijuana Use Related to Later Illicit Drug Abuse and Dependence(link is external) – CESAR FAX, University of Maryland, USA.


Submitted by Andy Travis

Much research on normative misconceptions among university students has been published in North America, but much less has surfaced in Europe. This cross-sectional study is based on 12 classes of second-year French college students in sociology, medicine, nursing or foreign language. Rather than focus on one substance the students were asked to estimate the proportion of tobacco, cannabis, alcohol use and heavy episodic drinking among their peers and to report their own use.

Researchers found that that substance use patterns and perceptions of the norms differ significantly across academic disciplines and that substance users are more likely to misjudge real peer use prevalence.

They conclude that social norms of substance use are an important factor among students personal use. Overestimating these norms is associated with increased levels of use. In addition to other strategies, the researchers recommend that prevention programs should consider changing use perception when it is overestimated.

“These results show that there are grounds for university level prevention campaigns based on local survey results.”

read more…


This is a very powerful and heartbreaking story –  let us hope many young people will take notice and never ‘try’ drugs offered by ‘a friend’

Connor Reid Eckhardt added a new video.

“THIS IS SO IMPORTANT TO SHARE….THIS IS NOT A MOVIE!! OUR 19 YEAR OLD SON CONNOR IS NOT WAKING UP FROM THE SINGLE HIT OF “SPICE, K2,” HE TOOK. It has over 600 names. The credits are not going to roll. He is not going surfing this morning. He is GETTING “THAT HAIR CUT” we never wanted to give before he goes into surgery to donate 4 of his organs to SAVE FOUR OTHER LIVES. Connor died. Our son, our only son died from a legal high purchased at the corner market. No drugs or alcohol in his system. Most, not all legal highs are made in CHINA and sold to our youth. Millions are being affected by these legal highs. Please help us get the attention of presidential candidates. We must get this stopped. An entire generation of children and youth are at risk. Please get educated. The Connor Project Foundation is about Education, Awareness, and Prevention. Doit4connor. Do it for your kids and for your communities.

OUR 19 OLD SON CONNOR IS DEAD FROM ONE HIT OF A SYNTHETIC DRUG called spice. WHERE DOES MOST OF THIS POISON COME FROM??? CHINA!!! Who sells this poison to our kids? Go check out these shop owners. WE LET THESE CHEMICALS INTO THE USA?? Why?? Connor made a decision that night that changed our lives forever. He chose to try legal high offered to him “by a friend”. It is sold over the counter in gas stations, mini marts, smoke shops, etc. Targeted at our youth. Stop the madness and share with at least one person. We must take a stand for Connor and all the others who have died or are institutionalized because of these killer legal highs.”


Submitted by Livia Edegger 

US researchers that analysed over a million lab samples found that prescription drug abuse is twice as likely to decrease in states with drug prevention programmes in place. The states of Florida, Georgia, Kentucky, New York and Tennessee have seen a decline of 10% in prescription drug abuse, a rate 2.5 higher than the average rate for the rest of the country. In addition to the nationwide drug monitoring programme, these states have implemented programmes such as awareness raising initiatives, training and guidance for physicians and additional regulations to curb prescription drug abuse. Overall, prescription drug abuse has fallen from 63% in 2011 to 55% in 2013 with the most significant decline in teen rates from 70% to 57%. Despite these improvements, prescription drug abuse continues to be widespread in the US with more than half the patients endangering their health by misusing prescription drugs.



23rd July 2014

Submitted by joanna

This month the Australian Drug Foundation published the latest issue of their Prevention Research journal which features alcohol and drug prevention programmes in communities across Australia. The issue provides guidelines for organisations, individuals, practitioners and others developing and running prevention programmes and activities in community settings. The issue highlights the importance of comprehensive community programmes involving families, schools and other community entities and offers guidelines to community-based organisations and groups working in the field of drug prevention.



3rd July 2014

Submitted by Livia Edegger 

A new study carried out by the European Institute of Studies on Prevention (IREFREA) explores the role of parenting styles on drug use among teenagers. A group of researchers interviewed almost 8,000 students between 11 and 19 years of age across six European countries. The study analysed four parenting styles – authoritarian, authoritative, indulgent and neglectful. The first two parenting styles were characterised by strict rules and control. Authoritative parenting was marked by good communication, affection and flexibility from the parents’ side while the authoritarian style lacked those characteristics. The more lenient parenting styles – ‘indulgent’ and ‘neglectful’ – differed to the extent that in the former parents were affectionate and understanding, qualities that were absent in the latter. The ‘authoritative’ and ‘indulgent’ parenting styles, in which parents were affectionate and understanding, were the most effective in keeping children from using drugs.



17th June 2014

Submitted by Livia Edegger on  – 14:25

One of the most widely used school-based prevention programmes has proven to be effective in reducing drug use among adolescents in yet another country. After a team of researchers translated the programme known as Botvin LifeSkills Training into Italian, it was launched in around 180 schools in Lombardy, a region of Northern Italy. Within those schools the programme reached approximately 30,000 students and involved 1,800 teachers. The programme was found to reduce teenage smoking rates by 40% while boosting students’ self-esteem and equipping them with the relevant skills to deal with stressful situations. Following the success of the programme in Northern Italy, the Regional Observatory on Drug Addiction of Lombardy would like to see the programme implemented in schools across the country.



17th June 2014

Submitted by Livia Edegger 

This study, carried out in several Dutch schools, was administered to adolescents and parents simultaneously as well as separately. While simultaneous interventions held off the onset of regular drinking, separate interventions did not have an impact on teenage drinking. Combined prevention, targeting adolescents and their parents, was found to be the most effective among adolescents with low self-control and lenient parents. The study highlights the importance of addressing self-control among adolescents and parenting styles as part of comprehensive prevention programmes.



28th May 2014

Neil McKeganey fears police are not as interested in cracking down on heroin any more SCOTLAND’S efforts to tackle its status as Europe’s worst drugs blackspot has been branded a “record of failure not success” by one of the country’s a leading drugs experts.

The Scottish Government’s flagship “Road to Recovery” strategy has not had any “marked impact” on drug abuse, according to Dr Neil McKeganey, director of the Centre for Drug Misuse research.

He also hits out at failures among local Alcohol and Drug partnerships (ADPs) to deliver on the ground and fears police are not as interested in cracking down on heroin any more as cocaine.

“It is not a lack of knowledge (although there are significant gaps in knowledge) that has truly hampered efforts at tackling Scotland’s drugs problem,” he states in a new essay.

“Rather there appears to have been successive shortcomings in the capacity to combine drug policy at the strategic level with a clear mechanism for implementation at the `street level.’”

The criticism has been published in a new booklet published by the Conservatives entitled Justice Matters.

Dr McKeganey also warns there are “very real concerns” at the way Scotland’s methadone programme is being used, with a lack of information about those on the programme and those leaving it drug free.

“Half of all drug deaths in Scotland are now linked to methadone compared to a figure of 14% in England” he adds.

Tory leader Ruth Davidson said the booklet sets out “straightforward, no-nonsense Conservative policies that reflect the concerns of mainstream Scotland.”

She added: “Our aim is to cut crime and anti-social behaviour, make our communities safer and improve the quality of life for ordinary Scots.”

Source:  19th Jan.2015

The Advocates for Substance Abuse Prevention (ASAP) coalition serves the top two counties of the northern panhandle of West Virginia. The coalition got creative and utilized trending youth activities to draw youth to prevention work.

The coalition is located only a half hour from Pittsburgh, PA, and roughly three hours from Columbus, Ohio.  Based on a 2015 United States Census, the total population served is 53,165 combined for Brooke and Hancock counties.  One of the largest cities, Weirton, resides in both counties and has always had a proud tradition of steel making and industrial employment.  Unfortunately, this tradition has seen many declines in recent years and the increase in unemployment has hit the area hard, causing many families and young adults to move or have long commutes to find decent work.

Hancock County borders a major interstate where drug trafficking occurs easily between three states.  The local news reports multiple drug arrests in the Ohio Valley almost daily with incidents involving drug trafficking, abuse, and death, as is illustrated by the story of four heroin overdoses in Weirton in one weekend.  The ASAP coalition started as a small committee who met to discuss the drug problems in the area in 1996 and grew to where they are today.  The coalition’s main focus remains towards community youth with the mission of “working together to reduce substance abuse in the Brooke and Hancock communities, focusing on youth and families, by means of prevention efforts in community education, mobilization, and the change of values and beliefs.”

In 2014, ASAP found a group of youth to form a new committee called the Youth Council.  Thanks to these youth, they have gained new insight about how they should be hosting and promoting alternate activities to community youth, and actually get them to participate.  They have seen a vast increase in participation at events targeted towards youth. One such activity, that has become an instant hit, is the ASAP Youth Council Video Game Tournament.

Youth focused activities are hard for any group, but thanks to the ASAP Youth Council, the coalition has been having success getting youth involved.

“Their input is invaluable, and when you have youth telling you “don’t advertise you are doing drug prevention to kids or they won’t come,” you listen,” said Mary Ball, ASAP Coordinator. “Their ideas were simple, focus on what kids like to do, then use that as a way into their world.  So, we did.  The first event we held was a video game tournament that we used for multiple purposes.  First, it was a great fundraiser for the kids.  Second, it was the perfect draw to get youth to show up.  Third, it was fun!  We chose a game everyone, young and old could play (Smash Bros.) and changed how we promoted the event to word-of-mouth, flyers where kids hang out, and utilized social media promotions.  The response was amazing.  But nothing in the advertising said anything about substance abuse prevention.  We had over 50 attendees at our first event, which was a small miracle compared to the 10-12 we normally got, if we were lucky.“

To incorporate the message of prevention, displays were placed at the event and announcements dispersed, reminding attendees about the dangers of sharing prescriptions; where to dispose of prescriptions; and pointing out how much fun they were having at an alcohol-free event.

The event not only drew youth, but the parents, friends, grandparents of the youth who participated, did not leave.  They stayed for the entire thing to cheer those competing in the tournament on, expanding the audience from the target of just youth, to all ages.  The success of this program led the coalition to try other things, such as taking advantage of the Pokémon Go game to bring people to ASAP by hosting a “Lure Party.”  The coalition got creative and added a cosplay contest to the video game tournament and increased participation by almost 10 percent. The coalition even designed pop culture prevention buttons that kids snag off the prevention tables because they want to wear that message.

“Listen to your youth members.  They are smart, they know what other kids want to see and will participate in,” advises Ball. “Do not be closed off to stepping out of your adult-zone and entering their world.  If we want kids to listen to our messages, we need to go to them and not expect them to come to us.”

Source:   8th Aug.2017

As the U.S. is facing its most challenging drug epidemic in history, the need to prevent adolescence drug misuse is imperative. For the past two years, Mentor Foundation USA and George Washington University have piloted an innovative drug prevention peer-to-peer initiative at three high schools in Columbia County, NY. The program, which engages youth through social media is showing some promising results in terms of shifts in attitudes towards drugs and intent to use.

The interactive “multi-media” initiative is called Living the Example (LTE), a program that incorporates messages for prevention specifically designed to counteract the misinformation adolescents have about drugs and alcohol.  Messages are framed to promote the benefits of prevention behaviors. “This approach to branding, an alternative, healthy behavior, or ‘counter-marketing’ as it has been termed in tobacco control, has been highly effective and is recognized as one of the main elements in successful prevention programs, such as in tobacco control,” says Principal Investigator, Dr. Doug Evans, a pioneer in the use of this strategy. Dr. Evans is a Professor of Prevention and Community Health & Global Health, with Milken Institute School of Public Health at George Washington University.

Youth Ambassadors are trained to create LTE branded prevention messages, disseminate them via social media platforms, and engage peers in their preferred social networks, with the intention of increasing peer interaction around the brand’s core messaging.  Positive receptivity to LTE messages was associated with some evidence of reduced self-reported drug use intentions, specifically for marijuana use, and reports of intent to use any drug. Among youth who reported exposure and receptivity to LTE, they reported a significant decrease in marijuana use intentions. The most common overall reason for drug use among all respondents was family stress (81.3%), boredom (40%) and academic stress (40%).

“Findings from the study suggest that peer-to-peer substance use prevention via social media is a promising strategy, especially given the low cost and low burden as an intervention channel, which schools, communities, and prevention programs can use as an approach, even in low resource settings,” says Michaela Pratt, President of Mentor Foundation USA. “Through our international network, Mentor Foundation shares over 20 years of global experience in best prevention practices, and Mentor Foundation USA has always been a pioneer in empowering young people to become their own advocates for drug prevention.”

This program was generously supported by The Conrad N. Hilton Foundation, Rip Van Winkle Foundation, among local foundations in Columbia County. Mentor Foundation USA is a member affiliate of Mentor International, which was founded in 1994 by Her Majesty Queen Silvia of Sweden and the World Health Organization and is the largest network of its kind for evidence based programs that prevent drug abuse among youth. Collectively, Mentor has implemented projects in over 80 countries impacting more than 6 million youth.  Mentor Foundation USA is a Delaware registered 501(c)3 non-profit organization.


An UdeM study confirms the link between marijuana use and psychotic-like experiences in a Canadian adolescent cohort. Credit: © Syda Productions / Fotolia

Going from an occasional user of marijuana to a weekly or daily user increases an adolescent’s risk of having recurrent psychotic-like experiences by 159%, according to a new Canadian study published in the Journal of Child Psychology and Psychiatry.

The study also reports effects of marijuana use on cognitive development and shows that the link between marijuana use and psychotic-like experiences is best explained by emerging symptoms of depression.

“To clearly understand the impact of these results, it is essential to first define what psychotic-like experiences are: namely, experiences of perceptual aberration, ideas with unusual content and feelings of persecution,” said the study’s lead author, Josiane Bourque, a doctoral student at Université de Montréal’s Department of Psychiatry. “Although they may be infrequent and thus not problematic for the adolescent, when these experiences are reported continuously, year after year, then there’s an increased risk of a first psychotic episode or another psychiatric condition.”

She added: “Our findings confirm that becoming a more regular marijuana user during adolescence is, indeed, associated with a risk of psychotic symptoms. This is a major public-health concern for Canada.”

What are the underlying mechanisms?

One of the study’s objectives was to better understand the mechanisms by which marijuana use is associated with psychotic-like experiences. Bourque and her supervisor, Dr. Patricia Conrod at Sainte Justine University Hospital Research Centre hypothesized that impairments in cognitive development due to marijuana misuse might in turn exacerbate psychotic-like experiences.

This hypothesis was only partially confirmed, however. Among the different cognitive abilities evaluated, the development of inhibitory control was the only cognitive function negatively affected by an increase in marijuana use. Inhibitory control is the capacity to withhold or inhibit automatic behaviours in favor of a more contextually appropriate behaviour. Dr. Conrod’s team has shown that this specific cognitive function is associated with risk for other forms of substance abuse and addiction.

“Our results show that while marijuana use is associated with a number of cognitive and mental health symptoms, only an increase in symptoms of depression — such as negative thoughts and low mood — could explain the relationship between marijuana use and increasing psychotic-like experiences in youth,” Bourque said.

What’s next

These findings have important clinical implications for prevention programs in youth who report having persistent psychotic-like experiences. “While preventing adolescent marijuana use should be the aim of all drug strategies, targeted prevention approaches are particularly needed to delay and prevent marijuana use in young people at risk of psychosis,” said Patricia Conrod, the study’s senior author and a professor at UdeM’s Department of Psychiatry.

Conrod is optimistic about one thing, however: the school-based prevention program that she developed, Preventure, has proven effective in reducing adolescent marijuana use by an overall 33%. “In future programs, it will be important to investigate whether this program and other similar targeted prevention programs can delay or prevent marijuana use in youth who suffer from psychotic-like experiences,” she said. “While the approach seems promising, we have yet to demonstrate that drug prevention can prevent some cases of psychosis.”

A large youth cohort from Montreal

The study’s results are based on the CIHR-funded Co-Venture project, a cohort of approximately 4,000 adolescents aged 13 years old from 31 high schools in the Greater Montreal area. These teens are followed annually from Grade 7 to Grade 11. Every year they fill out computerized questionnaires to assess substance use and psychiatric symptoms. The teens also complete cognitive tasks to allow the researchers to evaluate their IQ, working memory and long-term memory as well as their inhibitory control skills.

To do their study, the research team first confirmed results from both the United Kingdom and Netherlands showing the presence of a small group of individuals (in Montreal, 8%) among the general population of adolescents who report recurrent psychotic-like experiences. Second, the researchers explored how marijuana use between 13 and 16 years of age increases the likelihood of belonging to the 8%. Finally, they examined whether the relationship between increasing use of marijuana and increasing psychotic-like experiences can be explained by emerging symptoms of anxiety or depression, or by the effects of substance use on developing cognitive abilities.

Source:  University of Montreal. “Marijuana and vulnerability to psychosis.” ScienceDaily. ScienceDaily, 5 July 2017.


Both experience and research has proven that drug addiction and other drug-related problems are both preventable and treatable. Prevention is effective, humane, cost-effective, and empowering. Prevention solves problems before they ever occur. And prevention reduces other social problems and should therefore be integrated into general health and development strategies based on the United Nations’ Sustainable Development Goals. Indeed, the introductory paragraphs of the UNGASS Outcome Document highlight prevention as an important part of a drug strategy that is integrated, multidisciplinary, mutually reinforcing, balanced, evidence-based, and comprehensive.

Chapter 1 of that same document details the many aspects of prevention, demand reduction, and early intervention. Of course, no “silver bullets” to drug-related problems exist. Rather, the causes of drug use, the consequences of such use, and the interventions needed to reduce drug-related harm are all multi-dimensional, as the UNGASS Outcome Document stresses.

Member States should use the UNODC International Standards on Drug Use Prevention for guidance on prevention programs. These Standards offer a wide range of evidence-based primary prevention interventions that governments and civil society can easily implement. There is no reason to wait for more theoretical discussion in this area. Effective prevention efforts as listed in the UNODC Standards are even more effective when they are combined and implemented across a broad cross-section of a community.

Accordingly, local coalitions should involve a wide range of local authorities and public services, such as schools, police, parents groups, and community-based organisations. Several countries have developed this type of community actions through coalitions of committed people, and we advise Members States to build on these examples and experiences.

· Define the overarching goal of their drug policies as reduction in drug use prevalence, or maintaining low levels of drug use.

· Monitor drug use prevalence on a regular basis, both on national and local level, and to use results to adjust policies and develop even more efficient prevention programmes.

· Develop and implement a culturally-sensitive model for “community-based multicomponent actions” where communities are mobilized as part of a national programme of prevention. Drug Policy Futures is a global platform for a new drug policy debate based on health

· Involve young children and youth in prevention, instead of exclusively engaging adolescents as a target audience for such programmes.

· Establish a national clearinghouse that can connect the many local prevention coalitions, provide them with training and documentation, and elevate prevention initiatives on the national political agenda.

· Introduce training and support programmes for local prevention workers and volunteers.

· Mobilize human resources and funds to secure that schools and local communities have proper systems for identification of and assistance to vulnerable groups, for young children and adolescents in particular.

· Establish national “better parenting” programmes that can be used by local communities and schools.

Given the existing heavy burden on public health systems in many developing societies, prevention may be the only viable option for many Member States. Public health infrastructure in many of these states is often weak or already overburdened, further increasing the need for successful prevention programmes, before drug-related problems develop.

Similarly, drug prevention programmes must aim to reduce drug use prevalence, as it is a good proxy for the level of drug-related harm in a society. This means that prevention programmes must address both the availability of drugs and the social acceptability of drug use. Reduced numbers of regular drug users will lead to lower rates of problematic drug users, as well as a reduction in numbers of adolescents who are exposed to drug use in their circle of friends.

Effective prevention programmes result in more than just reduction in drug-related harm. They also contribute to the prevention of other social problems, empower individuals and communities, mobilize of human resources, promote good governance, rebuild the social fabric, and strengthen civil society. This is particularly true when prevention programs begin early, such as with early detection of adolescents who struggle with childhood traumas, family problems, abuse, school attendance, and other problematic issues. At such an early stage, basic support and interventions by teachers, health personnel or social workers, and even by family and neighbours can make a great difference for the rest of a child’s life.

This statement is supported by an alliance of networks covering more than 300 NGOs from all over the world: Drug Policy Futures European Cities Against Drugs IOGT International Smart Approaches to Marijuana World Federation Against Drugs Active – Sobriety, Friendship and Peace Recovered Users Network EURAD – A network for prevention, treatment and recovery Actis – Norwegian Policy Network on Alcohol and Drugs FORUT – Campaign for Development and Solidarity

Source:  2017

Utah, more than other area of the nation, is suffering from a silent epidemic.  From 2000 to 2014, Utah has experienced a nearly 400% increase in deaths from the misuse and abuse of prescription drugs. Each month there are 24 individuals who die from prescription drug overdoses.

What can we do to help alleviate this growing epidemic? Constant education of the public is essential to prevent drug and alcohol abuse. There is great danger in legal prescription medications and illicit drugs.

What is addiction? As defined by the American Society of Addiction Medicine: “Addiction is a biological, psychological, social and spiritual illness.”   We are learning more and more that opioids now kill more young adults than alcohol. Yet, these deaths are preventable.

Addictionologist, Dr. Sean A. Ponce, M.D., at Salt Lake Behavioral Health Hospital is an advocate of prevention and clinical expert in the treatment of addiction.    Dr. Ponce relates having cancer to that of drug or alcohol addiction. “For cancer, we want to know the prognosis, how far it’s spread… we want to hear the word remission.  Do we talk about that with addiction?”

He goes onto say, “Addiction is a disease that can also spread.  It is a disease that can be mild, moderate or severe.  We want to put it into remission. When cancer reoccurs everyone rallies around that patient to help. When addiction reoccurs what happens?  We send a mixed message.  It is also a disease and we need to be able to help.”

Dr. Ponce also tells us that, “Surviving isn’t really a way to live.  Thriving is.”

Intermountain Health Care recently kicked off a prescription opioid misuse awareness campaign with new artwork in the main lobby of McKay-Dee Hospital including a chandelier built entirely of pill bottles.

This artwork highlights the hospital’s efforts to raise awareness about prescription opioid misuse and represents the 7,000 opioid prescriptions filled each day in Utah. It’s aim: to inform visitors that the risk of opioid addiction “hangs over everyone.”

The campaign’s partners include: Bonneville Communities That Care, Weber Human Services, Use Only as Directed, and Intermountain’s Community Benefit team.

There are also several elevator doors, in McKay Dee Hospital, covered with warnings against opioid use. It definitely sends a strong message to stop and think about the dangers involved.

As previously mentioned, Salt Lake Behavioral Health is a private, freestanding psychiatric hospital specializing in mental health and substance abuse treatment.

You may use this link to learn more about how to help prevent the spread of this deadly epidemic.


The surrender of more than 2,000 minors involved in drugs in Cebu shows the need to step up efforts to educate the youth on the ill effects of illegal drugs. The Cebu Provincial Anti-Drug Abuse Office has produced a module on this for integration in Grades 7 to 9 classes starting this school year.

Jane Gurrea, Education Supervisor I of the Department of Education’s Division of Cebu Province, says anti-drug activities in schools have been strengthened by a memorandum issued by the department mandating the establishment of Barkada Kontra Droga chapters in schools.

Barkada Kontra Droga is a preventive education and information program to counter the dangers of drug abuse. HALF of the 2,203 minors rounded up under Project Tokhang were out-of-school youth, according to data collected by the Police Regional Office 7 from July 1, 2016 to Feb. 2, 2017.

Tokhang is the Philippine National Police’s program to knock on the doors of homes to persuade those suspected of involvement in illegal drugs to surrender. Some 2,166 of the minors in Cebu were drug users, 28 were sellers, while nine were mules. Could the rampant involvement of out-of-school youth in drugs have been prevented if Section 46 of the Comprehensive Dangerous Drugs Act of 2002 had been implemented?

Section 46 requires the establishment of a Special Drug Education Center (SDEC) for out-of-school youth and street children in every province to implement drug abuse prevention programs and activities. The SDEC should be led by the Provincial Social Welfare Officer. “Cebu Province still has to establish one,” however, said Grace Yana, social welfare officer  in charge of social technology unit of the Department of Social Welfare and Development (DSWD) . But areas in Cebu with active Pag-Asa Youth Association of the Philippines (PYAP) chapters, like Talisay, Naga, Danao and Mandaue cities, already have SDECs, she said. PYAP is the organization of out-of-school youth organized by the local government units.

“When the local government units hear the word center, they think they will need a building, and it needs a budget. So we tell them, even if it’s just a corner,” Yana said of the challenges of setting up the SDEC. Cebu Province may not have an SDEC, but the Cebu Provincial Anti-Drug Abuse Office (Cpadao) unveiled last November Project YMAD (Youth Making a Difference) that aims to provide out-of-school youth with socio-economic, physical, psychological, cultural and spiritual support through the PYAP.

Barkada Kontra Droga For in-school youth, the Cpadao is facilitating the implementation of the Barkada Kontra Droga drug prevention program, said Cpadao executive director Carmen Remedios Durano-Meca. Dangerous Drugs Board (DDB) Regulation 5, Series of 2007 calls for the institutionalization of the Barkada Kontra Droga (BKD), a preventive education and information program to counter the dangers and disastrous effects of drug abuse. It empowers the individual to be the catalyst in his peer groups in advocating healthy and drug-free lifestyles, the regulation says. “Cpadao is the one facilitating that this be implemented in every school,” Meca said. “We tap the Supreme Student Government officers. We have a Student Assistance Program (SAP) designed to help children who get into trouble with drugs in the school setting.”

SAP includes an intervention program to reduce substance abuse and behavioral problems by having the parent-teacher association take up school and home concerns. Under SAP, which will be established through the guidance office, the school will establish drug policies and regulations.

In addition, Cpadao made a module, which it has given to the Department of Education (DepEd) to distribute to schools. “It’s been agreed to be integrated in the Grades 7, 8 and 9 classes starting school year 2017. It will be one hour a week from MAPEH (Music, Arts, Physical Education and Health) for the whole school year. Later, we plan to teach it to the younger children, like Grade 4,” she said. “We’ve had a review of the module,” Jane Gurrea, Education Supervisor I of DepEd’s Division of Cebu Province, said last month. “If we receive that module, this will be integrated initially for public schools as additional reference materials.”

The DepEd Division of Cebu Province covers the 44 towns in Cebu. This month, the division will have a training of teachers for the integration of drug abuse prevention education, which will include a discussion of the Cpadao module. But even now, under the present K to 12 curriculum, basic concepts on illegal drugs can already be tackled as early as in Grade 4, as teachers could integrate these concepts in subjects like Health, when the subject of medicine use and abuse is discussed, she said. Gurrea, who is also the National Drug Education Program coordinator in the Division, said drug prevention education can be taught in subjects dealing with values education, social studies or MAPEH. “For music, students can write a poem or song on drug use prevention. They can have role playing. In art, they can do drawing (on drugs).”

Additionally, under Section 42 of the Dangerous Drugs Act, all student councils and campus organizations in elementary and secondary schools should include in their activities “a program for the prevention of and deterrence in the use of dangerous drugs, and referral for treatment and rehabilitation of students for drug dependence.” It is unclear how actively these student groups have campaigned against illegal drugs, but Gurrea said that every third week of November, students join the celebration of Drug Abuse Prevention and Control Week under the Supreme Student Government.

“The officers have to campaign room to room to talk about issues related to prevention of drug use. In the public schools in rural areas, you can see signs on fences or pergolas saying, ‘Get high on grades, not on drugs.’ They invite speakers for drug symposiums, like the police,” she said. The Supreme Student Government is for high school, while the Supreme Pupil Government is for elementary school. “In every town, we have a federated Supreme Student Government (SSG) and Supreme Pupil Government (SPG), and also a Division Federation of SSG and SPG. One of the programs is drug education,” Gurrea said. The Department of Education mandates all schools to have a student council organization strengthened. Gurrea said the anti-drug activities in schools were already there, but the term Barkada Kontra Droga was not used then. It was only when the DepEd coordinated with Cpadao that the term BKD was used. With the assistance of Cpadao that spent for resource speakers and meals of the students last year, BKD was institutionalized. BKD was strengthened further by DepEd Memorandum 200, Series of 2016 issued on Nov. 23, 2016 mandating the establishment of BKD chapters in schools, Gurrea said. “With this institutionalization, on the part of the budget for activities, students now have access through the Municipal Anti-Drug Abuse Councils (Madac).

So instead of spending their SSG funds for their activities, they can present their planned activities to the Madac, from which they can seek financial or other assistance (like for speakers),” she said. With the memo, the SSG has been recognized as an entity, enabling it to connect with the community, such as with agencies and non-government organizations for anti-drug activities, she said. “We have continuous advocacy and awareness programs. Some schools have a walk for a cause or caravan,” Gurrea said. The public schools in the division also have their student handbook. “One thing stipulated there is that no student is allowed to be involved in illegal drugs. There are schools that let students sign that piece of paper containing the rules and regulations, for their commitment to follow the rules in that handbook,” she said.

So if awareness of the dangers of illegal drugs is not the problem, what accounts for the high number of minors involved in drugs? “We are looking at peer pressure or circumstances in the family,” Gurrea said.


(Comment by NDPA:  Some shocking figures from the USA in this article)

In 1964 the Surgeon General’s report on smoking and health began a movement to shine the bright light on cigarette smoking and dramatically change individual and societal views. Today, most states ban smoking in public spaces.

Most of us avoid private smoky places and sadly watch as the die-hard huddle 15 feet from the entrance on rainy, snowy or frigid coffee breaks. Employers often charge higher health insurance premiums to employees who smoke, and taxes on cigarettes are nearly triple a gallon of gas. Yet, some heralded progressive states have passed referendums to legalize the recreational use of a different smoked drug.

Now, more than 50 years later, another very profound statement has been made in the introduction to the recent report, “Substance misuse is one of the critical public health problems of our time.”

“Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health,” was released in November 2016 and is considered to hold the same landmark status as that report from 1964. And maybe, just maybe, it will have the same impact.

Many key findings are included that are critical to garnering support in the health care and substance abuse treatment fields. But the facts are just as important for the general public to know:

— In 2015, substance use disorders affected 20.8 million Americans — almost 8 percent of the adolescent and adult population. That number is similar to the number of people who suffer from diabetes, and more than 1.5 times the annual prevalence of all cancers combined (14 million).

— 12.5 million Americans reported misusing prescription pain relievers in the past year.

— 78 people die every day in the United States from an opioid overdose, nearly quadruple the number in 1999.

— We have treatments we know are effective, yet only 1 in 5 people who currently need treatment for opioid use disorders is actually receiving it.

— It is estimated that the yearly economic impact of misuse and substance use disorders is $249 billion for alcohol misuse and alcohol use disorders and $193 billion for illicit drug use and drug use disorders ($442 billion total).

— Many more people now die from alcohol and drug overdoses each year than are killed in automobile accidents.

— The opioid crisis is fuelling this trend with nearly 30,000 people dying due to an overdose on heroin or prescription opioids in 2014. An additional roughly 20,000 people died as a result of an unintentional overdose of alcohol, cocaine or non-opioid prescription drugs.

Our community has witnessed many of these issues first hand, specifically the impact of the heroin epidemic. The recent Winnebago County Coroner’s report indicated that of 96

overdose deaths in 2016, 42 were a result of heroin, and 23 from a combination of heroin and cocaine.

We know that addiction is a complex brain disease, and that treatment is effective. It can manage symptoms of substance use disorders and prevent relapse. More than 25 million individuals are in recovery and living healthy, productive lives. I, myself, know many. Most of us do.

Locally, the disease of addiction hits very close to many of us. I’ve had the privilege of being part of Rosecrance for over four decades, and I have seen the struggle for individuals and families — the triumphs and the tragedies. Seldom does a client come to us voluntarily and without others who are suffering with them. Through research and evidence-based practices at Rosecrance, I have witnessed the miracle of recovery on a daily basis. Treatment works!

If you believe you need help, or know someone who does, seek help.  Now. Source:  4th March 2017

This study found:

* The Strengthening Families Program for Youth 10-14 (SFP10-14) reduced substance use among the friends of teens who participated in the intervention, as well as the participants themselves.

* The friends’ substance use reductions were mediated by altered attitudes toward substance use and reductions in unsupervised socializing with peers.

In SFP10-14, families with children ages 10 to 14 meet with intervention facilitators once a week for 7 weeks to discuss substance use, parenting practices, communication skills, responses to peer pressure, and other topics. Previous studies have demonstrated that the program reduces participating children’s substance use and improves participating parents’ parenting practices. The new study evaluated the program’s effects on the participating teens’ nonparticipating friends.

Dr. Kelly Rulison of the University of North Carolina at Greensboro and colleagues at Pennsylvania State University analysed data collected from more than 5,400 students who attended sixth grade in 13 rural Pennsylvania and Iowa communities. None of the students participated in SFP10-14, even though the intervention was offered to all sixth graders in their schools. Each year for 3 years, the researchers elicited from each student the names of up to 7 peers in the same grade who were “close” friends. They also collected information on each student’s exposure to friends who participated in SFP10-14, to friends’ positive or negative attitudes about substance use, friends’ smoking or drinking to inebriation, and other variables.

Figure. Nonparticipants With Friends Who Participated in SFP10-14 Are Less Likely to Use Cigarettes Immediately before and after implementation of the SFP10-14 intervention, past-month cigarette use did not differ among nonparticipants with a varying number of friends participating in the intervention. Over time, however, diffusion of the program’s effects resulted in differences in cigarette use among the nonparticipants that were proportional to the number of their friends who had participated in SFP10-14. Nonparticipants with greater numbers of participating friends reported lower rates of past-month cigarette use than their peers with fewer participating friends.

The researchers’ analysis revealed that the benefits of SFP10-14 spread from participants to their friends. Thus, the more participant friends a nonparticipant had, the less likely he or she was to engage in substance use in the years following the intervention. At the 3-year follow-up, nonparticipants who had three or more participant friends were roughly 2/3 as likely to report that they had been drunk in the past month, and roughly 1/3 as likely to have smoked a cigarette in the past month, compared with those who had no participant friends (see Figure).

Two mediating factors accounted for most of the indirect benefit experienced by the SFP10-14 nonparticipants. Most influential was the amount of time they spent “hanging out” with friends without adult supervision. Dr. Rulison says, “Multiple mechanisms for

this result are possible, but it’s most likely that SFP10-14 changed participating parents’ supervision practices. Parents who have participated in the intervention tend to supervise their adolescents closely. Nonparticipating teens who spend time with friends who participate receive indirect supervision from their friends’ parents, regardless of how much their own parents supervise them.”

SFP10-14 nonparticipants’ substance use also was influenced by their participant friends’ attitudes toward smoking and drinking alcohol. Although this effect was small compared to that of unsupervised socializing, it implies that encouraging participants to advocate negative attitudes about substance use to their friends could help reduce community-wide teen substance use.

Additional findings from the study underscore the strong influence that peer behavior can have among teens and the potential for interventions such as SFP10-14, which reduce problem behaviors, to benefit teens who do not directly experience them. The researchers calculated that a unit increase in smoking prevalence among a teen’s friends was associated with a 14-fold increase in his or her odds of smoking, and an increase in the friends’ prevalence of drunkenness was associated with a near quintupling of his or her odds of getting drunk. However, the researchers acknowledge that selection processes also play a role in shaping teen behavior—that is, that teens who drink alcohol or smoke gravitate to friends who do the same.

Dr. Rulison notes that all the school districts in the study were majority-white with stable student populations, and the findings may not apply to other types of communities. She comments, “Diffusion results from the stability of the community and changing community norms, not community demographics. Whether diffusion occurs in more transient communities depends on the specifics of the intervention.” For example, she says, because the benefits of SFP10-14 spread partly by altering the behavior of participating parents, “diffusion is less likely if participating parents move away.”

However, the researchers also believe that diffusion may occur via the cumulative, normative effect of students’ beliefs. “Changing individual attitudes could lead to a sustained school- or community-wide change in norms, even if many of the original program participants move away,” Dr. Rulison says.

The researchers say that identifying the specific mechanisms and processes that support diffusion of a programs’ benefits can enable researchers to improve in program design and implementation. Accordingly, they recommend that program developers and evaluators measure their programs’ impact, if any, on nonparticipants, such as those who join the community after the intervention, siblings of participants, and nonparticipants who are not in the same class or grade in which the program is implemented.

Dr. Rulison and colleagues advise intervention designers to leverage diffusion effects to maximize their programs’ impact. “Intervention developers should target factors, such as peer attitudes and unstructured socializing, that might facilitate diffusion,” Dr. Rulison says. “Some programs already do so by specifically training student leaders to spread intervention messages.”

This study was supported by NIH grants DA018225, DA013709, HD041025, AA14702, and the WT Grant Foundation.

Source: Rulison, K.L.; Feinberg, M.; Gest, S.D.; and Osgood, D.W. Diffusion of intervention effects: The impact of a family-based substance use prevention program on friends of participants. Journal of Adolescent Health 57(4):433-440, 2015. 

In Iceland, teenage smoking, drinking and drug use have been radically cut in the past 20 years. Emma Young finds out how they did it, and why other countries won’t follow suit

State funding for organised sport and other clubs has increased in Iceland to give kids new ways to feel like part of a group all pics: Dave Imms

It’s a little before three on a sunny Friday afternoon and Laugardalur Park, near central Reykjavik, looks practically deserted. There’s an occasional adult with a pushchair, but the park’s surrounded by apartment blocks and houses, and school’s out – so where are all the kids?

Walking with me are Gudberg Jónsson, a local psychologist, and Harvey Milkman, an American psychology professor who teaches for part of the year at Reykjavik University. Twenty years ago, says Gudberg, Icelandic teens were among the heaviest-drinking youths in Europe. “You couldn’t walk the streets in downtown Reykjavik on a Friday night because it felt unsafe,” adds Milkman. “There were hordes of teenagers getting in-your-face drunk.”

We approach a large building. “And here we have the indoor skating,” says Gudberg.

A couple of minutes ago, we passed two halls dedicated to badminton and ping pong. Here in the park, there’s also an athletics track, a geothermally heated swimming pool and – at last – some visible kids, excitedly playing football on an artificial pitch.

Young people aren’t hanging out in the park right now, Gudberg explains, because they’re in after-school classes in these facilities, or in clubs for music, dance or art. Or they might be on outings with their parents.

Today, Iceland tops the European table for the cleanest-living teens. The percentage of 15- and 16-year-olds who had been drunk in the previous month plummeted from 42 per cent in 1998 to 5 per cent in 2016. The percentage who have ever used cannabis is down from 17 per cent to 7 per cent. Those smoking cigarettes every day fell from 23 per cent to just 3 per cent.

The way the country has achieved this turnaround has been both radical and evidence-based, but it has relied a lot on what might be termed enforced common sense. “This is the most remarkably intense and profound study of stress in the lives of teenagers that I have ever seen,” says Milkman. “I’m just so impressed by how well it is working.”

The country has created new opportunities for kids of all ages to get involved with the community

If it was adopted in other countries, Milkman argues, the Icelandic model could benefit the general psychological and physical wellbeing of millions of kids, not to mention the coffers of healthcare agencies and broader society. It’s a big if.

“I was in the eye of the storm of the drug revolution,” Milkman explains over tea in his apartment in Reykjavik. In the early 1970s, when he was doing an internship at the Bellevue Psychiatric Hospital in New York City, “LSD was already in, and a lot of people

were smoking marijuana. And there was a lot of interest in why people took certain drugs.”

Milkman’s doctoral dissertation concluded that people would choose either heroin or amphetamines depending on how they liked to deal with stress. Heroin users wanted to numb themselves; amphetamine users wanted to actively confront it. After this work was published, he was among a group of researchers drafted by the US National Institute on Drug Abuse to answer questions such as: why do people start using drugs? Why do they continue? When do they reach a threshold to abuse? When do they stop? And when do they relapse?

“Any college kid could say: why do they start? Well, there’s availability, they’re risk-takers, alienation, maybe some depression,” he says. “But why do they continue? So I got to the question about the threshold for abuse and the lights went on – that’s when I had my version of the “aha” experience: they could be on the threshold for abuse before they even took the drug, because it was their style of coping that they were abusing.”

At Metropolitan State College of Denver, Milkman was instrumental in developing the idea that people were getting addicted to changes in brain chemistry. Kids who were “active confronters” were after a rush – they’d get it by stealing hubcaps and radios and later cars, or through stimulant drugs. Alcohol also alters brain chemistry, of course. It’s a sedative but it sedates the brain’s control first, which can remove inhibitions and, in limited doses, reduce anxiety.

“People can get addicted to drink, cars, money, sex, calories, cocaine – whatever,” says Milkman. “The idea of behavioural addiction became our trademark.”

This idea spawned another: “Why not orchestrate a social movement around natural highs: around people getting high on their own brain chemistry – because it seems obvious to me that people want to change their consciousness – without the deleterious effects of drugs?”

By 1992, his team in Denver had won a $1.2m government grant to form Project Self-Discovery, which offered teenagers natural-high alternatives to drugs and crime. They got referrals from teachers, school nurses and counsellors, taking in kids from the age of 14 who didn’t see themselves as needing treatment but who had problems with drugs or petty crime.

“We didn’t say to them, you’re coming in for treatment. We said, we’ll teach you anything you want to learn: music, dance, hip hop, art, martial arts.” The idea was that these different classes could provide a variety of alterations in the kids’ brain chemistry, and give them what they needed to cope better with life: some might crave an experience that could help reduce anxiety, others may be after a rush.

At the same time, the recruits got life-skills training, which focused on improving their thoughts about themselves and their lives, and the way they interacted with other people. “The main principle was that drug education doesn’t work because nobody pays attention to it. What is needed are the life skills to act on that information,” Milkman says. Kids were told it was a three-month programme. Some stayed five years.

It’s less common to see children out on the streets in Iceland, as many are in after-school programs and participating in recreational activities

In 1991, Milkman was invited to Iceland to talk about this work, his findings and ideas. He became a consultant to the first residential drug treatment centre for adolescents in

Iceland, in a town called Tindar. “It was designed around the idea of giving kids better things to do,” he explains. It was here that he met Gudberg, who was then a psychology undergraduate and a volunteer at Tindar. They have been close friends ever since.

Milkman started coming regularly to Iceland and giving talks. These talks, and Tindar, attracted the attention of a young researcher at the University of Iceland, called Inga Dóra Sigfúsdóttir. She wondered: what if you could use healthy alternatives to drugs and alcohol as part of a programme not to treat kids with problems, but to stop kids drinking or taking drugs in the first place?

Have you ever tried alcohol? If so, when did you last have a drink? Have you ever been drunk? Have you tried cigarettes? If so, how often do you smoke? How much time to you spend with your parents? Do you have a close relationship with your parents? What kind of activities do you take part in?

In 1992, 14-, 15- and 16-year-olds in every school in Iceland filled in a questionnaire with these kinds of questions. This process was then repeated in 1995 and 1997.

The results of these surveys were alarming. Nationally, almost 25 per cent were smoking every day, over 40 per cent had got drunk in the past month. But when the team drilled right down into the data, they could identify precisely which schools had the worst problems – and which had the least. Their analysis revealed clear differences between the lives of kids who took up drinking, smoking and other drugs, and those who didn’t. A few factors emerged as strongly protective: participation in organised activities – especially sport – three or four times a week, total time spent with parents during the week, feeling cared about at school, and not being outdoors in the late evenings.

“At that time, there had been all kinds of substance prevention efforts and programmes,” says Inga Dóra, who was a research assistant on the surveys. “Mostly they were built on education.” Kids were being warned about the dangers of drink and drugs, but, as Milkman had observed in the US, these programmes were not working. “We wanted to come up with a different approach.”

The mayor of Reykjavik, too, was interested in trying something new, and many parents felt the same, adds Jón Sigfússon, Inga Dóra’s colleague and brother. Jón had young daughters at the time and joined her new Icelandic Centre for Social Research and Analysis when it was set up in 1999. “The situation was bad,” he says. “It was obvious something had to be done.”

Using the survey data and insights from research including Milkman’s, a new national plan was gradually introduced. It was called Youth in Iceland.

Laws were changed. It became illegal to buy tobacco under the age of 18 and alcohol under the age of 20, and tobacco and alcohol advertising was banned. Links between parents and school were strengthened through parental organisations which by law had to be established in every school, along with school councils with parent representatives. Parents were encouraged to attend talks on the importance of spending a quantity of time with their children rather than occasional “quality time”, on talking to their kids about their lives, on knowing who their kids were friends with, and on keeping their children home in the evenings.

A law was also passed prohibiting children aged between 13 and 16 from being outside after 10pm in winter and midnight in summer. It’s still in effect today.

Home and School, the national umbrella body for parental organisations, introduced agreements for parents to sign. The content varies depending on the age group, and individual organisations can decide what they want to include. For kids aged 13 and up, parents can pledge to follow all the recommendations, and also, for example, not to allow their kids to have unsupervised parties, not to buy alcohol for minors, and to keep an eye on the wellbeing of other children.

These agreements educate parents but also help to strengthen their authority in the home, argues Hrefna Sigurjónsdóttir, director of Home and School. “Then it becomes harder to use the oldest excuse in the book: ‘But everybody else can!’”

State funding was increased for organised sport, music, art, dance and other clubs, to give kids alternative ways to feel part of a group, and to feel good, rather than through using alcohol and drugs, and kids from low-income families received help to take part. In Reykjavik, for instance, where more than a third of the country’s population lives, a Leisure Card gives families 35,000 krona (£250) per year per child to pay for recreational activities.

Children between the ages of 13 and 16 are prohibited from being outside after 10pm

Crucially, the surveys have continued. Each year, almost every child in Iceland completes one. This means up-to-date, reliable data is always available.

Between 1997 and 2012, the percentage of kids aged 15 and 16 who reported often or almost always spending time with their parents on weekdays doubled – from 23 per cent to 46 per cent – and the percentage who participated in organised sports at least four times a week increased from 24 per cent to 42 per cent. Meanwhile, cigarette smoking, drinking and cannabis use in this age group plummeted.

“Although this cannot be shown in the form of a causal relationship – which is a good example of why primary prevention methods are sometimes hard to sell to scientists – the trend is very clear,” notes Álfgeir Kristjánsson, who worked on the data and is now at the West Virginia University School of Public Health in the US. “Protective factors have gone up, risk factors down, and substance use has gone down – and more consistently in Iceland than in any other European country.”

Jón Sigfússon apologies for being just a couple of minutes late. “I was on a crisis call!” He prefers not to say precisely to where, but it was to one of the cities elsewhere in the world that has now adopted, in part, the Youth in Iceland ideas.

Youth in Europe, which Jón heads, began in 2006 after the already-remarkable Icelandic data was presented at a European Cities Against Drugs meeting and, he recalls, “People asked: what are you doing?”

Participation in Youth in Europe is at a municipal level rather than being led by national governments. In the first year, there were eight municipalities. To date, 35 have taken part, across 17 countries, varying from some areas where just a few schools take part to Tarragona in Spain, where 4,200 15-year-olds are involved. The method is always the same: Jón and his team talk to local officials and devise a questionnaire with the same core questions as those used in Iceland plus any locally tailored extras. For example, online gambling has recently emerged as a big problem in a few areas, and local officials want to know if it’s linked to other risky behaviour.

Just two months after the questionnaires are returned to Iceland, the team sends back an initial report with the results, plus information on how they compare with other participating regions. “We always say that, like vegetables, information has to be fresh,” says Jón. “If you bring these findings a year later, people would say, Oh, this was a long time ago and maybe things have changed…” As well as fresh, it has to be local so that schools, parents and officials can see exactly what problems exist in which areas.

The team has analysed 99,000 questionnaires from places as far afield as the Faroe Islands, Malta and Romania – as well as South Korea and, very recently, Nairobi and Guinea-Bissau. Broadly, the results show that when it comes to teen substance use, the same protective and risk factors identified in Iceland apply everywhere. There are some differences: in one location (in a country “on the Baltic Sea”), participation in organised sport actually emerged as a risk factor. Further investigation revealed that this was because young ex-military men who were keen on muscle-building drugs, drinking and smoking were running the clubs. Here, then, was a well-defined, immediate, local problem that could be addressed.

While Jón and his team offer advice and information on what has been found to work in Iceland, it’s up to individual communities to decide what to do in the light of their results. Occasionally, they do nothing. One predominantly Muslim country, which he prefers not to identify, rejected the data because it revealed an unpalatable level of alcohol consumption. In other cities – such as the origin of Jón’s “crisis call” – there is an openness to the data and there is money, but he has observed that it can be much more difficult to secure and maintain funding for health prevention strategies than for treatments.

No other country has made changes on the scale seen in Iceland. When asked if anyone has copied the laws to keep children indoors in the evening, Jón smiles. “Even Sweden laughs and calls it the child curfew!”

Across Europe, rates of teen alcohol and drug use have generally improved over the past 20 years, though nowhere as dramatically as in Iceland, and the reasons for improvements are not necessarily linked to strategies that foster teen wellbeing. In the UK, for example, the fact that teens are now spending more time at home interacting online rather than in person could be one of the major reasons for the drop in alcohol consumption.

But Kaunas, in Lithuania, is one example of what can happen through active intervention. Since 2006, the city has administered the questionnaires five times, and schools, parents, healthcare organisations, churches, the police and social services have come together to try to improve kids’ wellbeing and curb substance use. For instance, parents get eight or nine free parenting sessions each year, and a new programme provides extra funding for public institutions and NGOs working in mental health promotion and stress management. In 2015, the city started offering free sports activities on Mondays, Wednesdays and Fridays, and there are plans to introduce a free ride service for low-income families, to help kids who don’t live close to the facilities to attend.

Between 2006 and 2014, the number of 15- and 16-year-olds in Kaunas who reported getting drunk in the past 30 days fell by about a quarter, and daily smoking fell by more than 30 per cent.

At the moment, participation in Youth in Europe is a haphazard affair, and the team in Iceland is small. Jón would like to see a centralised body with its own dedicated funding to focus on the expansion of Youth in Europe. “Even though we have been doing this for

ten years, it is not our full, main job. We would like somebody to copy this and maintain it all over Europe,” he says. “And why only Europe?”

After our walk through Laugardalur Park, Gudberg Jónsson invites us back to his home. Outside, in the garden, his two elder sons, Jón Konrád, who’s 21, and Birgir Ísar, who’s 15, talk to me about drinking and smoking. Jón does drink alcohol, but Birgir says he doesn’t know anyone at his school who smokes or drinks. We also talk about football training: Birgir trains five or six times a week; Jón, who is in his first year of a business degree at the University of Iceland, trains five times a week. They both started regular after-school training when they were six years old.

“We have all these instruments at home,” their father told me earlier. “We tried to get them into music. We used to have a horse. My wife is really into horse riding. But it didn’t happen. In the end, soccer was their selection.”

Did it ever feel like too much? Was there pressure to train when they’d rather have been doing something else? “No, we just had fun playing football,” says Birgir. Jón adds, “We tried it and got used to it, and so we kept on doing it.”

It’s not all they do. While Gudberg and his wife Thórunn don’t consciously plan for a certain number of hours each week with their three sons, they do try to take them regularly to the movies, the theatre, restaurants, hiking, fishing and, when Iceland’s sheep are brought down from the highlands each September, even on family sheep-herding outings.

Jón and Birgir may be exceptionally keen on football, and talented (Jón has been offered a soccer scholarship to the Metropolitan State University of Denver, and a few weeks after we meet, Birgir is selected to play for the under-17 national team). But could the significant rise in the percentage of kids who take part in organised sport four or more times a week be bringing benefits beyond raising healthier children?

Could it, for instance, have anything to do with Iceland’s crushing defeat of England in the Euro 2016 football championship? When asked, Inga Dóra Sigfúsdóttir, who was voted Woman of the Year in Iceland in 2016, smiles: “There is also the success in music, like Of Monsters and Men [an indie folk-pop group from Reykjavik]. These are young people who have been pushed into organised work. Some people have thanked me,” she says, with a wink.

Elsewhere, cities that have joined Youth in Europe are reporting other benefits. In Bucharest, for example, the rate of teen suicides is dropping alongside use of drink and drugs. In Kaunas, the number of children committing crimes dropped by a third between 2014 and 2015.

As Inga Dóra says: “We learned through the studies that we need to create circumstances in which kids can lead healthy lives, and they do not need to use substances, because life is fun, and they have plenty to do – and they are supported by parents who will spend time with them.”

When it comes down to it, the messages – if not necessarily the methods – are straightforward. And when he looks at the results, Harvey Milkman thinks of his own country, the US. Could the Youth in Iceland model work there, too?

Three hundred and twenty-five million people versus 330,000. Thirty-three thousand gangs versus virtually none. Around 1.3 million homeless young people versus a handful.

Iceland’s government has made a long-term commitment to supporting the national project

Clearly, the US has challenges that Iceland does not. But the data from other parts of Europe, including cities such as Bucharest with major social problems and relative poverty, shows that the Icelandic model can work in very different cultures, Milkman argues. And the need in the US is high: underage drinking accounts for about 11 per cent of all alcohol consumed nationwide, and excessive drinking causes more than 4,300 deaths among under-21 year olds every year.

A national programme along the lines of Youth in Iceland is unlikely to be introduced in the US, however. One major obstacle is that while in Iceland there is long-term commitment to the national project, community health programmes in the US are usually funded by short-term grants.

Milkman has learned the hard way that even widely applauded, gold-standard youth programmes aren’t always expanded, or even sustained. “With Project Self-Discovery, it seemed like we had the best programme in the world,” he says. “I was invited to the White House twice. It won national awards. I was thinking: this will be replicated in every town and village. But it wasn’t.”

He thinks that is because you can’t prescribe a generic model to every community because they don’t all have the same resources. Any move towards giving kids in the US the opportunities to participate in the kinds of activities now common in Iceland, and so helping them to stay away from alcohol and other drugs, will depend on building on what already exists. “You have to rely on the resources of the community,” he says.

His colleague Álfgeir Kristjánsson is introducing the Icelandic ideas to the state of West Virginia. Surveys are being given to kids at several middle and high schools in the state, and a community coordinator will help get the results out to parents and anyone else who could use them to help local kids. But it might be difficult to achieve the kinds of results seen in Iceland, he concedes.

Short-termism also impedes effective prevention strategies in the UK, says Michael O’Toole, CEO of Mentor, a charity that works to reduce alcohol and drug misuse in children and young people. Here, too, there is no national coordinated alcohol and drug prevention programme. It’s generally left to local authorities or to schools, which can often mean kids are simply given information about the dangers of drugs and alcohol – a strategy that, he agrees, evidence shows does not work.

O’Toole fully endorses the Icelandic focus on parents, school and the community all coming together to help support kids, and on parents or carers being engaged in young people’s lives. Improving support for kids could help in so many ways, he stresses. Even when it comes just to alcohol and smoking, there is plenty of data to show that the older a child is when they have their first drink or cigarette, the healthier they will be over the course of their life.

But not all the strategies would be acceptable in the UK – the child curfews being one, parental walks around neighbourhoods to identify children breaking the rules perhaps another. And a trial run by Mentor in Brighton that involved inviting parents into schools for workshops found that it was difficult to get them engaged.

Public wariness and an unwillingness to engage will be challenges wherever the Icelandic methods are proposed, thinks Milkman, and go to the heart of the balance of responsibility between states and citizens. “How much control do you want the government to have over what happens with your kids? Is this too much of the government meddling in how people live their lives?”

In Iceland, the relationship between people and the state has allowed an effective national programme to cut the rates of teenagers smoking and drinking to excess – and, in the process, brought families closer and helped kids to become healthier in all kinds of ways. Will no other country decide that these benefits are worth the costs?


The United States surgeon general’s landmark report on alcohol, drugs and health entitled “Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health,” concludes that alcohol and drug misuse, disorders and addiction are among America’s most pressing public health concerns. As noted in the report, nearly 21 million Americans – more than the number of people who have all cancers combined – suffer from substance use disorders.

The exhaustive report’s chapter dedicated to prevention programs concludes that evidence-based prevention interventions, carried out before the need for treatment, are critical because they can delay early use and stop the progression from use to addiction resulting in costly individual, social and public health consequences. As the study states, “The good news is that there is strong scientific evidence supporting the effectiveness of prevention programs and policies.”

The report concludes that interventions for adolescents ages 10 to 18 have been shown to affect either the initiation or escalation of substance use. D.A.R.E.’s “keepin’ it REAL” curriculum is among a number of select programs the surgeon general identifies as building social, emotional, cognitive and substance refusal skills that provide children with accurate information on rates and amounts of peer substance use.

D.A.R.E. America formed an alliance in 2008 with Pennsylvania State University for adoption of the curriculum as the D.A.R.E. middle school program. The program was developed by PSU with support from the National Institute on Drug Abuse, utilizing rigorous longitudinal scientific evaluations to create this evidence-based program. D.A.R.E. adopted the “keepin’ it REAL” middle-school curriculum that same year and its elementary school curriculum in 2013. D.A.R.E.’s “keepin’ it REAL” Elementary and Middle School Curricula adhere to relevant National Institute of Health’s Lessons from Prevention Research principles.

In 2014, Scientific American magazine commended D.A.R.E.’s Keepin’ it REAL curricula in its article, The New D.A.R.E. Program — This One Works. The “keepin’ it REAL” substance-abuse curriculum focuses on elementary and middle-school students’ decisions, not drugs (




The social developmental processes by which child maltreatment increases risk for marijuana use are understudied. This study examined hypothesized parent and peer pathways linking preschool abuse and sexual abuse with adolescent and adult marijuana use.


Analyses used data from the Lehigh Longitudinal Study. Measures included child abuse (physical abuse, emotional abuse, domestic violence, and neglect) in preschool, sexual abuse up to age 18, adolescent (average age=18years) parental attachment and peer marijuana approval/use, as well as adolescent and adult (average age=36years) marijuana use.


Confirming elevated risk due to child maltreatment, path analysis showed that sexual abuse was positively related to adolescent marijuana use, whereas preschool abuse was positively related to adult marijuana use. In support of mediation, it was found that both forms of maltreatment were negatively related to parental attachment, which was negatively related, in turn, to having peers who use and approve of marijuana use. Peer marijuana approval/use was a strong positive predictor of adolescent marijuana use, which was a strong positive predictor, in turn, of adult marijuana use.


Results support social developmental theories that hypothesize a sequence of events leading from child maltreatment experiences to lower levels of parental attachment and, in turn, higher levels of involvement with pro-marijuana peers and, ultimately, to both adolescent and adult marijuana use. This sequence of events suggests developmentally-timed intervention activities designed to prevent maltreatment as well as the initiation and progression of marijuana use among vulnerable individuals.

Source:  Addict Behav. 2016 Nov 17;66:70-75. doi: 10.1016/j.addbeh.2016.11.013. 

Since many drug dependent individuals are known to be depressed and sometimes suicidal this research is encouraging. NDPA

Suicide is the cause of more than 42,000 deaths in the United States every year, making it the 10th leading cause of death in the country. Now, a new study paves the way for a drug to avert suicidal behavior, after identifying an enzyme related to brain inflammation that has the potential to predict and prevent suicide.

Researchers say their findings may bring us closer to a drug that can prevent suicidal behavior.

In the journal Translational Psychiatry, researchers reveal how a certain variant of the enzyme ACMSD leads to abnormal levels of two acids in the brain, which may encourage suicidal behavior.

The research team – including senior author Dr. Lena Brundin of the Center for Neurodegenerative Science at Van Andel Research Institute in Grand Rapids, MI – say their findings could bring us closer to a blood test that can identify patients at high risk of suicide.

What is more, the study suggests ACMSD could be a promising drug target for suicide prevention.

According to Dr. Brundin and colleagues, previous research has suggested the immune system plays a role in depression and suicidal behavior, primarily by responding to stress with inflammation.

However, the underlying mechanisms of this association have been unclear, which has hampered the discovery of clinical strategies to prevent suicide. The new study aimed to shed some light.

Past studies have shown patients with suicidal behavior experience persistent inflammation in their blood and cerebrospinal fluid (CSF).

With this in mind, the researchers assessed the blood and CSF samples of more than 300 individuals from Sweden, some of whom had attempted suicide.

ACMSD enzyme variant more prevalent in people with suicidal behavior

On comparing samples, the team found that individuals who had attempted suicide had abnormal levels of both picolinic acid and quinolinic acid. These irregular acid levels were identifiable in samples taken straight after a suicidal attempt and at various points over the subsequent 2 years.

Among subjects with suicidal behavior, levels of picolinic acid – known to have neuroprotective effects – were too low, while their levels of quinolinic acid – a known neurotoxin – were too high.

These abnormal levels were most prominent in CSF, the team reports, though they could still be identified in blood samples.

Since previous research had shown that both picolinic and quinolinic acid are regulated by the enzyme ACMSD – known to regulate brain inflammation – the researchers conducted a genetic analysis of individuals with suicidal behavior, as well as healthy controls.

From this, they found that individuals who had attempted suicide were more likely to possess a specific variant of ACMSD, and this variant was associated with increased levels of quinolinic acid.

While the study is unable to demonstrate that ACMSD activity is directly linked to suicide risk, the researchers say their findings suggest the enzyme could be a potential drug target for suicide prevention. “We now want to find out if these changes are only seen in individuals with suicidal thoughts or if patients with severe depression also exhibit this. We also want to develop drugs that might activate the enzyme ACMSD and thus restore balance between quinolinic and picolinic acid.”

Co-study leader Dr. Sophie Erhardt, Karolinska Institutet, Sweden

Additionally, since the results show that abnormal levels of picolinic and quinolinic acid can be identified in the blood, the team says they may bring us closer to a blood test that can identify patients at high risk of suicidal behavior.

Source:  4th Oct.2016

BRIDGEPORT — A drug-prevention organization uses reverse peer pressure to persuade teenagers to steer clear of controlled substances, Bridgeport City Council learned Monday night. Angie Ferguson, executive director of Drug Free Clubs of America, said teens who join the organization agree to undergo random drug testing and receive rewards for being members.

The rewards range from school field trips to special deals at local businesses, Ferguson told city council during a work session that preceded the regular meeting at Bridgeport City Hall. “That makes the other kids jealous, and they want to join,” she added.

Drug testing is the centrepiece of the organization’s drug-prevention efforts, Ferguson said.

Teens who agree to join consent to an initial drug screen and receive a photo identification card upon passing the test, Ferguson said. They also know they could be randomly tested throughout the year, Ferguson said. “If somebody offers you something, you can say, ‘I can’t because I might be drug-tested,’” she said. “And there’s no comeback for that.”

Ferguson said Drug-Free Clubs was started by her father, a retired Cincinnati firefighter.

He and another firefighter were brainstorming how to reverse the devastation that drugs were wreaking on their community, Ferguson said. They settled on drug testing, with those testing negative receiving recognition and positive reinforcement, Ferguson said.

Drug testing is seen as something punitive and heavy-handed, but it doesn’t have to be leveraged like that,” she said. “Drug testing works all the time. That’s why we do it in business.”

Forming a local Drug Free Club requires a buy-in by the schools, students, parents and the community, said Ferguson, who also gave a presentation during the council meeting.

Drug test results are shared only with the parent, with membership at stake should a test return positive, Ferguson said.

The cost to join is $67 per student per year, Ferguson said.

Councilwoman Melissa Matheny expressed concerns about students whose parents might not have the means to pay the membership fee. The organization never launches a chapter without a plan for those who can’t afford the fee, Ferguson replied.

Source: 13th May 2015

This is a good example of positive prevention. When local businesses agree to be involved, more teens agree to sign up. Offers of free cinema tickets, entry to skating rinks, meals at McDonald’s and similar encourage drug free youngsters to remain clean.

Whilst students already using heavily might not want to join, the school would then be able to keep a watchful eye on those refusing membership and identify users early on; this would enable helping strategies to be used for such pupils. Fewer users in an area results in safer communities, better academic results in schools and would be a win-win situation all round. NDPA


This essay is about the drug problem in society, particularly in the United States. By “drug” I mean alcohol, tobacco, and illegal drugs such as marijuana, hallucinogens, stimulants, depressants, and opiates. In regard to youth, inhalants (household chemicals inhaled to get a “high”) are also included.

This is not about the struggles faced by individuals who are addicted, or who struggle with any of the many life problems that can arise from drug use. Others are well addressing those issues in the treatment programs they offer and the publications they write. That society should be more diligent in ensuring availability of treatment for all who need it has been well stated by others. This essay is not about people’s drug problems so much as society’s drug problem.

The problem is that drugs are significantly decreasing our collective quality of life: decreasing our capacity to solve the problems that we collectively face in living. Whether you turn to issues of economics, health, social justice, family life, or the strength of the work force, the magnitude of the damage done by drugs is striking:

  • The number of deaths due to drugs in the United States alone each year exceeds 400,000 from tobacco, 100,000 from alcohol, and 35,000 from other drugs.
  • The most recent estimate of cost to U.S. society (not to users) of alcohol and other drug abuse was 246 billion dollars: 148 billion from alcohol abuse and 98 billion from other drug abuse.
  • A large percentage of health problems and health care costs are due to alcohol or other drugs.
  • Substance abuse in a single year costs American businesses 37 billion dollars due to premature deaths and another 44.6 billion dollars due to employee illness. Drug dependence and alcohol together cost businesses 200 billion dollars. A majority of the alcohol problems are caused by light and moderate drinkers, rather than alcoholics.
  • A high percentage of child abuse and neglect is associated with parental AOD (alcohol or other drug) abuse.
  • A recent study of teen marijuana users found they were 4 times more likely than non-users to attack someone, 3 times more likely to destroy others’ property, and 5 times more likely to have stolen things.
  • The combination of alcohol-related accidents, assaults, and suicides makes alcohol the leading risk factor for adolescent death and injury.

Whether or not you have directly experienced a drug problem in your life, society’s drug problem is shared by all of us. Most of the people who are aware of the impact of drugs on families and other relationships would argue forcefully one person’s drug use hurts more than just that person. The issue may be debatable in the case of any single individual, but collectively there can be no doubt: the drug problem is a problem for all of us.

In the twelve years I have worked in drug prevention, I have learned a lot about how drug use develops, and how it can be prevented. I have discovered that there is tremendous energy and potential in drug prevention, but progress has sometimes been slow, for good reason. The reason is that the general public, and in some cases even prevention professionals, hold some core assumptions about the drug problem that are actually incorrect. As a result, much of the effort put into prevention strays slightly, but significantly, from what is needed.

This essay is an attempt to identify, describe, and correct those faulty assumptions. This is not a “how to” book on prevention. I have written such a book (Best Practices in ATOD Prevention, 1997), with much help. But having the right tools are not enough to become a builder. To be successful with “how to,” you have to start with, “what’s that?” This essay is about understanding the drug problem: what causes it and what is needed to stop it. The application of this knowledge is up to each reader. I hope you find some valuable insights here, or perhaps find support for some of your own observations.

I am convinced that if we stop going down dead-end streets, we can really get places in prevention. Thanks for letting me share the results of my explorations in drug prevention.

Fallacy #1: The primary target of drug prevention should be hard-core drug abuse.

This fallacy has three main parts: (a.) which drugs are the problem, (b.) which drug users are the problem, and (c.) the relation of addiction to drug abuse.

a. “Shouldn’t crack, speed, and heroin be our number one concern?”

No. Ounce for ounce these drugs are certainly among the most potent, but they are (or should be) of secondary concern to drug prevention because of the developmental nature of drug abuse, the limitations of prevention, and the greater amount of societal problems associated with other drugs.

Development of Drug Abuse

It is exceedingly rare for an adult who has never used any drug to use drugs like cocaine or heroin. Nearly as rare is a youth or adult who uses one of these drugs without a history of use of at least one, and often all three, “gateway” drugs: alcohol, tobacco, and marijuana.

Don’t misunderstand the gateway drug phenomenon: obviously not all people who use alcohol, tobacco, or marijuana progress to other drug use. But, the odds of other drug use depend on gateway use because those who don’t use gateway drugs are so extremely unlikely to use other drugs.

The gateway phenomenon includes two other notable features in addition to the issue of whether or not gateway drugs are used. One is that the younger a person is when they begin gateway use, the greater their likelihood of drug problems (with gateway and other drugs) later in life. The other is that people who use two or three gateway drugs are more likely to progress to other drugs than people who use one (use of all three is most significant).

So alcohol, tobacco, and marijuana are truly “gateways” to other drug use. Although most of the people who go through the gate don’t do on to other drug use, nearly everyone who goes on to other drugs passes first through the threshold of gateway use. This alone doesn’t conclude the case for where to direct drug prevention, but sets the stage for two other two facts.

Limitations of Prevention

Prevention is just one of the major strands of anti-drug efforts. The other two are treatment and legal restrictions (regarding use, possession, and sale of drugs). To a great extent the target population for prevention and the target for treatment are opposite. By the time people go through gateway use and begin using other drugs, they have become (due to some combination of self-selection and the results of earlier gateway use) fairly habituated to drugs. In many cases they are already addicted. The habit formed from regular drug use is hard to break. When addiction is also present, the strong forces involved are not only psychological but also bio-chemical. We like to think our minds are in control, but addiction can rule behavior at a level so deep and powerful that rational thought pales in comparison.

As a result, prevention efforts that may be appropriate for youth who are non-users or experimenters with drugs are simply not effective with more committed users, and certainly not with addicts. Addiction calls for drug treatment: prevention is inadequate for those trying to back away from heavy drug use.

On the other hand, treatment is not appropriate for first-time experimenters. The treatment process is not designed for that population, and the cost of providing such intensive services is neither justified for the individual drug experimenter nor remotely available for the whole population of experimenters. For them and for those who are yet to experiment, prevention is the key.

Of those who use gateway drugs, some require treatment (or cessation aid, in the case of tobacco), but most do not. Of those who use other drugs, a large proportion requires treatment, and few would benefit from prevention. This strengthens the case for targeting gateway drugs in prevention, and leads to the third point.

Societal Cost of Gateway Drug Problems

Recall that ounce per ounce, gateway drugs are not as destructive as crack, crank, and heroin. But the scope of any one drug’s impact on society depends on the amount of use (including number of users and degree of use by each) as well as the drug’s dangers. Unlike crack and heroin, gateway drugs are used by a large portion of the population. And, though gateway drugs seem less dangerous than so called “hard” drugs, research and bitter experience have shown that the gateway drugs are dangerous enough:

  • Tobacco kills four times as many Americans as does alcohol, and alcohol kills three times as many as all illegal drugs combined.
  • Alcohol seems to be the leading cause of teen deaths, based on the high percent of instances in which alcohol is a major factor in car crashes, suicides, homicides, drownings, and other unintended injuries.
  • Marijuana combines the cancer potential of tobacco with the cognitive impairment of alcohol, except that impaired thought lasts longer after each marijuana use than after each alcohol use.

As a result, the benefit to society of cutting gateway drug use in half would be much greater than cutting other drug use in half. Combine this point with the point about prevention’s limits and the point about the development of drug abuse, and you get a strong case for making gateway drug use (particularly by youth) the prime target of prevention.

b. Shouldn’t prevention always target “high risk” youth?

No. Although it may be appropriate to devote extra preventive effort to some groups of youth, conceiving ATOD prevention in only those terms is problematic for reasons that include the breadth of risk, the importance of environmental risk, and the need for different approaches according to the nature of different risk conditions.

Breadth of Risk

While some characteristics act as “risk factors” for youth ATOD use, the absence of those risk factors doesn’t guarantee a drug-free youth. To some extent, everyone is at risk. The older a persons gets without using, the lower the risk that they will use. Furthermore, while the primary aim of ATOD prevention is to prevent use, an important secondary function is to help prepare all youth for addressing the drug problem in society: as family members, co-workers, or citizens. We are currently a society at risk.

This is not to say that community risk conditions shouldn’t be considered, nor that “selective” ATOD prevention efforts can’t be done for groups of medium risk youth or families. I use the term “medium risk” to refer to youth who haven’t begun ATOD use, but whose family or personal characteristics include some risk factors (e.g., poverty, low academic achievement, parental drug use or addiction, etc.) for youth ATOD use. But these efforts are a supplement to prevention efforts for all youth, rather than a replacement.

Environmental Risk

Preoccupation with risk profiles of individual youths, or even groups of youths, diverts attention away from the strongest influences of whether most youth will try drugs or avoid drugs. The combination of youths’ peer social environment, family environment, school environment, media environment, and their community’s adult social environment account for the vast majority of variation in youth drug behavior. A “low risk” youth who enters a “high risk” environment (e.g., a “no-use” youth who moves to a school where drinking is the norm) is no longer low risk.

Prevention planners who only look at what’s “inside” youth can miss the environmental factors (including media influences) that shape youths’ attitudes. If not directly addressed, these environmental factors can misdirect youths’ attitudes and behaviors as fast or faster than youth-focused programs can positively affect them.

Different Risks – Different Approaches

The risk factor that is most important to the largest number of youth in regard to initiation of gateway drug use is their perception of peer attitudes about drugs, as will be discussed in regard to “Fallacy #3.” However, for a smaller number of youth other factors play a major role. For example, children raised in households with parental violence, neglect, or addiction are more likely than average to develop their own problems with alcohol or other drugs. The number of children in this kind of situation, though much larger than it should be, is small compared to the overall number of children and families.

For a child in a household with parental violence (domestic violence and/or child abuse), what happens to that violence may be the most important “risk factor” for their future mental health, including their relation to drugs. Their greatest need may have little to do with drug prevention, and everything to do with appropriate resolution of the violence.

For a youth failing school, the greatest need may be assistance with whatever is interfering with school achievement.

In each case, the most effective form of drug prevention may be to resolve the problem(s) that increase risk for drug use, rather than to directly address the issue of drugs. On the other hand, a youth who has started to experiment with drugs may need intervention services, sometimes called “indicated prevention”, but actually more closely akin to some forms of substance abuse treatment counseling. In all these instances, the kinds of programs that constitute “universal” drug prevention programs may be less relevant. So, these kinds of “high risk” youth need more focused and intensive assistance than is available through what I am calling drug prevention, i.e. programs designed to impact the gateway drug attitudes and behaviors of large groups of youth. They may be helped somewhat by such programs, and so should not be excluded, but to limit participation in prevention programs only to such “high risk” youths is probably not appropriate, particularly given the risk of a norm of gateway drug use arising among program participants if all are “high risk.”

c. Isn’t addiction prevention the main goal of substance abuse prevention?

No. Addiction is one major outcome of drug use, but the impairment of rational thought, the plethora of anti-social and injurious behaviors caused or heightened by that impairment, and the direct toxic effects of drugs are all substantial societal problems worthy of prevention. Addiction increases these other problems, but a person need not be addicted in order to seriously injure of kill themselves or others while impaired, typically due to negligence (as in DUI crashes) rather than violent intent.

Further, since the number of alcohol or other drug users at any given point in time far exceeds the number of addicts (including alcoholics), the societal damage done by non-addicted persons can cumulatively exceed the damage done by addicts. Even though individual addicted persons are more problematic to society than individual non-addicted AOD (alcohol and other drug) users, the much larger number of non-addicted users makes them a major part of societal AOD problems.

Efforts to make the public more aware of realities of addiction should continue, but preventing addiction is one main goal of drug prevention: not the main goal.

Fallacy # 2: Alcohol and other drug problems are mainly a result of other problems, and drug prevention can best be accomplished by addressing those other problems.

Drug abuse has multiple causative factors: this has become an oft stated truism. Unfortunately, people tend to notice and magnify the causative strand that is most evident in their personal or professional experience. Their observations are strengthened by studies which demonstrate the connection between each of a variety of “risk factors” and drug abuse, but which fail to consider the larger context of the societal drug problem, including which of the many risk factors play the most important roles within the largest numbers of people. Rather than starting with convergence on the most prevalent and powerful risks, people therefore tend to diverge into various less central issues:

  • Persons who focus on poverty see poverty as the main root of drug problems.
  • Persons concerned with stimulating positive youth development see their work as the best form of drug prevention.
  • Persons familiar with dysfunctional family systems see family dysfunction as the main root of drug problems.

Attention to this whole range of negative factors may be appropriate, but mistaking any one of these for the “main” cause of drug problems is not. One person or subgroup may be profoundly influenced by one of these factors, but the prevalence of each factor in the population is far less than the prevalence of drug problems.

Family Dysfunction: Major dysfunction (such as family violence) greatly heightens the chance of youth drug problems, but the majority of youth AOD users (and hence, most of the future AOD abusers) do not come from dysfunctional families. Dysfunctional family life is a potent risk factor but not a prevalent one, in comparison to the scope of youth AOD problems.

Poverty: Poverty makes drug problems more likely, but only slightly more likely: a large number of well-to-do people are among those who children use and abuse alcohol and other drugs.

Positive Youth Development: Policies that empower youth development are a good idea, but aren’t sufficient to prevent youth drug use. The notion that positive youth development can substitute for specific attention to drug prevention is similar to the 1970’s notion that good self-esteem is the key to drug prevention. Unfortunately, ignoring drug prevention in favor of self-esteem tends to produce drug users with high self-esteem. Self-esteem doesn’t protect from the destructive effects of drugs. Youth development programs can be an important aid for youths who lack key developmental assets, but will only impact drug use if:

  1. anti-drug norms are already present in the lives of those youth, or
  2. the youth development program includes building anti-drug norms as part of its mission.

Two kinds of problems arise from the mis-attribution of heightened importance of these factors as causes of substance abuse:

  1. More global causes of ATOD problems, such as youths’ and parents’ attitudes about drug use, may be glossed over in the design of prevention strategies. In other words, potentially efficacious approaches to prevention may be ignored in favor of less broadly effective approaches.
  2. Parents may believe that avoiding family dysfunction is sufficient to prevent youth drug problems.

The worst instances of this fallacy in action have parents or other adults allowing and enabling youth alcohol or other drug use under the misguided notion that only troubled individuals abuse substances. Statements like, “It’s no big deal,” or “They’re just going through a phase,” or “It’s part of growing up” tend to be evidence of this. While it’s true that troubled youth are more likely to develop a drug problem, also true is that alcohol or other drug use can cause a person to become troubled – especially if addiction is involved.

Youth alcohol and other drug use is a bad idea no matter how positive an individual’s circumstances. Youth with substantial personal or family problems are more likely to experience significant problems with drugs, but the initial absence of personal disturbance is no insurance policy against addiction or other ATOD problems. And, although family problems constitute a risk factor for youth ATOD use, family wellness is not a sufficient protective factor to counter other negative influences on youth ATOD decisions. Parents who don’t have general problems with family management can take steps (particularly in regard to monitoring youth activities) to decrease their children’s likelihood of ATOD use, but just being a “good” parent isn’t a cure-all. Drug prevention needs to go beyond the foundation of healthy families and positive youth development, to build attitudes and behaviors that especially counter ATOD influences in society.

Fallacy #3: The main essence of successful drug prevention is communication about the dangers of drugs.

This very common misperception probably sidetracks more prevention efforts than any other single error. Actually the essence of success in preventing youth use of gateway drugs is making drug use unpopular: destroying the myth that peers approve of drug use. This can be supplemented by fact-based approaches and parent programs, but the most basic reason youth as a whole start gateway drug use is because they believe their peers approve of it. No matter how dangerous they are told drug use may be, if they think many others are doing it they will tend to do the same, unless they consistently see very negative effects on those believed to be using.

There are two reasons I see for the continuing strength of Fallacy #3 in spite of evidence to the contrary. The first is our nature as human beings. We like to think we are logical, sensible beings. To some extent we are, but most of us, and especially children and youth, base our actions first on what we observe from those around us, and only secondly on what we believe.

Remember that we are talking about society as a whole here: there are certainly some people who are less prone to be influenced by others (psychology calls them “field independent” as opposed to field dependent), and all of us vary in our susceptibility. But as a whole, we’re just not as logical as we like to think. To be human is to be influenced by our observations of others.

The second reason for the fallacy is a more complex one having to do with the nature of scientific studies of youth alcohol and other drug use. Common scientific method in the social sciences involves looking for things that go together in large populations. The question is what “factors” tend to go with, and particularly to predict, youth ATOD use. A basic premise is that correlation does not necessarily equate to causation, especially in cross-sectional one-time studies. However, when a factor such as “perception of harm” is closely matched with drug use over a period of years, as has been the case in the national “Monitoring the Future” study, observers are hard pressed to ignore the likely conclusion that changing perception of harm is the key to prevention.

The problem is, how does one change perception of harm? The common assumption is that you do this by communicating drug dangers. Often overlooked is that there is an equally strong association with perceived peer approval or disapproval for use of drugs: what youth believe their peers think of drugs. I think that, contrary to common assumptions, the perception of peer attitude drives youths’ own attitudes about drugs (both perceived harmfulness and intent to use). Perception of harm then ends up being a strong indicator of whether a youth will use a drug, especially because it is probably also affected by other risk factors. But the route to turning around perception of harm usually has to go through perceptions of peer approval/ disapproval. When we present logical facts about drug dangers to youth, if they think most of their peers approve of drug use, and indeed use drugs, then the warnings seem ungrounded and are easily ignored.

I base this point on a variety of research, but some of the most striking and easiest to communicate is research about what works in prevention. Of all the things that have been tried in prevention curricula for young teens, the most powerful is simply to correct their typically exaggerated assumptions about how many peers use drugs. When they are shown that far fewer than thought peers use, their attitudes change to a degree not seen with mere truth about drugs.

This is not to say that education about drug dangers is not important for youth: it is! These facts back up the facts about peer attitudes, and may be especially important for some youth who are able to base their behavior on rational truth about drug dangers. Even if this weren’t the case, it would simply not be right to let youth grow up in this society without exposing them to the truth about drugs. But to assume that exposure is the key element of prevention is to severely limit the effectiveness of one’s prevention efforts.

One of the important implications of this is that the images presented by mass media, especially in regard to images of youth attitudes and behaviors, should be a vital concern of prevention. We all like to think that we are too sophisticated to be influenced by the images of television and other media, but it’s just not so. We are influenced. That’s why advertising works. While any one youth may be more influenced by their parents than by the media, youth as a whole are dramatically influenced (as has been demonstrated by studies showing that youth smoke those cigarette brands that are most heavily advertised to youth). Media plays the role of a “super-peer,” playing directly into the heart of youth decisions by telling them what is cool and what isn’t. Prevention cannot afford to ignore this. Luckily, the same principles currently used by alcohol and tobacco advertisers to snare youth users can also be used in prevention. But, first we have to get past this fallacy that drug facts are the key.

Fallacy # 4: Making and enforcing laws against the use of drugs, and against underage use of alcohol and tobacco, is contrary to prevention and treatment of drug use.

This premise has been advanced by legalization groups, claiming all would be well if we did away with laws against drug use and relied solely on prevention and treatment. But the truth is that prevention, treatment, and legal barriers to use all depend on each other for effectiveness. The kind of “prevention” touted by legalization groups is not prevention of use but facilitation of “safe” use, called “harm reduction.” The role of prevention in this scenario is to teach people how to use drugs safely. The problem with this is that the laws against each particular drug are enacted because its use is inherently unsafe. An analogy would be explosives manufacturers lobbying to take the funds used to enforce laws against possessing bombs and instead just teaching youth how to use them “safely,” and of course not until they were 18 or 21. Would the public stand for that? Would even the most avid libertarians be crazy enough to support it? Legalizers suggest that drugs hurt only the user, but impacts of our society’s drug problem go far beyond the circle of users, as was discussed earlier.

Even if, after legalization, the current drug-free message of prevention were maintained, a country that tolerates drug use would be giving a strange message that would undercut any such “no-use” message. “Drugs are dangerous and hurt society, but you can go ahead and do them if you want.” Use would soon rise, not so much from drug-free adults starting use but from every new generation of teens becoming more and more enmeshed in drug use, in spite of any legal age restrictions. This is what has happened when legalization has been tried. Similarly, the number of people entering treatment, cooperating with treatment, and avoiding relapse would be far less without the force of law to compel users to quit.

High quality drug prevention and treatment are currently vital to our society, but their success would be lessened, not increased, if legal sanctions against use were eliminated. The specific workings of the legal and criminal justice system in regard to drug use can always be examined for improvement, but most groups who currently call for drug law “reform” are using the term as a euphemism for legalization.

Fallacy # 5: Marijuana is not dangerous.

We tend to think of drugs as poisons to the body, and measure the potency of a drug by how fast and how completely it can interfere with physical health. We are less quick to recognize that the most crucial characteristics of drugs are their “psychoactive” effect: their alteration of thought, feelings, and behavior. Measured by physical effects only, marijuana is not as dangerous as many other drugs (though it has the potential to kill as many people as tobacco does, if it were as popular as tobacco). But, examined for its behavioral effect, marijuana is quite potent. The subtlety with which it alters behavior, typically over a period of weeks or months, makes it all the more effective as a behavioral change agent. The data that has begun to emerge as younger teens and pre-teens smoke more potent marijuana shows a devastating effect on the social functioning of many users. Some users may have been self-centered when they began use, but marijuana heightens that characteristic, killing the empathy and capacity for altruism that embody the best qualities of society. What is left is a person addicted to marijuana and concerned about marijuana, but not so much about relationships, achievement, or even obeying the law. People sometimes discount the effects of marijuana because many users do not seem to be greatly impaired, but the luck of some in warding off clear impairment is a poor balance to the studies and accumulated life experiences of those who have been severely changed by marijuana use.

Fallacy # 6: Anti-drug laws and anti-drug law enforcement is driven by national bureaucracy and the zealousness of federal officials.

People who travel in a sub-culture of drug tolerance tend to perceive the government’s anti-drug actions as being out of touch with the populace, but polls show that a large majority of the American (and other) public opposes drug legalization. The greatest passion in favor of enforcing drug laws comes not from any government but from families that have seen the worst that drugs do. The proper balance between society’s interest in stopping drugs and the freedom of individuals becomes clear when one has witnessed a family or community ravaged by drug use and addiction. The social value of drugs is far below zero. Any loosening of restrictions on drug use has tended to lead to a cycle of increased use, increased damage to society, and a resulting determination to toughen enforcement of laws against drug use. Ultimately, the source of calls for strict enforcement of laws against drugs come not from any one group but from the power of drugs to damage people, and damage society.

Alan Markwood is the Prevention Projects Coordinator at Chestnut Health Systems, Inc. in Bloomington, Illinois. Responsibilities include:

  • Participating in prevention research, development, and training projects as a contractor to the Illinois Department of Human Services.
  • Directing prevention coalitions in three counties, funded by the federal Center for Substance Abuse Prevention and the Illinois Department of Human Services under grants he wrote.

Mr. Markwood is the principal author of the Best Practices in ATOD Prevention Handbook (1997), and has managed a series of statewide studies on youth substance use in Illinois. He served as InTouch Area 14 Prevention Coordinator at Chestnut Health Systems from 1987 until promoted to his current position in 1995. Prior to his work in prevention, he worked as a School Psychologist for seven years in Illinois and Massachusetts. He has a Master of Arts degree in Psychology from Alfred University and a Certificate of Advanced Graduate Study in Education from Boston University.

Source: Sept.1999

A recently published study sheds new light on how to prevent teen drug abuse. It also provides new evidence that the conventional wisdom regarding the timing of prevention efforts may be wrong. The current study shows that, with the right program, it’s possible to cut high school drug abuse in half.

The results of this study are especially important because they challenge the prevailing wisdom that high school is too late a time to start prevention programs. This program offers a successful approach to helping teens not exposed to an effective prevention program at an earlier age.

The new study, published in the World Journal of Preventive Medicine, shows that an approach proven effective with elementary and middle school students also works with high school students. The study compared students attending schools assigned at random to either receive or not receive the Botvin LifeSkills Training (LST) high school program, which was adapted from the evidence-based LST Middle School program. The LST program prevents tobacco, alcohol, and illicit drug use by teaching students skills for coping with the challenges of life, reducing motivations to use drugs and engaging in unhealthy behaviors, and fostering overall resilience.

Researchers found that the LST high school program reduced drug abuse in teens. Compared to the non-LST control group, there were 52% fewer daily substance users in the LST group. The study shows that dramatic reductions in drug abuse are possible with high school students across different racial/ethnic groups and different parts of the country.

“These are very exciting findings. This study not only shows that it’s possible to cut drug abuse in half among high school students. It also shows that you can do so with a program delivered by classroom teachers who only need minimal specialized training. Since this kind of program is inexpensive and can be widely disseminated to schools across the country, it offers tremendous potential as a cost-effective approach to a major public health problem,” said Dr. Gilbert J. Botvin, developer of the LifeSkills Training program and professor emeritus of Cornell University’s Weill Medical College.

The LifeSkills Training high school program is a highly interactive curriculum that teaches students skills that have been found to prevent substance use and violence. Rather than merely teaching information about the dangers of drug abuse, the LST program promotes healthy alternatives to risky behavior. Throughout the program, students develop strategies for making healthy decisions, reducing stress, and managing anger, as well as strengthening their communication skills and learning how to build healthy relationships. The program also helps students understand the consequences of substance use, risk-taking, and the influences of the media.

SOURCE National Health Promotion Associates. WHITE PLAINS, N.Y.June 25, 2015 /PRNewswire   World Journal of Preventive Medicine

A new drug prevention initiative has been initiated in Lee County, Va. that will provide youth with another way to resist the peer pressures of experimenting with drugs.

“This new program, ‘Give Me A Reason’, was designed to establish a way for parents to obtain free-of-charge drug testing kits that they can use to test their children for drug use,” said Lee County Sheriff Gary Parsons.

The kit uses a cheek swab saliva-based method that is much less invasive than blood test and less susceptible to tamper with. The press release states the kit will test for cocaine, marijuana, methadone, methamphetamine, hydrocodone, barbiturates, opiates, morphine and oxycodone.

“The best thing about these kits it is that they can be used in the privacy of your own home, and you can have the results in 10 minutes,” said the sheriff. “If parents have a drug test kit at home, their children will hopefully think twice before giving into peer pressure.”

The release states the kit will be one way to be able to help deter children from making a decision that may ruin their life. The department wants to have as many resources available to help parents deter their children form making the decision to try drugs.

“This is a voluntary program to help children make positive choices,” Parsons said. “We want our children in this community to have a successful future and make productive adults.”

Source:   4th My 2015

Cigarette warning labels with images depicting diseases caused by smoking help young adults learn about the dangers of lighting up, new research suggests. A study appearing in the Annals of Behavioral Medicine suggests graphic images accompanying written health warnings on cigarette packs may help people better understand and increase their concern about how smoking can harm their health.

“Our outcomes suggest that focusing on enhancing understanding and knowledge from smoking warning labels that convey true consequences of smoking may not only influence motivation directly – both in terms of quitting and prevention of smoking – but may actually drive the emotional experience of the label, which we know is an important predictor of motivation,” Renee Magnan, an assistant professor of psychology at Washington State University, Vancouver, said in a news release.

Magnan added that this was a preliminary study, but it suggested such labels could contribute to larger anti-smoking education campaigns. Researchers took two groups of people between the ages of 18 and 25, which included both smokers and non-smokers, and asked, via an online survey about how much they learned about the harms of smoking from different warning labels.

Participants were shown labels highlighting the negative impacts of lung cancer, heart disease, stroke, impotence, eye disease, neck, throat and mouth cancers and vascular disease, some of which were accompanied by images of the disease. Some labels included pictures that showed the disease, while others were text only.

Young adults in both groups said the labels paired with images did a better job at giving them better understanding, more knowledge, caused more worry and did a better job at discouraging them from smoking than the text alone.

The only exceptions were images of a cigarette held limply in a hand, which was supposed to represent impotence, and an IV in someone’s hand, which was meant to show a long illness, both of which received similar ratings to the corresponding text-only warning.  Magnan said in the news release she wanted to do this study because not much research has been done on whether people learn anything from the labels, although an increasing amount of evidence suggests images on warning labels may help discourage smoking. Magnan’s research was conducted with colleague Linda D. Cameron of the University of California-Merced.

As part of the 2009 Family Smoking Prevention and Tobacco Control Act, the Food and Drug Administration (FDA) published a final rule in 2011 requiring tobacco companies to include color graphics on cigarette packets warning consumers of the negative health implications of smoking. In August 2012, this rule was overturned by the government after it was challenged by several tobacco companies, who claimed such graphic warnings would violate the tobacco industry’s right to free speech. This decision was upturned by the Supreme Court in 2013, giving the FDA permission to enforce graphic warnings on cigarette packets.

Source:   CADCA’s online newsletter, April 9, 2015 


Background and Purpose

An increasing number of case reports link cannabis consumption to cerebrovascular events. Yet these case reports have not been scrutinized using criteria for causal inference.


All case reports on cannabis and cerebrovascular events were retrieved. Four causality criteria were addressed: temporality, adequacy of stroke work-up, effects of re-challenge, and concomitant risk factors that could account for the cerebrovascular event.


There were 34 case reports on 64 patients. Most cases (81%) exhibited a temporal relationship between cannabis exposure and the index event. In 70%, the evaluation was sufficiently comprehensive to exclude other sources for stroke. About a quarter (22%) of patients had another stroke after subsequent re-exposure to cannabis. Finally, half of patients (50%) had concomitant stroke risk factors, most commonly tobacco (34%) and alcohol (11%) consumption.


Many case reports support a causal link between cannabis and cerebrovascular events. This accords well with epidemiological and mechanistic research on the cerebrovascular effects of cannabis.

  1. Daniel G. Hackam, MD, PhD, FRCPC

+Author Affiliations

  1. From the Division of Clinical Pharmacology, Department of Medicine, Western University, London, Ontario, Canada.

  1. Correspondence to Daniel G. Hackam, MD, PhD, FRCPC, 1400 Western Rd, London, Ontario, Canada N6G 2V2. E-mail


There’s a new drug in town.

It’s called Shatter and it looks like dark-amber toffee. It’s THC, the chemical that causes the high in marijuana, extracted from the plant and has highly addictive qualities, said Stratford police Insp. Sam Theocharis.

It’s been around for a while but it’s new to Stratford, Theocharis said.  Police have started to see the drug a bit more frequently and wanted to get the message out to the public.

“When you look at it, it just looks like goo but it’s a new form of marijuana drug,” he said.

Shatter is clear, smooth and solid. It can consist of more than 80% THC, according to the High Times website.

Police seized some Tuesday along with methamphetamine, cocaine, marijuana and prescription drugs after an investigation by the Street Crime Unit.  Two men in their 40s were arrested and face several charges including possession for the purpose of trafficking. The drugs seized are valued at more than $1,500. Cell phones, scales and baggies were also seized, police said.

Shatter sells for about $100 a gram on the streets. It’s dangerous and often leads to overdose, police said.  Whether it will overshadow crystal meth and oxycodone in popularity has yet to be seen.

“I can’t predict but anything that gives you a better high is going to be sought after,” Theocharis said.



Lynne Featherstone accepts advisory council’s recommendation of 12-month ban on substances including most widely used alternative to cocaine

Mephedrone, also known as 4-MMC and used as an alternative to cocaine, has already been banned in the UK. Photograph: Rex

Five legal highs, including an alternative to cocaine that is one of the most common in Britain, are to be banned from midnight on Thursday, ministers have announced.

The drug minister, Lynne Featherstone, said she had accepted a recommendation from the government’s official drug advisers that the five legal highs should face a temporary ban of 12 months while a full assessment of the harm they posed was undertaken.

The Advisory Council on the Misuse of Drugs has said one of the five legal highs, ethylphenidate, which users inject and is widely marketed as a “research chemical” or as a component in branded products such as Gogaine, Nopaine, Burst and Banshee Dust, has been available over the internet in Britain for four years. They said it was one of the most commonly encountered new psychoactive substances (NPSs), as legal highs are officially known, in Britain and has emerged as an alternative to cocaine.

The ACMD recommended the ban on ethylphenidate based on evidence that it had caused serious problems, particularly in Edinburgh and Taunton, Somerset. Four related compounds are to banned at the same time to prevent users switching.

Ethylphenidate is typically sold at £15 a gram for powder, £20 a gram in crystal form and £1 for a 50mg tablet. Professor Les Iversen, the chair of ACMD, said injecting users were putting themselves at risk of blood-borne disease and infections.

Police Scotland said Burst, as it is marketed in Edinburgh, was responsible for the majority of legal-high casualties seeking emergency hospital treatment in the city last summer.

Avon and Somerset police said an epidemic of injecting legal highs in public places in Taunton last summer had led to more than 200 needles being recovered in one clean-up day. In December, the high street “head shop” selling the products was closed down.

The banned substances are closely related to methylphenidate, a licensed stimulant marketed under the brand name of Ritalin that is regularly prescribed to children for the treatment of attention deficit hyperactivity disorder.

The temporary ban means anyone caught making, supplying or importing the drugs will face up to 14 years in prison and an unlimited fine. Possession is not illegal but police and border officials are allowed to search or detain anyone they suspect of having the drugs and seize, keep or dispose of the banned substance.

Drug law reform campaigners said such bans were simply trapping authorities in an “endless game of whack-a-mole” as they tried to play catch-up with drugs chemists. They said that while the government had responded to the frenzy over legal highs, drug misuse deaths overall had risen sharply.

The decision to ban methylphenidate-related substances while continuing to use the parent chemical as a medicine might raise questions over the safety of a drug often prescribed to children.

Ethylphenidate-based products are a growing issue and their use is associated with bizarre and violent behaviour

Advisory Council on the Misuse of Drugs

“The methylphenidate-related materials being marketed as NPS have psychoactive effects so similar to the parent compound that they can be expected to present similar risks to users,” Iversen said in the letter.

Although it has been marketed as a party drug, the ACMD’s advice warns that some ethylphenidate users appear to have developed chronic problems, continually redosing the drug intravenously in binges.

The ACMD report says that in Edinburgh “there has recently been a report of an outbreak of Staphylococcus aureus and Streptococcus pyogenes infections in this area associated with NPS injecting, which is believed to involve ethylphenidate.”

It added: “Ethylphenidate-based products are a growing issue in Edinburgh and their use is associated with bizarre and violent behaviour.”

Drugs reform campaigners said the government’s use of temporary bans on new substances had authorities constantly playing catch up with drugs chemists. The only answer was wholesale reform of drug policy, they said. Danny Kushlick, head of external affairs for Transform, said: “These substances have been brought out because of the success in enforcing the ban on ecstasy and cocaine in particular. Really we have to recognise that this is a self-inflicted trade.








Legal high drug deaths soar in UK

“If we were to have a regulated trade in drugs these ones would not exist. You would not have ‘fake cocaine’ if you could get real cocaine. The whole NPS market is a product of prohibition.

“This is a never-ending game of whack-a-mole because even using the analogues legislation there are new analogues; they can churn these out by the hundreds. This is the opposite of control and regulation. It’s fuelling anarchy in the market and we need to look at regulating frameworks for more benign drugs.”

Niamh Eastwood, director of Release, said new bans on substances only served to push drug use further underground and spur the development of new chemicals with unknown risks to users.

She said: “Speaking more broadly, the government appears to have made NPS something of a cause célèbre in its fight against drugs, apparently in response to the media frenzy over what many unhelpfully term ‘legal highs’. While NPS are indeed a part of the modern debate on drugs, they form a comparatively small part of the market.

“At a time when the associated harms are increasing for other substances – drug misuse deaths rose 21% in 2013, 32% when focusing solely on heroin/morphine deaths – there is a real risk that the government is turning its attention away from addressing the failures of its drug policy holistically in order to pander to poorly-founded fears over this new phenomenon.”

Ethylphenidate is already banned in Denmark, Austria, Germany, Hungary, Portugal, Sweden, Jersey and Turkey. It is also classified under analogue scheduling in the US and Australia.

The other substances recommended for the temporary ban by the ACMD included 3,4-dichloromethylphenidate, methylnaphthidate, isopropylphenidate and propylphenidate. It wasn’t clear how widespread their use was.

Methylphenidate, the drug from which ethylphenidate and its related compounds is derived, is currently controlled as a class B drug in Britain but also licensed as a medicine for conditions including ADHD and narcolepsy. It has also been widely used recreationally, and as a study aid. Research has found it can offer modest improvements in working memory and episodic memory.


Some good news, some not-so-good news about brain recovery from alcohol use disorders

According to a recent review article on recovery of behavior and brain function after abstinence from alcohol[1], individuals in recovery can rest assured that some brain functions fully recover; but others may require more work. In this article, authors looked at 22 separate studies of recovery after alcohol dependence, and drew some interesting conclusions.

First, the good news; studies show improvement or even complete recovery to the performance level of healthy participants who had never had an alcohol use disorder in many important areas, including short-term memory, long-term memory, verbal IQ, and verbal fluency. Even more promising, not only behavior, but the structure of the brain itself may recover; an increase in the volume of the hippocampus, a brain region involved in many memory functions, was associated with memory improvement.

Another study showed that after 6 months of abstinence, alcohol-dependent participants showed a reduction in a “contextual priming task” with alcohol cues; in day to day terms, this could mean that individuals in early recovery from alcohol dependence may be less likely to resume drinking when confronted with alcohol and alcohol-related cues in their natural environment because these alcohol-related triggers are eliciting less craving.- a good thing for someone seeking recovery!

Still other studies showed that sustained abstinence was associated with tissue gain in the brain; in other words, increases in the volumes of brain regions such as the insula and cingulate cortex, areas which are important in drug craving and decision-making, were seen in abstinent alcoholics. This increase is a good thing, because more tissue means more recovery from alcohol-induced damage. A greater volume of tissue in these areas may be related to a greater ability to make better decisions.

Now, the not-so-good news: these studies reported no improvement in visuospatial skills, divided attention (e.g. doing several tasks at once), semantic memory, sustained attention, impulsivity, emotional face recognition, or planning.  This means that even after abstinence from alcohol, people in recovery may still experience problems with these neurocognitive functions, which may be important for performing some jobs that require people to pay attention for long periods of time or remember long lists of requests. These functions may also be important for daily living (i.e. assessing emotions of a spouse, planning activities, etc.).

Importantly, there were many factors that influenced the degree of brain recovery; for example, the number of prior detoxifications. Those with less than two detoxifications showed greater recovery than those with more than two detoxifications.  A strong family history of alcohol use disorder was associated with less recovery. Finally, cigarette smoking may hinder recovery, as studies have shown that heavy smoking is associated with less recovery over time.

So what does all this mean? Recovery of brain function is certainly possible after abstinence, and will naturally occur in some domains, but complete recovery may be harder in other areas. Complete recovery of some kinds of behavior (e.g. sustained attention, or paying attention over long periods of time) may take more time and effort! New interventions, such as cognitive training or medication (e.g. modafinal, which improved neurocognitive function in patients with ADHD and schizophrenia, as well as in healthy groups), may be able to improve outcomes even more, but await further testing.

[1] Recovery of neurocognitive functions following sustained abstinence after substance dependence and implications for treatment

Source:  Mieke H.J. Schulte et al., Clinical Psychology Review 34 (2014) 531–550   October 2014



Between 1986 and 2003, I served as the evaluator of an innovative approach to the treatment of addicted women with histories of neglect or abuse of their children.  Project SAFE eventually expanded from four pilot sites to more than 20 Illinois communities using a model that integrated addiction treatment, child welfare, mental health, and domestic violence services.  

This project garnered considerable professional and public attention, including being profiled within Bill Moyers’ PBS documentary,Moyers on Addiction:  Close to Home.  My subsequent writings on recovery management and recovery-oriented systems of care were profoundly influenced by the more than 15 years I spent interviewing the women served by Project SAFE and the Project SAFE outreach workers, therapists, parenting trainers, and child protection case workers.  This blog offers a few reflections on what was learned within this project about the role of trauma in addiction and addiction recovery.

Trauma, particularly physical/sexual abuse, was ever present in the lives of the women served by Project SAFE, but one must be cautious in over-interpreting trauma as the etiological agent in addiction and related problems.  After all, multitudes of women have experienced childhood and adult trauma without developing the severity, complexity, and chronicity of problems commonly experienced by the women in Project SAFE.  So an early challenge within Project SAFE was to understand what distinguished the trauma resilient from the trauma impaired.  Our collective experience with thousands of women across diverse community and cultural contexts led to the conclusion that the resilient and the impaired differed in two fundamental ways.  They differed in the nature of the trauma they had experienced, and they differed substantially in the recovery capital that influenced their capacities for resilience. 

What separated community populations of women and our clinical population of women was not the presence of trauma but the characteristics of such trauma.  A cluster of traumagenic factors distinguished the clinical group from the more resilient community group.  Trauma in the former was more likely to: 

1) begin at an earlier age (marking less developmental resources to cope with the trauma),

2) involve more physically and psychologically invasive forms of victimization,

3) take place over a longer period of time (e.g., multiple events over days, months, or years rather than a single point-in-time episode),

4) involve multiple perpetrators over time (confirming lack of safety, personal vulnerability, and suspicion that the cause lies within oneself),

5) involve perpetrators drawn from the family or social network (marking a greater violation of trust),

6) involve physical injury/disfigurement or threats of such if event(s) disclosed, and

7) generate environmental responses of disbelief or victim blaming when victimization disclosed.  

Women with histories of perpetration of violence against their children, partners, or others also had experienced three additional factors:  serial episodes of abandonment, desensitization to violence through prolonged horrification (witnessing violence against persons close to them in their developmental years), and violence coaching (transmission of a technology of violence and praise for violence from the family and social environment).  Combinations of these potent traumagenic factors dramatically increased the risk of a broad cluster of problems in personal and interpersonal functioning.

The second conclusion we drew was that women experiencing one or more of these traumagenic factors in community and clinical populations differed widely in the their level of adult functioning, with some exhibiting profound impairments and others exhibiting extraordinary levels of resilience and positive personal and social functioning.  While some of this difference could be accounted for by variations in the number and intensity of traumagenic factors, there was another quite influential force that often tipped the scales from pathology to resilience. Women exhibiting the greatest resilience had experienced trauma, but they also possessed high levels of recovery capital–internal and external assets that could be mobilized to initiate and sustain recovery from trauma and its potential progeny of related problems.  Such resources fell into three categories:  personal recovery capital, family recovery capital, and community recovery capital, with each arena constituting a potential focus of policy development and service programming.   

In contrast to this resilience profile, women served by Project SAFE were collectively marked by the combination of multiple traumagenic factors and low recovery capital.  That combination predictively produced distorted thinking about oneself and the world, emotional distress and volatility, migration from self-medication to addiction, assortative mating (recapitulation of developmental trauma in toxic adult intimate relationships), addiction to crisis, impaired parenting, and chronic self-defeating styles of interacting with professional helpers.

The first challenge in Project SAFE was for the outreach workers, therapists, case workers, parenting trainers, and others not to be personally paralyzed in response to the horror contained in the stories of the women they were serving.  The second challenge was not to be professionally paralyzed by the number, severity, complexity and chronicity of the problems presented by the women entering Project SAFE and the resulting multitude of community agencies involved in their lives.  Through training, skilled clinical supervision, and mutual professional support, those twin challenges were overcome, traditional models of clinical sense-making and intervention were cast aside, and new understandings and approaches were forged that have been described in a series of reports and training manuals.

So let me now share the rest of the story–the story of recovery.  As a long-tenured addiction professional and the evaluator on this project, what most intrigued me was that so many women who were given little chance of success achieved levels of health and functioning that no one, most importantly the women themselves, could have predicted. Equally intriguing were the processes involved in that achievement.  Here are just a few of the lessons of Project SAFE that still have salience today.

Hope, not pain or consequence, is the critical ingredient to successful treatment and recovery of traumatized women. Women with multiple traumagenic factors and low recovery capital don’t hit bottom, they live on the bottom.  They have incomprehensible capacities for physical and psychological pain.  What is catalytic is not pain, but the discovery of hope within relationships that are personally empowering–experienced sequentially within Project SAFE with outreach workers, SAFE clinical staff, a community of peers in recovery, and then within a larger community of recovering women.  In project SAFE, this process most often began through a process of assertive outreach during what I have called a stage of precovery (See Precovery:  “And then the Miracle Occurred”).   The move from precovery to recovery initiation was marked by exposure to women in recovery with whom they could identify and who made recovery contagious by the examples of their own survival and transformed lives.  

Life-limiting mottoes for living must be experientially disconfirmed for recovery to proceed. The mottoes that women brought to their involvement in Project SAFE included:  I am unlovable; I am bad; there is no safety; everybody’s on the make–no one can be trusted; if I get close to people, they will leave me or die; my body does not belong to me; and I am not worthy or capable of recovery. The triple challenges in providing effective addiction treatment to traumatized women are to: 1) avoid confirming these messages by recapitulating processes of victimization (e.g., problems rather than solutions focus, emotional battering via confrontation techniques, or emotional or sexual exploitation) and abandonment (e.g., acute care that provides brief stabilization without continued support or disciplinary discharge from treatment for regressive behavior), 2) experientially challenge these messages (e.g., providing enduring support within frequently tested relationships that unequivocally convey acceptance, regard, respect, safety, and security), and 3) forge new mottoes for living within the processes of story reconstruction and storytelling.

The most powerful catalyst for healing trauma is the experience of mutual identification and support within a community of recovering people.  Such an experience within Project SAFE marked the transition from toxic dependencies on drugs, people, and enabling institutions to healthy interdependence and mutual accountability within a community of recovering women and children.  This suggests that recovery outcomes in traumatized women may be as contingent on community recovery capital (welcoming recovery landscapes) as one’s personal vulnerabilities and resources.  Systematically increasing community recovery capital involves expanding beyond intrapersonal, clinically focused models of recovery support to encompass models for building strong cultures of recovery and models of recovery community building and recovery community mobilization.    

Effective parenting is contingent upon experiencing the essence of such parenting.  Parents cannot authentically give to their children what they have not personally experienced.   In Project SAFE, the journey to effective parenting involved an emotional/relational component (active resistance, emotional regression/dependence, reparenting of mothers by Project SAFE staff and volunteers; and a subsequent focus on selfhood and mutual help) and a skill component (parental modeling, training, and coaching with SAFE clients and their children).  

Effective parenting emerges in middle-to-late stage recovery.  While abuse and neglect of children often remit upon initial recovery stabilization, effective parenting and the larger arena of improved family health must be preceded by heightened recovery stabilization and maintenance and the subsequent transition to an enhanced focus on the quality of personal and family life in long-term recovery.  This suggests the need for structured supports for the developmental needs of children during early recovery (via indigenous peer and professional support) and the need for scaffolding (See Stephanie Brown’s discussion of scaffolding) for the whole family from these same supports during the early recovery process.

Project SAFE began with a focus on the psychopathology of the women it served but quickly shifted its emphasis to the creation of a healing community within which the potential and transformative power of recovery was nurtured and celebrated.  I remain in awe of the stories of these women and what they were able to achieve.

 Source: 28th February 2015

This article shows how drug use in an area can impact more than the individual and their families and friends.  The local economy and small businesses are having to cope with lower productivity due to ‘functioning’ drug dependents in the workforce.    NDPA

New Hampshire drug czar: Addiction dragging state’s economy down

Providing more treatment and recovery options for drug addicts is as much about the addicts as it is about helping spur the state’s economy, said the state’s new drug czar.

“For me, it’s all about the money,” said John G. “Jack” Wozmak, senior director for substance misuse and behavioral health.  Wozmak was appointed in January by Gov. Maggie Hassan. The position is funded by a grant from the New Hampshire Charitable Foundation. Wozmak spent nearly a decade as the administrator of the Beech Hill substance abuse treatment facility in Dublin, and since 1998 had been the Cheshire County administrator.

“With a broad range of experience dealing with substance misuse through his roles in the public sector and in private substance abuse treatment, Jack will help strengthen our efforts to improve the health and safety of Granite Staters, and I thank him for his commitment to serving the people of New Hampshire, as well the New Hampshire Charitable Foundation for making his position possible,” Hassan said in a statement.

Wozmak’s task: Get a host of agencies and organizations to work together to reduce the state’s drug abuse, particularly heroin addiction.  Wozmak takes the post at a time when heroin overdoses and deaths are at an all-time high in New Hampshire. The Centers for Disease Control reports that New Hampshire is among 28 states that saw big increases in heroin deaths.

But Wozmak said drug addiction is more than the headline-generating heroin overdoses and drug-related burglaries and robberies that dominate the news.
“Yes, the number of heroin deaths is doubling (from the previous year). But that’s just the tip of the iceberg” of the state’s drug epidemic, he said.

Functioning addicts

The underlying problem – and what the drug czar said will help him get more money for treatment and prevention efforts from state legislators – is the thousands of drug abusers who do not necessarily overdose but drive up costs for employers, he said.
“You don’t hear about the day-to-day drug exposure that companies have because it’s all below the surface, like an iceberg,” he said.

Employers see everything from diminished production to having to overstaff or pay overtime to cover for employees addicted to drugs who miss work, he said. This hurts profit and, in turn, decreases the state’s revenue from business profits taxes. He said estimates from the state’s hospitality sector indicate that as many as 20 percent of that field’s employees may have drug addiction issues.

“I want to increase jobs and this is getting in the way,” he said. “It’s just interfering with productivity. It’s interfering with the economy.”  Wozmak said the drug problem as been exacerbated by a myriad of issues, including budget cuts for treatment programs, along with insurance companies cutting or capping policy coverage for substance abuse treatment.

In the 1980s, he said, the state had more than 600 beds at six private centers providing treatment for substance abuse. After all the cuts by insurance companies, the state now has 62 beds available, he said.

Further, the state ranks second-to-last – after Texas – in providing treatment for drug addiction and has the lowest rate in the country – 6 percent – of people who get treatment for their addictions.  “We have decimated the system of treatment and recovery, and we have to rebuild it,” he said. “Imagine the outrage if diabetes were treated this way.”

More money

Hassan has proposed more than tripling the state’s spending for the Commission on Alcohol and Drug Abuse Prevention, Treatment and Recovery in her proposed two-year budget, from a total of nearly $2.9 million in the 2014-15 budget, to nearly $9.6 million in 2016-17.

The way to convince legislators that the funding is necessary is by appealing to their desire for job growth in a state that has had anemic population growth, Wozmak said.  To get population and job growth, he said, the state has to make its work force healthier and the best way to do that is to reduce drug addiction.

“If you ran on a platform of job growth, you have to deal with this issue,” he said. “If (job growth is) not going to be from people moving here, then you have to improve the work force that’s here.  “If you’re not looking to take care of this problem, then you’re falling down on your promise,” he said. “If you want to create jobs, you have to make the work force more viable.”

Wozmak said the problem can be solved. He said his role includes getting the affected parties – including law enforcement, public resources, private or nonprofit organizations, charities and treatment facilities – working together. He said a provision of the Affordable Care Act that requires insurers to cover substance abuse again should help spur private investment in treatment and recovery facilities.

“There is no easy answer, but I believe there are many opportunities to make the change now on a variety of levels and a myriad of fronts,” he said. “I think we’re going to have a lot of success.”  He said getting help from the state’s medical professionals will also be key, as most heroin addicts, he said, start with addictions to prescription painkillers. He said medical professionals are “not the sole source” of the issue, but could be involved in changing the way pain is managed to help prevent addictions.

“None of them wanted to become addicts,” he said.

– See more at:    8th March 2015

STATEN ISLAND, N.Y. — As the prescription drug and heroin epidemic continues to worsen on Staten Island and elsewhere, Borough President James Oddo plans on combating that by impressing on kids the importance of staying away from drugs.

He outlined an initiative recently during an editorial board meeting with the Advance, beginning with fifth-graders and imparting on them why they are “Too Good For Drugs.”

The aptly named program will either pair classroom teachers with police officers during the school day or pair after-school leaders with officers to teach students “an evidence-based program that has proven to work,” Oddo said.

The program will be piloted in the spring in one public school in each Staten Island police precinct and later broadened to other public and private schools.

In the 120th Precinct, PS 16 will pilot the program; PS 44 in the 121st Precinct; PS 8 in the 122nd Precinct; and PS 3 in the 123rd Precinct.


Statistics show that alcohol and substance abuse among high school students is higher on Staten Island than the city average. That applies to all categories of use, including for alcohol, marijuana, heroin, cocaine, opioids and other prescription drugs.

Oddo’s director of education, Rose Kerr, said the NYPD, Department of Education and the Roman Catholic Archdiocese of New York reviewed the curriculum and found “that it will be one that can be adapted to the police officer in the classroom.”

There will be a mechanism, she said, to monitor behavioral changes or use feedback forms to determine effectiveness of the curriculum and then decide how to spread it to other schools.

Oddo said of the initiative, “to a certain degree, it’s the same approach” as the D.A.R.E program, which is no longer implemented in NYC schools.

Ms. Kerr said, “The curriculum is contact-based on specifically ways in which abuses can be combatted: Decision-making skills and other content and life skills.”

She added, “We are hoping that this will be an ounce of prevention as opposed to a cure. We need the prevention piece, we need young ones to think differently and make different choices.”


Oddo said it became clear that high school and even middle school is too late to begin talking to kids about substance abuse.

He hopes to “start at the fifth grade and then grow this curriculum so that at each grade, in multiple steps along the way, these kids have the right message to kind of counter the pressures.”

Oddo added, “Is this the panacea? No. But it’s the beginning of getting a much larger presence in our schools, to get much more aggressive with this captive audience to fight this. Because this is life and death and there’s been, frankly, too much death.”

Source: 27th Feb.2015

Grant JD1, Scherrer JF, Neuman RJ, Todorov AA, Price RK, Bucholz KK.



Little empirical evidence exists to determine if there are alternative classification schemes for cannabis abuse and dependence beyond the definitions provided by Diagnostic and Statistical Manual (DSM) criteria. Current evidence is not conclusive regarding gender differences for cannabis use, abuse and dependence. It is not known if symptom profiles differ by gender.


Latent class analysis (LCA) was used to assess whether cannabis abuse and dependence symptom patterns suggest a severity spectrum or distinct subtypes and to test whether symptom patterns differ by gender. Data from 3312 men and 2509 women in the National Longitudinal Alcohol Epidemiologic Survey (NLAES) who had used cannabis 12 + times life-time were included in the present analyses. The comparability of the solutions for men and women was examined through likelihood ratio chi(2) tests.


Based on the Bayesian information criterion and interpretability, a four-class solution was selected, and the classes were labeled as ‘unaffected/mild hazardous use’, ‘hazardous use/abuse’, ‘abuse/moderate dependence’ and ‘severe abuse/dependence’. The solutions were generally suggestive of a severity spectrum. Compared to men, women were more likely to be in the ‘unaffected/mild hazardous use’ class and less likely to be in the ‘abuse/moderate dependence’ or ‘severe abuse/dependence’ classes. The results were generally similar for men and women. However, men had consistently and substantially higher endorsements of hazardous use than women, women in the ‘abuse/moderate dependence’ class had moderately higher rates for four dependence symptoms, and women in two of the classes were more likely to endorse withdrawal.


Our findings generally support the severity dimension for DSM-IV cannabis abuse and dependence symptomatology for both men and women. While our results indicate that public health messages may have generic and not gender-specific content, treatment providers should focus more effort on reducing hazardous use in men and alleviating withdrawal in women.

Source: Addiction. 2006 Aug;101(8):1133-42.

Anderson KG1, Sitney M, White HR.


Background. Motivational models for marijuana use have focused on reasons to use marijuana, but rarely consider motives to abstain.


We examined how both adolescent marijuana abstinence motives and use motives contribute to marijuana use and problems at the end of emerging adulthood. Methods. 434 community recruited youth who had not initiated marijuana use at baseline were followed from adolescence (at ages 12, 15, and 18 years) into emerging adulthood (age 25 years).  Motives to abstain and to use marijuana, marijuana consumption, and marijuana-related problems were assessed across time.

Results. Endorsing more motives to abstain from marijuana across adolescence predicted less marijuana use in emerging adulthood and fewer marijuana-related problems when controlling for past motives to abstain and marijuana-related behavior. Positive reinforcement use motives related to increased marijuana consumption and problems, and negative reinforcement motives predicted problems when controlling for past marijuana use motives and behaviors. Expansion motives during adolescence related to lower marijuana use in emerging adulthood. When considered together, motives to abstain buffered the effect of negative reinforcement motives on outcomes at age 25 for youth endorsing a greater number of abstinence motives.

Conclusions/ Implications. Given these findings, inclusion of both motives to use and abstain is warranted within comprehensive models of marijuana use decision making and may provide important markers for prevention and intervention specialists.

Source: Subst Use Misuse. 2015;50(3):292-301. doi: 10.3109/10826084.2014.977396. Epub 2014 Nov 14.

Australians have become accustomed to labels on cigarettes warning about the risk of smoking causing cancer and other diseases. And our research, published in the latest edition of BMC Public Health, shows similar labels could help consumers better understand the harms of drinking alcohol. Alcohol is estimated to cost the Australian economy A$36 billion a year in preventable death, illness, injury, and hospitalisation. There is growing evidence that alcohol increases the risk of certain types of cancer, diabetes and heart disease. The national alcohol guidelines recommend Australians limit their alcohol consumption to no more than two standard alcoholic drinks per day or drink no more than four drinks in a single sitting to reduce the risk of alcohol-related disease and injury.

But despite the risks, no warnings are given when alcohol is advertised, other than to suggest responsible drinking, often tacked on at the end of the ad.

Even worse, ads sponsored by Australia’s alcohol industry, such as DrinkWise’s ad showing young people how to drink “properly”, do little to inform. They serve only as a token demonstration of balancing the A$125 million-plus a year spent on indirect and direct advertising of alcohol.

There are few opportunities for the public to be made aware of the health risks of alcohol. Around 90% of men and 81% of women believe that they can drink alcohol every day without affecting their health.

Labelling cans and bottles with health warnings is one way of raising awareness of the risks of alcohol, and has been adopted in a range of countries including France and the United States.

The problem with these messages is that they tend to focus on the risks of drinking when pregnant and the dangers of drink driving. Even in these countries, few people would necessarily associate alcohol with an increased risk of a range of cancers, including breast cancer.

Unsurprisingly, little research has been done into the effectiveness of labelling of alcohol with cancer warnings. This is what motivated a team of researchers from Curtin, the University of Western Australia and the Cancer Council WA to investigate how the public would respond to cancer warnings and which messages would be the most effective in getting salient information across.

The online survey tracked the responses of 2,168 drinkers to 12 different health messages: 11 about cancer and a general health warning. The messages had been generated out of a previous round of focus sessions with a group of 48 drinkers.

The results showed that overall, responses to cancer statements were neutral or favourable. Younger, female and more educated participants were more likely to find the messages believable, convincing and personally relevant.

Heavy drinkers – defined as those who drink more than two drinks a day and more than four drinks in a single sitting – were also more likely to consider the messages personally relevant than those who drank less. This is particularly encouraging because this group is most at short-term and long-term risk from the harmful effects of alcohol.

People tended to believe messages about specific cancers and those that said alcohol can “increase the risk of cancer” more than general messages about cancer. A message such as “Alcohol increases your risk of bowel cancer” was more effective than the message “Alcohol causes one in 20 cancer deaths”.

The results of the survey showed there would not be a significant amount of negative reaction to the labelling of alcohol among the general public. This is important because legislation will be easier to pass if it’s unlikely to cause a public backlash.

The other important finding was that the messages about the risk of alcohol and cancer were believable, convincing and personally relevant. This suggests they could help inform consumers about the true risks involved in drinking, especially large amounts regularly.

It’s important for consumers to make informed decisions about whether and how much alcohol to drink. It’s time for Australia to join the growing list of nations mandating alcohol labelling. But we should do so with more targeted and relevant health warnings.

Source:  18th August 2014

A new study found that campaigns to prevent prescription drugs misuse can be more effective by focusing on peers and not peer pressure.

The study was conducted by researchers from Purdue University. The researchers evaluated survey interviews with 404 adults ages 18 to 29 who misused prescription drugs in the past 90 days. This included 214 in-person interviews. These individuals were recruited from popular nightlife locations such as bars, clubs, and lounges in New York City. Average misuse of prescription drugs, such as painkillers, sedatives and stimulants, was 38 times in the past 90 days.

“With the 18-29 age group we may be spending unnecessary effort working a peer pressure angle in prevention and intervention efforts. That does not appear to be an issue for this age group,” said study co-author Brian Kelly, a professor of sociology and anthropology who studies drug use and youth cultures, in a press statement. “Rather, we found more subtle components of the peer context as influential. These include peer drug associations, peers as points of drug access, and the motivation to misuse prescription drugs to have pleasant times with friends.”

“People normally think about peer pressure in that peers directly and actively pressure an individual to do what they are doing,” said Kelly, who also is director of Purdue’s Center for Research on Young People’s Health. “This study looks at that form of direct social pressure as well as more indirect forms of social pressure. We find that friends are not actively pressuring them, but it’s a desire to have a good time alongside friends that matters.”

For the study, researchers evaluated the role of peer factors on three prescription drug misuse outcomes: the frequency of misuse; administering drugs in ways other than swallowing, such as sniffing, smoking, and injecting the drugs; and symptoms of dependency on prescription drugs.

“We found that peer drug associations are positively associated with all three outcomes,” Kelly said. “If there are high perceived social benefits or low perceived social consequences within the peer network, they are more likely to lead to a greater frequency of misuse, as well as a greater use of non-oral methods of administration and a greater likelihood of displaying symptoms of dependence. The motivation to misuse prescription drugs to have a good time with friends is also associated with all three outcomes. The number of sources of drugs in their peer group also matters, which is notable since sharing prescription drugs is common among these young adults.”

The Centers for Disease Control and Prevention (CDC) has officially declared that prescription drug abuse  in the United States is an epidemic.

As of 2012, overdose deaths involving prescription opioid analgesics, which are medications used to treat pain, have increased to almost 17,000 deaths a year in the United States. In 2013, only 16 percent of Americans believed that the United States is making progress in its efforts to reduce prescription drug abuse. Significantly more Americans, 37 percent, say the country is losing ground on the problem of prescription drug abuse. That figure is among the most pessimistic measures for any of the seven public health issues included in the survey.

The study was funded by the National Institute on Drug Abuse (NIDA). Findings will be presented at the 109th Annual Meeting of the American Sociological Association by study co-author Alexandra Marin, a Purdue sociology doctoral student.

Source:   16th August 

 An early onset of drinking is a risk factor for subsequent heavy drinking and negative outcomes among high school students, finds a new study. 

Researchers asked 295 adolescent drinkers (163 females, 132 males) with an average age of 16 years to complete an anonymous survey about their substance use. These self-report questions assessed age at first intoxication – for example, “How old were you the first time you tried alcohol/got drunk?”  They also took stock of the previous month’s consumption of alcohol, including an assessment of the frequency of engaging in binge drinking.

“Teenagers who have their first drink at an early age drink more heavily, on average, than those who start drinking later on,” said Meghan E. Morean, an assistant professor of psychology at the Oberlin College, Ohio and adjunct assistant professor of psychiatry at Yale School of Medicine. The findings also suggest that how quickly teenagers move from having their first drink to getting drunk for the first time is an important piece of the puzzle.

“In total, having your first drink at a young age and quickly moving to drinking to the point of getting drunk are associated with underage alcohol use and binge drinking, which we defined as five or more drinks on an occasion in this study,” Morean noted. We would expect a teenager who had his first drink at age 14, and who got drunk at 15, to be a heavier drinker than a teenager who had his first drink at age 14, and waited to get drunk until age 18, researchers emphasised.

“The key finding here is that both age of first use and delay from first use to first intoxication serve as risk factors for heavy drinking in adolescence,” said William R. Corbin, associate professor and director of clinical training in the department of psychology at Arizona State University

The study is scheduled to be published in the journal Alcoholism: Clinical and Experimental Research.

Source:  20th Sept 2014

Many people who struggle with alcohol or drugs have a difficult time getting better. There are many reasons why these people do not get the help they need to get better. Many family members who see their loved ones struggle have a very difficult time in getting their loved ones assistance. Here are six suggestions on how to convince a person struggling with alcohol or drugs to get the help they need to get better. 

1. Family Intervention

The most popular way to get someone the help they need is to do a family intervention. This is when family members and an interventionist get together with the addict to tell them how they love them and wish that they get help to get better. Each family member takes a turn and tells the person how special they are and that they need to get help. The person who is struggling listens and hopefully they become convinced to get the help they need.

2. Talk To The Person On What Will Happen If They Do Not Get Help

Another way to convince the person who is struggling with alcohol or drugs is to get someone who is an expert on addiction and have them do a one on one talk with this person. This expert on addiction should explain to the addict what will happen if they do not get the help they need to get better. Basically, the expert should warn the person of the dire consequences of what will happen if they do not change their ways. The expert should be vivid as possible and hold nothing back. The goal is to convince the person to get help or they will suffer and eventually their life will slowly come to an end.

3. Use The Services of A Professional Or A Former Addict

Try to find a professional or even a former addict who has “Been There” to talk to the person. This is similar to Step Two, however instead of warning the person, these professionals can use their skills to talk and try to reason with the person. These experts are usually trained and can use a proactive approach into trying to convince the addict to get help. The goal is to try to reason and talk with the person so they can get professional help.

4. Find Out The Reasons Why The Person Won’t Get Help

Many people overlook this suggestion. Ask the person who is struggling with alcohol or drugs to list 3 reasons why they will not get help. At first, they will say all kinds of things, but continue to engage the person and get the 3 main reasons why they refuse to get help. It might take a couple of tries but listen to what they say. Once you get the answers, WRITE them down on a piece of paper. Note: Fear and Frustration are huge factors for the person not getting help.

5. Determine The Solutions To Those Barriers

Once you get those 3 reasons, get a professional or an expert to find the solutions to those issues. For example, the person says that they will not get help because they tried a few times and they failed and that they will fail again. Ask a few addiction professionals to find a solution to this issue that will help the addict overcome this barrier. One good answer to this example is the following: “Yes, you tried to get better and failed however this time we will do things differently. We will keep a daily diary of everything you do and you or someone else will document what you do each day. If you stumble or fail you will write down your feelings at the time and why you failed. When you recover from a bad episode you can READ your diary and find out what went wrong. Once you know what went wrong you will know why you failed and will find a way to prevent this from happening again.”

Use your list from step three and list every positive thing that will counter those barriers. When you are finished, present this to the person who is struggling and explain what you came up with. This will help reduce the person’s fears and anxieties and may convince them to get help. Developing a plan to counter their reasons of not getting help will go a long way.

6. Talk to the Person Instead of Talking At Them

Nobody wants to be lectured. Be honest with them and tell them that it will require some hard work on their part but that they can get better. If they don’t get help, they will suffer. The person who is struggling is scared and they need help in overcoming their fears and resistance to getting help. Remember to find out those fears, address possible solutions to those fears, and you will have a better chance of getting through to that person. Hopefully, sooner or later, you will be able to get through to the person. The key is to be persistent. Be very persistent.

Source:  25th September 2014

Michael Botticelli was seated on a tattered purple couch in an old Victorian here, just outside of Boston. Above his head was a photo of Al Pacino as a drug kingpin in “Scarface,” and gathered around was a group of addicts who live together in the house for help and support. On one door hangs a black mailbox labeled “urine,” where residents must drop samples for drug tests. Botticelli is listening to their stories of addiction and then offered this:   “I have my own criminal record,” he said. 

 “Woo-hoo!” one man yelled after Botticelli’s declaration. The crowd burst into applause.  

The nation’s acting drug czar has a substance abuse problem. Botticelli, 56, is an alcoholic who has been sober for a quarter century. He quit drinking after a series of events including a drunken-driving accident, waking up handcuffed to a hospital bed and a financial collapse that left him facing eviction.  Decades later, Botticelli is tasked with spearheading the Obama administration’s drug policy, which is largely predicated around the idea of shifting people with addiction into treatment and support programs and away from the criminal justice system. Botticelli’s life story is the embodiment of the policy choice and one that he credits with saving his own life.

 The approach at the White House Office of National Drug Control Policy has been, Botticelli said, a “very clear pivot to, kind of, really dealing with this as a public health-related issue of looking at prevention and treatment.” He now heads an office that has shifted away from a “war on drugs” footing to expanding treatment to those already addicted and preventing drug use through education.  

Botticelli became the acting director of drug-control policy earlier this year, about a year and a half after he came to Washington to be former drug czar Gil Kerlikowske’s deputy. The White House has not formally nominated him to take over the job permanently. It is a job that has previously been held by law enforcement officials, a military general and physicians. But for now, it is occupied by a recovering addict.

The nation is in the midst of an epidemic of prescription drug and heroin abuse. The number of drug overdose deaths increased by 118 percent nationwide from 1999 to 2011, most of it driven by powerful prescription opioids and a recent shift that many users are making away from prescription drugs to heroin, which can be cheaper and more accessible.  

Drug trends and issues tend to vary geographically, making a sustained national effort difficult. Insurance companies often do not cover inpatient treatment and an obscure federal rule restricts the expansion of addiction treatment under the Affordable Care Act. The White House is also grappling with the legal, financial and political implications of medical and legalized marijuana. Botticelli’s office has taken the administration’s toughest stance against legalization.  

“Part of this is, ‘How do we look at solutions that work for the entirety of the drug issue?’” he asked. “And not just the entirety of the drug issue, but the entirety of the population?” Botticelli is trying to expand on some of the programs he used at the Massachusetts Department of Public Health, where he was director of the state’s bureau of substance abuse services. They include allowing police to carry naloxone — a drug commonly known as Narcan that can reverse a heroin overdose — and helping people who have completed treatment find stable housing and jobs. 

Botticelli spends much of his time on the road, meeting with state and local officials. He visits treatment programs where he is, by all accounts, treated like a rock star by people with substance-abuse issues, a group he calls “my peeps.” While Botticelli easily shares his struggles, those who worked with him said that he doesn’t let it dictate policy. “He was very good at separating his story from the work, which I think allowed him a little more objectivity,” said Kevin Norton, chief executive of Lahey Health Behavioral Services in Massachusetts. 

The bar scene 

Botticelli drank in high school and college, and he once got fired from a bartending job after repeatedly telling the manager he couldn’t work, only to show up as a patron. In the 1980s he moved to Boston, where he spent most of his time outside of work at the Club Café, a legendary Boston gay bar. Along with a group of regulars, Botticelli would stay well into the next morning, knocking back drinks and ridiculing people who were heading into the gym below the bar for an early workout.  “A lot of the center of gay life, particularly in urban areas, focused on bars,” Botticelli said. “And so that’s where you went to socialize, to meet people.”

In May 1988, Botticelli was drunk when he left a Boston bar and drove west on the Massachusetts Turnpike. What happened next is hazy: He may have been reaching for a cigarette in the console of the car. Botticelli’s car collided with a disabled truck. He remembers being placed on a stretcher and put in an ambulance. Hours later he woke up in the hospital, handcuffed to a bed. A state trooper stood sentry in his room. Botticelli was lucky: His injuries consisted mainly of bumps and bruises. He was taken to the state police barracks, booked and had his license suspended. 

“At some level I knew I had a problem,” Botticelli said. “But at another level, because my license was taken away, I thought that my problems were solved. Because I wasn’t drinking and driving anymore, so how could it really be an issue?”  The case was continued without a finding after Botticelli paid the fines and restitution associated with the case. It is no longer a matter of public record. Botticelli had to ask his brother for the money to make the payments, but his downward spiral continued that summer. He ended a relationship and drank heavily, despite going to a court-ordered course on the dangers of drinking and driving and a 12-step recovery group. 

“I felt that because I wore a suit to work and a lot of the other people in the class came from more blue collar jobs, that somehow I was better and I didn’t have a problem. There was a sense of arrogance about me,” he said. “I finally said, ‘Yes’ ” 

Botticelli’s path to recovery began in, of all places, a bar. He met a man who acknowledged that he was an alcoholic. The two swapped stories and went on a date. The romance didn’t materialize, but they remained friends. Botticelli was soon after served an eviction notice and called his brother, who asked if Botticelli was an alcoholic. Botticelli talks with his hands, one of them often nursing an iced coffee. “I finally said, ‘Yes,’ ” he said. “I remember distinctly thinking to myself, ‘If I say I’m an alcoholic, there’s no going back.’” 

Botticelli’s friend took him to a 12-step meeting in downtown Boston. The following night Botticelli stepped into the Church of the Covenant in Boston, a neo-gothic sanctuary with Tiffany glass windows. In the basement there was a 12-step recovery program for gays and lesbians.   “That’s the first time that I raised my hand and said that my name was Michael, and I was an alcoholic, and that I needed help,” he said. “At that point people kind of rally around you.”

Botticelli stuck close to that group, attending meeting after meeting and avoiding his old haunts, going so far as to cross the street when walking past the Club Café. He said he learned something then that has guided him since: Identify with people who have a problem, but don’t compare yourself. 

Botticelli had worked in higher education since finishing graduate school but pivoted toward a career in public health. He started working on AIDS issues and then turned toward helping others with addiction issues. He eventually felt comfortable going to bars and not drinking. He met his husband, David Wells, at one in 1995. They got married in 2009.

The power of recovery 

One of Botticelli’s recent trips took him back to Boston earlier this month. Soon after arriving, he was smoking a cigarette outside a Starbucks when a woman had a question: Why are there burly agents standing around? (He gets a protective detail). They chatted; she told Botticelli she was addicted to prescription painkillers, progressed to heroin and became homeless. She began recovery months earlier and started working at Starbucks the week before.

“And that was like ‘Oh my God, our work is done here,’ ” Botticelli said in the back of a black SUV that weaved through the streets of Boston. “Anything else was going to pale in comparison to just listening to people’s stories.”

Botticelli’s day was packed with meetings on what he called his home turf. There was a roundtable with more than a dozen doctors, nurses, law enforcement agents, elected officials and others. He met with Boston Mayor Marty Walsh, who is also an alcoholic. Botticelli had sandwiches with law enforcement agents who spoke about the massive spike in heroin addiction. Here in Lynn, a city of 91,000 people, there were 188 opiate overdoses and 18 deaths in 2013; as of July 31 there were 163 overdoses and 20 deaths.  

Botticelli hugged and shook hands people at the home here, and spoke to the men about the struggles of addiction and finding what he called a bridge job — something that you do while getting better to make money and get back into the workforce. “Don’t be ashamed to work at Dunkin’ Donuts,” one of the men, Pat Falzarano, said.  Botticelli nodded. Hours later, Botticelli stood outside of the church where his recovery started and marveled at how he got from there to the White House. 

“When I first came here was, all I wanted to do was not drink and have my problems go away,” he said, choking up. “I’m standing here 25 years later, working at the White House. And if you had asked me 25 years ago when I came to my first meeting here if that was a possibility, I would’ve said you’re crazy. But I think it just demonstrates what the power of recovery is.”

Source:   26th August 2014



To provide a review of the evidence from 3 experimental trials of Project Towards No Drug Abuse (TND), a senior-high-school-based drug abuse prevention program.


Theoretical concepts, subjects, designs, hypotheses, findings, and conclusions of these trials are presented. A total of 2,468 high school youth from 42 schools in southern California were surveyed.


The Project TND curriculum shows reductions in the use of cigarettes, alcohol, marijuana, hard drugs, weapon carrying, and victimization. Most of these results were replicated across the 3 trials.


Project TND is an effective drug and violence prevention program for older teens, at least for one-year follow-up.

Source:  PMID: 12206445 Am J Health Behav. 2002 Sep-Oct;26(5):354-65.

Universal Internet-based prevention for alcohol and cannabis use reduces truancy, psychological distress and moral disengagement: A cluster randomised controlled trial.



A universal Internet-based preventive intervention has been shown to reduce alcohol and cannabis use. The aim of this study was to examine if this program could also reduce risk-factors associated with substance use in adolescents.


A cluster randomised controlled trial was conducted in Sydney, Australia in 2007-2008 to assess the effectiveness of the Internet-based Climate Schools: Alcohol and Cannabis course. The evidence-based course, aimed at reducing alcohol and cannabis use, consists of two sets of six lessons delivered approximately six months apart. A total of 764 students (mean 13.1years) from 10 secondary schools were randomly allocated to receive the preventive intervention (n=397, five schools), or their usual health classes (n=367, five schools) over the year. Participants were assessed at baseline, immediately post, and six and twelve months following the intervention on their levels of truancy, psychological distress and moral disengagement.


Compared to the control group, students in the intervention group showed significant reductions in truancy, psychological distress and moral disengagement up to twelve months following completion of the intervention.


These intervention effects indicate that Internet-based preventive interventions designed to prevent alcohol and cannabis use can concurrently reduce risk-factors associated with substance use in adolescents.

Source:  Prev Med. 2014 May 10;65C:109-115. doi: 10.1016/j.ypmed.2014.05.003. [Epub ahead of print]


This study examined descriptive and injunctive normative influences exerted by parents and peers on college student marijuana approval and use. It further evaluated the extent to which parental monitoring moderated the relationship between marijuana norms and student marijuana outcomes. A sample of 414 parent-child dyads from a midsize American university completed online surveys. A series of paired and one-sample t tests revealed that students’ actual marijuana use was significantly greater than parents’ perception of their child’s use, while students’ perception of their parents’ approval were fairly accurate. The results of a hierarchical multiple regression indicated that perceived injunctive parent and student norms, and parental monitoring all uniquely contributed to the prediction of student marijuana approval. Furthermore, parental monitoring moderated the effects of perceived norms. For example, at low but not high levels of parental monitoring, perceptions of other students’ marijuana use were associated with students’ own marijuana approval. Results from a zero-inflated negative binomial regression showed that students who reported higher descriptive peer norms, higher injunctive parental norms, and reported lower parental monitoring were likely to report more frequent marijuana use. A significant Parental Monitoring × Injunctive Parental norms interaction effect indicated that parental approval only influenced marijuana use for students who reported that their parents monitored their behavior closely. These findings have intervention implications for future work aimed at reducing marijuana approval and use among American college students.

Source:PMID: 24838776   Prev Sci. 2014 May 18. [Epub ahead of print]



The online universal Climate Schools intervention has been found to be effective in reducing the use of alcohol and cannabis among Australian adolescents. The aim of the current study was to examine the feasibility of implementing this prevention programme in the UK.


A pilot study examining the feasibility of the Climate Schools programme in the UK was conducted with teachers and students from Year 9 classes at two secondary schools in southeast London. Teachers were asked to implement the evidence-based Climate Schools programme over the school year with their students. The intervention consisted of two modules (each with six lessons) delivered approximately 6 months apart. Following completion of the intervention, students and teachers were asked to evaluate the programme.


11 teachers and 222 students from two secondary schools evaluated the programme. Overall, the evaluations were extremely positive. Specifically, 85% of students said the information on alcohol and cannabis and how to stay safe was easy to understand, 84% said it was easy to learn and 80% said the online cartoon-based format was an enjoyable way to learn health theory topics. All teachers said the students were able to recall the information taught, 82% said the computer component was easy to implement and all teachers said the teacher’s manual was easy to use to prepare class activities. Importantly, 82% of teachers said it was likely that they would use the programme in the future and recommend it to others.


The Internet-based universal Climate Schools prevention programme to be both feasible and acceptable to students and teachers in the UK. A full evaluation trial of the intervention is now required to examine its effectiveness in reducing alcohol and cannabis use among adolescents in the UK before implementation in the UK school system.

Source: PMID: 24840248 BMJ Open. 2014 May 19;4(5):e004750. doi: 10.1136/bmjopen-2013-004750.


This investigation used meta-analytic techniques to evaluate the effectiveness of school-based prevention programming in reducing cannabis use among youth aged 12 to 19. It summarized the results from 15 studies published in peer-reviewed journals since 1999 and identified features that influenced program effectiveness. The results from the set of 15 studies indicated that these school-based programs had a positive impact on reducing students’ cannabis use (d = 0.58, CI: 0.55, 0.62) compared to control conditions.

Findings revealed that programs incorporating elements of several prevention models were significantly more effective than were those based on only a social influence model.

Programs that were longer in duration (≥15 sessions) and facilitated by individuals other than teachers in an interactive manner also yielded stronger effects. The results also suggested that programs targeting high school students were more effective than were those aimed at middle-school students. Implications for school-based prevention programming are discussed.

Source:  Health Educ Behav. 2010 Oct;37(5):709-23. doi: 10.1177/1090198110361315. Epub 2010 Jun 3.


More than 3 million people died from using alcohol in 2012, for reasons ranging from cancer to violence, the World Health Organisation said on Monday, as it called on governments to do more to limit the damage.

“More needs to be done to protect populations from the negative health consequences of alcohol consumption,” said Oleg Chestnov, a WHO expert on chronic disease and mental health.

He added there was “no room for complacency”, warning that drinking too much kills more men than women, raises people’s risk of developing more than 200 diseases, and killed 3.3 million people in 2012.

On average, according to the WHO report, every person in the world aged 15 years or older drinks 6.2 liters of pure alcohol per year. But less than half the population – 38.3 percent – drinks, so those who do drink on average 17 liters of pure alcohol a year.

“We found that worldwide about 16 percent of drinkers engage in heavy episodic drinking – often referred to as ‘binge-drinking’ – which is the most harmful to health,” said Shekhar Saxena, director for mental health and substance abuse at the WHO.  Poorer people are generally more affected by the social and health consequences of alcohol, he said: “They often lack quality health care and are less protected by functional family or community networks.”

The global status report on alcohol and health covered 194 countries and looked at alcohol consumption, its impact on public health and policy responses.  It found that some countries are already strengthening measures to protect people from harmful drinking. Those include increasing taxes on alcohol, limiting its availability by raising age limits and regulating marketing.

More countries should take similar action, WHO said. More also needed to be done to raise awareness of the damage alcohol can do to people’s health and screen for those who may need earlier intervention to cut down or stop. Globally, Europe consumes the most alcohol per person. Some of its countries having particularly high rates of harmful drinking.  A study published earlier this year found that a quarter of all Russian men die before they reach their mid-fifties, largely from drinking to excess. Some men in that study reported drinking three or more bottles of vodka a week.

The WHO said global trend analyses showed that drinking has been stable over the last five years in Europe, Africa and the Americas. But it is growing in South-East Asia and the Western Pacific.


The National Anti-Drug Secretariat’s (SENAD) Demand Reduction Department, together with municipalities and neighborhoods in Asunción, is carrying out a variety of activities as part of its Community Prevention Program.

Beginning in April, the Day Center will be open to children and minors in Asunción with a history of drug abuse. They will receive guidance about their addiction and will be encouraged to participate in healthy activities and tasks that keep them away from vices, said Luis Chaparro, the community program’s coordinator in the city of Ñemby, 20 kilometers from Asunción.

In the beginning, the program will focus on neighborhoods in the capital city and its surrounding areas before it’s offered in cities in the country’s interior, Chaparro added. Following the start of classes in March, teachers who specialize in different educational levels received training on how to treat young people battling addiction, Chaparro said.

“Teachers will be able to direct the students with drug addiction problems to the Day Center without removing them from the educational environment,” he added.  Authorities can also choose not to prosecute minors facing drug charges if they are receiving treatment at the Day Center.

“(Now) … young persons involved with drugs are sent directly to the courts, where they receive a criminal record for drug possession or consumption, which will be with them for the rest of their lives,” Chaparro said. “The aim is to change that.”

SENAD Communications Director Francisco Ayala added the goal is “to help young people, not stigmatize them. Societal discrimination can often lead to even worse situations,” he said. Students advised to become involved at the Day Center will be able to go to the facility immediately after their classes, Chaparro added.  “If a young person attends school in the morning, he or she can come to the Day Center in the afternoon, or vice versa,” he said.

Inaugural summer camp exceeds expectations

The first activity carried out under the framework of the Community Prevention Program was the Santa Aventura summer camp, which brought together 500 students between the ages of 5 and 19 during the final weeks of January.   The summer camp was held at the San Antonio de Padua Parish in the city of Ñemby. It offered workshops in dance, music, creativity, photography, painting, sports and self-defense, in addition to classes in the electrical and plumbing trades.

“These programs are useful in raising awareness that there are other ways to eliminate idleness and the misuse of time that often lead them to fall into bad habits such as the use of alcohol, tobacco and illegal drugs,” Chaparro said.

Chaparro added that Santa Aventura also received a lot of interest from parents seeking more information about drug addiction prevention.   “Many of them don’t know where to turn or what to do when their child is in a situation like this,” he said.

Parents “have a desire to prevent [drug and alcohol abuse], and to do something for their children,” added Graciela Barreto, the general coordinator of SENAD’s community prevention programs.   Since September, A School for Parents has been under

development, hosting classes on prevention that are open to the public and held on the last Saturday of every month at SENAD’s headquarters.

“The workshops draw parents from cities throughout the Central Department, as well as the interior of the country,” Ayala said. “At these meetings, we hear about the different situations that parents of addicts are facing. They also provide us with guidance as to where we should focus our attention when implementing activities aimed at counteracting the problem.”

Marijuana, crack and cocaine continue to be the country’s most heavily consumed drugs. As of late 2013, SENAD had seized more than 500 tons of marijuana – 324 more tons than during all of 2012 – five tons of crack and three tons of cocaine.

More information about the SENAD’s drug prevention programs can be found at

Source:   18th March 2014



Exposure to tobacco and alcohol imagery in films is strongly associated with uptake and consumption of both tobacco and alcohol in young people. In an analysis of popular UK films over the 20 years from 1989 to 2008, we have previously documented substantial tobacco and alcohol content in films marketed to children and young people. In view of increasing awareness of the potential harm of this exposure, this study was undertaken to assess whether these exposures continue to be prevalent in more recent films, by analysing the most popular films in the years 2009—11.


Occurrence of tobacco (tobacco use, implied use, tobacco paraphernalia, and tobacco brand appearances) and alcohol (alcohol use, inferred alcohol use, other alcohol reference, and alcohol brand appearances) imagery was measured by 5-min interval coding in the 15 most commercially successful films in the UK in each year from 2009 to 2011. Each 5-min period of film was coded as positive for each category of tobacco or alcohol imagery, or both, if at least one such incident occurred during the 5-min period.


All of the 45 most popular films for 2009—11 were rated by UK film classifiers as suitable for youth audiences (those aged younger than 18 years). Any tobacco was present in a third of all films (15 of 45), whereas any alcohol was present in more than four-fifths (37 of 45 [82%]). Tobacco use occurred in 11 films, and alcohol use occurred in 26. Tobacco branding was infrequent, but two brands, Marlboro and K & J, were clearly identifiable. Alcohol branding was far more frequent, occurring in 22% (ten of 45) of films, with the most frequently occurring brands being Jagermeister, Singha, and Budweiser. When combined with earlier findings using the same methods in films from 1989 to 2008, tobacco was present in 65% (225 of 345) of films, and alcohol in 86% (295 of 345) of films. Tobacco content in each of the coded categories decreased between 1989 and 2010, but increased again in 2011, largely as a result of two films: The King’s Speech and Sherlock Homes: a Game of Shadows. Alcohol content fluctuated over the 23 years, without any significant decline overall (p>0·05). Overall, the most commonly represented tobacco brands were Marlboro, Silk Cut, and Embassy, and the most common alcohol brands were Budweiser, Miller, and Coors.


Although conventional tobacco promotion is heavily restricted in the UK, tobacco imagery continues to be evident in films classified for and popular with youth audiences. The amount of tobacco content in films has decreased over the years but increased again in 2011. Alcohol advertising and promotion remains largely self-regulated in the UK, and there has been no appreciable reduction in any alcohol depictions in youth classified films. UK film regulators are aware of the effects of film content on youth audiences, but in practice do not seem to consider either tobacco or alcohol imagery in the age classification process of films suitable for young people.


This research was done as part of the research undertaken by AL as part of a research fellowship funded by the UK Centre for Tobacco Control Studies, which is a UKCRC Centre of Public Health Research Excellence. Funding was from the British Heart Foundation, Cancer Research UK, the Economic and Social Research Council, the Medical Research Council, and the Department of Health.

Source:  The Lancet, Volume 382, Issue , Page S66, 29 November 2013

Teenagers in the child welfare system are at higher-than-average risk of abusing marijuana, inhalants and other drugs, according to a study in the November issue of the Journal of Studies on Alcohol and Drugs.

However, the study also shows that parental involvement matters. “When youth perceive that their parents or caregivers are actively engaged in their lives, this may steer them away from drugs,” according to lead researcher Danielle L. Fettes, Ph.D., of the University of California, San Diego. “Youth who feel supported by parents tend to have a better sense of self and better mental health and, in this case, are less likely to engage in high-risk behaviors—which is important for this already high-risk population.”

Using data from two national surveys, Fettes and colleagues found that 18 percent of teens in the welfare system admitted to ever smoking marijuana, versus 14 percent of other teens. Meanwhile, 12 percent said they’d abused inhalants, compared with 6 percent of other U.S. kids.

In addition, although abuse of “hard drugs,” like cocaine and heroin, was less common, teens in child welfare were still at greater risk: Six percent admitted to ever using the drugs, versus 4 percent of other teens.

The findings are not necessarily surprising, according to Fettes. It’s known that kids who enter the child welfare system typically have some risk factors for drug use—such as a history of domestic abuse or mental health issues.

But until now, there had been little research into their actual rates of substance abuse, Fettes said.

For their study, she and her colleagues culled data from two national health surveys: one covered 730 12- to 14-year-olds in the child welfare system; the other included 4,445 kids the same age from the general U.S. population.

Overall, teens in the welfare system were more likely to have tried marijuana, inhalants or hard drugs—but not alcohol. Around 40 percent of kids in each survey admitted to drinking at some point in their lives.

That, according to Fettes, may reflect a couple of facts. “Alcohol is readily available to teenagers,” she said, “and drinking is something of a normative behavior to them.”

But whereas drug use was more common among teens in the welfare system, not all of those kids were at equal risk. A key risk factor—for all teens in the study—was delinquency. Teenagers who admitted to things like shoplifting, theft, running away or using a weapon were at increased risk of both drug and alcohol abuse.

On the other hand, some family factors seemed to protect kids from falling into drug use.

Teens from two-parent homes were generally less likely to report drug use—and so were kids who said they felt close to their parents or other guardian. For the parents and others who care for these kids, Fettes said it’s important to be aware of the increased risk of substance abuse.

On the wider scale, Fettes said that right now, there are typically multiple, distinct service systems working with teens in the child welfare system. They may also be receiving mental health services and alcohol and other drug counseling, as well as having contact with the criminal justice system. “Often, they don’t work together,” she noted.

“Given the increased risk, the child welfare system may be an ideal venue to incorporate proven prevention and intervention programs for youth substance use,” Fettes concluded. “Drug abuse screening and treatment, or referrals for treatment, should be a regular part of kids’ case management.”

Source: Journal of Studies on Alcohol and Drugs  4th November 2013

A possible future legalization of cannabis (marijuana) would lead to wide commercial access of cannabis and an increase in the cannabis-using population, as found in other countries. As reported in many studies, increased cannabis use leads to a later increase in psychoses, especially schizophrenia. T.H. Moore and colleagues in the Lancet, 2007, concluded that there was “sufficient evidence to warn young people that using cannabis could increase their risk of developing a psychotic illness later in life”.

For example, cannabis use in the UK increased four-fold between 1970 and 2002, and increased 18-fold in the under-18s. They estimated that new cases of schizophrenia would increase by 29% in men between 1990 and 2010. In fact, it was later found that the annual new cases of schizophrenia and psychoses increased from 49 per 100,000 in 1996 up to 77 per 100,000 in 1999, an increase of 58% over three years.

In the canton of Zurich, Switzerland, cannabis use in 15-16-year old boys went up from 15% in 1990 to 50% in 2002. This was followed by a doubling in hospital first admissions for psychosis and schizophrenia in those aged 15 to 24. A major study by Zammit and colleagues in 2008 found that 1.1% of 1,648 Swedish men conscripts for military service who had ever used cannabis prior to 1970 subsequently developed schizophrenia, two-fold higher than those who never used cannabis. This went up to six-fold higher in those who ever used cannabis 50 times or more.

In general, studies found that psychosis occurs 2 to 8 years after a significant amount of cannabis use, and that the risk of psychosis is higher when cannabis use starts at an earlier age. An Australian study of 83 reports found that cannabis users had an age of onset of psychosis that was 2.7 years younger than non-users. Alcohol use was not associated with an earlier age of psychosis onset. In The Netherlands men cannabis users had a first psychotic episode 7 years younger than non-users.

Any future increases in cannabis-associated new cases of schizophrenia would add to the current high rate in Canada and the USA. M.-J. Dealberto at Queen’s University in Ontario found that the rate of new cases of schizophrenia in Canada is about 26 per 100,000 per year, considerably higher than the countries outside Canada which average about 12 new cases per 100,000 per year. (Quebec is even higher at 40.)

In addition, such an increase in new schizophrenia cases would need to be matched by significant increases in psychiatric hospital budgets and in community-based housing and welfare. For example, Ontario’s two major psychiatric centers (Ontario Shores Centre for Mental Health Sciences in Whitby, and the Centre for Addiction and Mental Health in Toronto) have a combined annual budget of about 400 million dollars, with

approximately half assigned for schizophrenia. Across Canada, such budgets would need major increases. Considering that Ontario, for example, receives about 1,100 million dollars each year for tobacco taxes, a cannabis tax might cover the increased needs of the psychiatric hospitals and the community housing.

While the majority of cannabis users would not develop schizophrenia, the wider use of cannabis would lead not only to more hospitalizations of the new cases of schizophrenia, but also to an increased confrontation of psychotically disturbed young men with police.

Although there are valid medical uses for cannabis in cases of resistant epilepsy, and various painful chronic illnesses, wider use of cannabis may also be associated with drowsy driving and car accidents.

Almost all aspects of cannabis use and the related laws are contentious. Whatever laws are adopted by government may have to be a compromise between medical need and a reduced burden to all citizens.


The author discovered the human brain’s dopamine receptor for psychosis and all antipsychotic drugs.

Source:   blog Oct. 17, 2013.

Young Swiss men who say that they believe in God are less likely to smoke cigarettes or pot or take ecstasy pills than Swiss men of the same age group who describe themselves as atheists. Belief is a protective factor against addictive behaviour. This is the conclusion reached by a study funded by the Swiss National Science Foundation.

Karl Marx said that religion was the opium of the people. New figures now suggest that religion plays a role in preventing substance misuse. A research team led by Gerhard Gmel from Lausanne University Hospital has shown in the journal Substance Use & Misuse that, in Switzerland, fewer religious young men consume addictive substances than men of their age group who are agnostics or atheists.

At the army recruitment centre For their study on substance use in Switzerland, Gmel and his colleagues interviewed almost twenty-year-old men at army recruitment centres in Lausanne, Windisch and Mels between August 2010 and November 2011. The researchers have now evaluated the 5387 questionnaires completed by the young men. Based on the responses, the scientists split the young men into five groups: the “religious” believe in God and attend church services, the “spiritual” believe in a higher power, but do not practice any religion, the “unsure” do not know what to believe about God, the “agnostics” assume that no-one can know whether there is a God or not, and the “atheists” do not believe in God.

The researchers found that these groups deal differently with addictive substances. Among the 543 religious young men, 30% smoked cigarettes daily, 20% smoked pot more than once a week and less than 1% had consumed ecstasy or cocaine in the past year. Among the 1650 atheists, 51% smoked cigarettes, 36% smoked pot more than once a week, 6% had consumed ecstasy and 5% cocaine in the past year. The three groups that lay between these extremes were in the mid-range both regarding their religious beliefs and the consumption of addictive substances.

A protective influence for Gmel, these figures indicate that research into addictive behaviour should not only consider risk factors, but also protective factors. The results of his study show that belief is a protective factor when it comes to the consumption of addictive substances. Whether the differences between the groups can be attributed to the ethical values of the young men or to social control in the environments in which they live, remains unanswered.

Source: Religion Is Good, Belief Is Better: Religion, Religiosity, and Substance Use Among Young Swiss Men. Substance Use & Misuse, 2013; 48 (12): 1085 DOI: 10.3109/10826084.2013.799017

US students already burdened by these emotions reacted to shame or guilt-inducing anti-drink ads by intending to and actually drinking more, the opposite of what was intended. This intriguing series of studies may reinforce the feeling that the ways anti-substance use ads can backfire are so various, the safest option is not to try them.

Summary This series of US studies using university students as subjects explored how people already experiencing or prone to shame or guilt respond to anti-alcohol adverts which induce the same unpleasant emotion. Unlike other aversive emotions, shame and guilt involve a conscious and negative perception of oneself as being seen to violate social norms and one’s ideal self (shame), or having unacceptably caused harm to others (guilt). Especially if already feeling bad about oneself in these ways, people may guard against and resist information (eg. ‘That won’t happen to me’) which would otherwise aggravate these uncomfortable feelings. The result could be to negate and even reverse the intended impacts of adverts which arouse these emotions. A case in point might be ads warning that the consequences of one’s over-drinking may be witnessed by friends and family (shame-inducing) or cause them serious inconvenience or harm (guilt-inducing).


To investigate this theory, in a pilot study an ad from a public service responsible-drinking campaign was modified to convey either shame or guilt due to the impact on “those you love” of a drink-laced “Best night of my life” illustrations.

By random allocation, one or other ad or none were shown to 75 students, who then rated the degree to which they were feeling guilt or shame. As expected, the shame-inducing ad did lead to the greatest feelings of shame, while the guilt-inducing ad led to the greatest feelings of guilt.

Having established that the ads aroused the intended emotions, the researchers then investigated this effect’s impact on how students responded to the ads, in particular their intended or actual drinking.

Study 1 randomly allocated 478 students to describe in writing an episode during which they had experienced either extreme shame or extreme guilt, or to simply describe their typical day. Again ratings indicated that the intended emotions had been aroused. Then the students were asked to evaluate either the shame-inducing anti-drinking ad or the guilt-inducing version. After a break they then completed a survey of the “habits of college students” which included the question, “Compared to last year, how often do you plan to binge drink this year?” A similar question asked their views about the intentions of the average student.

Students primed by the first task to feel shame, and then shown an advert inducing the same emotion, planned to binge significantly more often than the other students, including shame-primed students shown a guilt-inducing ad. The pattern was the same for the guilt variants of the preceding task and the ad. In contrast when, the individual was no longer themselves ‘threatened’ by the question, the combination of shame-inducing task and ad led them to make the lowest estimate of how often other students would binge-drink.

In other words, it was not the ads’ induction of negative emotions as such which generated a counterproductive impact on drinking intentions, but the ‘piling on’ of the same unpleasant emotion previously aroused, and then only when the viewer’s own drinking was at issue. The process of defending themselves from yet further shame (or further guilt) seemed to lead the students to reject the ad’s message, so that compared to seeing another ad, they planned to drink more. The opposing impacts on their ratings of their own versus other students’ intentions proves they had not simply ‘switched off’ in response to the ads – they were switched on and processing the messages, but not as the ads’ developers might have wished.

Study 2 extended the findings of study 1 from intentions to actual drinking. It recruited 71 students and followed a similar procedure to study 1 – a shame- or guilt-arousing recall task followed by viewing the shame- or guilt-arousing ad. Then the students were asked to evaluate the ad, and after a break, told they would be sampling and rating a new alcoholic drink mixer, of which they could drink as much they wanted. Among other questions, they were then asked to rate how likely they would be to shame themselves (or for students assigned to the guilt-arousing task, do something they felt guilty about) after having had a couple of drinks at a party, an attempt to assess whether they really had been provoked by the ads in to being defensive about their drinking.

When a shame- or guilt-inducing ad followed a task intended to arouse the same emotion, students drank more than when task and ad had been intended to arouse different emotions. They also saw themselves as less likely to get in to a situation causing the same feelings after drinking at a party. It seemed that piling on the same negative emotion led them to deny the link between their drinking and possibly behaving in ways which cause shame or guilt, a defensive posture which led them to actually drink more than if these emotions had not been serially provoked.

Unlike the previous studies, study 3 used ads to prime shame or guilt, more like what might happen in real life. The first ads shown to 182 students were unrelated to alcohol, but explicitly sought to generate shame about cheating, or guilt about the environmental consequences of buying bottled water. A test confirmed the intended effects. Then they were shown one of the two anti-drinking ads, and after a break asked to rate the likelihood that during the next two weeks they would patronise a bar, or consume three or more drinks in one evening. Combining these answers created a single measure of drinking intentions.

As expected, when a shame-inducing anti-drink ad followed another shame-inducing ad, students expressed firmer intentions to go out and drink heavily, but not because they had ignored the anti-drink ad – in fact, they recalled the ad better than the other students. Moreover, even though they had serially been exposed to shame-inducing ads, these students felt less shame at the end than other students in the study (but not less guilt). Similarly for the guilt-inducing ads. This pattern was consistent with the students successfully resisting the alcohol ads’ attempts to generate yet more of the same uncomfortable emotion already generated by the preceding ad, and as a result also resisting its anti-drink message.

The assumption was that students exposed to the shame-inducing adverts ended up feeling less shame than before, and similarly with guilt – but with no pre-ad measures of shame and guilt, this was just an assumption which fit the evidence. Study 4 rectified this by replicating study 1 with another 64 students, but this time taking before-and-after measures of guilt and shame.

As before, first the students described a shame or guilt-inducing incident from their lives. This time they were then asked to rate their feelings of shame and guilt, measures repeated after they later watched one of the two anti-alcohol adverts. When the advert was intended to arouse the same emotion as the preceding task, the opposite happened – feelings of that emotion actually fell from before to after watching the ad, relative to watching one intended to arouse a different emotion. In contrast, students primed to feel shame did feel more guilt after seeing the guilt-inducing ad. When processed defensively by people already burdened by these emotions, it seemed that a message designed to induce shame or guilt actually reduced the intended emotion.

The preceding studies had ‘artificially’ induced feelings of guilt or shame before exposing students to the anti-alcohol ads. Study 5 instead investigated the effects of the ads on people naturally prone to feel either guilt or shame. A questionnaire was used to assess these propensities among 233 students, who after a break were then shown one of the two anti-alcohol adverts. As in study 1, they were then asked, “Compared to last year, how often do you plan to binge drink this year?” The results were similar to the other studies. Shame-prone students were more likely to plan to drink heavily more often if they had been shown the shame-inducing advert, but not the other. For guilt-prone students there was a corresponding finding.

The authors’ conclusions

In relation to ‘irresponsible’ drinking, these studies show that when emotions which entail an uncomfortable perception of oneself are further stimulated in ways which threaten to heighten this discomfort, viewers tend to convince themselves that the message does not apply to them (‘defensive’ processing), leaving them freer to do what the message warned against than if it had never been received. In particular, shame-laden consumers exposed to messages which asserted that drinking might lead to additional shame-inducing situations, believed that their own drinking would not lead to those consequences, and similarly for guilt. In contrast, when there was no threat to the self and the viewer was asked to think about the behaviour of others, the warnings had the intended impacts.

The findings also suggests that people ‘repair’ negative mood states not in general but in relation to the specific mood they are experiencing; shame-laden consumers resist messages that might lead to greater shame, but are open to messages that lead to guilt, and vice versa.

In some of the studies effects were not large, but much larger in study 2 which assessed actual drinking, suggesting that guarding against the ‘piling up’ of negative emotions might strongly influence health-related behaviour.

Public service health promotion messages often highlight how friends or others might see you if you behave in the way the ad is seeking to deter. In relation to binge drinking, commonly ads arouse concern over ‘making a fool of oneself’ or ‘losing control and doing something bad’. Commonly these ads also highlight emotions which play on these concerns (eg, ‘Avoid the shame and embarrassment of a drunk-driving arrest’) and the consequences of one’s actions on others (eg, ‘Think about those you may harm if you cause an accident while driving drunk’).

The featured research suggests that emotional appeals such as these playing on guilt or shame should be used cautiously, and that attention should be paid to the broader milieu within which the ad will be embedded. For instance, a guilt-inducing message may not be optimal if inserted in a guilt-ridden television drama. However, such appeals may work as intended if the viewer is directed to the behaviour of others rather than themselves, as for example in the popular public service message, ‘Friends don’t let friends drive drunk’.

This intriguing series of studies might well reinforce a feeling that the ways anti-substance use campaigns can backfire are so various, the safest option is not to mount them. Describing the implications of the findings, one of the featured article’s authors warned that “public health and marketing communities expend considerable effort and capital on [anti- or ‘responsible’ drinking] campaigns but have long suspected they were less effective than hoped. But the situation is worse than wasted money or effort. These ads ultimately may do more harm than good because they have the potential to spur more of the behaviour they’re trying to prevent.”

It can happen, he said, because “Advertisements are capable of bringing forth feelings so unpleasant that we’re compelled to eliminate them by whatever means possible. This motivation is sufficiently strong to convince us we’re immune to certain risks.” The implication for health promoters was that “If you’re going to communicate a frightening scenario, temper it with the idea that it’s avoidable. It’s best to use the carrot along with the stick.”

The mechanism the authors propose for this effect is distinct from the ‘reactance’ thought partly to underlie counterproductive reactions to the anti-drug messages of the US National Youth Anti-Drug Media Campaign. Seeing these ads, some young viewers may have resented being (as they saw it) ‘told what to do’, and reacted by moving in the opposite direction. Another way these ads may have backfired is by implying that drug use was so common and so hard to resist that the government had to warn young people about it. Ads which contradict personal experience may also be counter-productively discounted by viewers. Yet another mechanism is that ads can generate discussion between young people, which may be dominated by the more voluble risk-takers among them who tend to favour substance use. Another proposed mechanism is that ads which generate too much emotion lead recipients to ‘shut down’ and simply not process the message. One way to avoid these reactions is to end on a more positive note after presenting a warning, relieving the negative emotion and defusing defensiveness – found in a Spanish study to lead students to say they were less likely to drink excessively than a totally negative anti-drinking message or no message at all.

For the authors of the featured article, none of these explanation account for their findings. Instead they deduce that the students did pay attention to and process the messages of the two anti-alcohol ads, but in such a way as to defensively divorce themselves (if not others) from the risks portrayed. If this, as they persuasively argue, was the case, it may however have been due to the situation. The students had ‘signed up’ (sometimes in return for course credits) to participate in a study which involved assessing the ads; they may not have considered themselves at liberty not to ‘process’ them – that the situation and their obligations demanded they do not simply ignore them. To avoid further unpleasant emotions, perhaps they were left with little option but the ‘defensive processing’ hypothesised by the researchers. In real-life situations, viewers normally can simply turn over the page, look the other way, or stop paying attention to the TV, reactions which might neutralise the ad’s messages but not lead to counter-productive reactions.

All the studies involved young people in the USA, who below the age of 21 are not permitted to legally buy alcohol and usually also forbidden to drink. All too were students, a group newly liberated from parental control and known to in some quarters value excessive drinking. Rather bluntly, in some of the studies they were asked “Compared to last year, how often do you plan to binge drink this year?” Their reactions to the ads and to this loaded question may not transfer to other sub-populations in the USA or to students in the UK.

Another limitation is that only the pilot study compared the ads to no ad at all; in all the others, students were allocated to see one or other of the two anti-alcohol ads. None of the studies tell us whether, compared to no ad at all, the ads led students to intend to drink excessively or actually do so. All we know is that in certain circumstances, seeing one ad was counterproductive vis-à-vis seeing the other; it may nevertheless have been better (or at least, no worse) than no health promotion at all.

Also, both adverts look amateur and seem to give not very persuasively framed messages, the content of which may easily be discounted. Better expressed and produced ads may have lent themselves less easily to ‘defensive processing’, and produced a different reaction.

However, the general ineffectiveness of anti-drinking advertising campaigns suggest that the featured studies’ results are not merely due to context or ad quality. When experts assessed the full panoply of strategies to prevent or minimise alcohol-related harm, they could find no media campaign strategies to recommend: “Media campaigns prepared by government agencies and non-governmental organizations (NGOs) that address responsible drinking, the hazards of drink-driving and related topics are an ineffective antidote to the high-quality pro-drinking messages that appear much more frequently as paid advertisements in the mass media”. In respect of illegal drugs too, in controlled studies anti-drug adverts have if anything bolstered intentions to use these substances.

Source:  Agrawal N., Duhachek A.  Journal of Marketing Research: 2010, 47(2), p. 263–273. Last revised 26 September 2013. 

Orchestrated by WHO, across all four countries this rare attempt at screening and brief intervention for problems arising from illegal drug use identified at front-line health care centres found modest reductions in use/risks, but there was a puzzling opposition between particularly positive results from Australia and seemingly negative ones from the USA.

Summary Results of the featured study are also available in a research report previously analysed by Findings. Both this and the featured journal article are drawn on in the following account.

There is good evidence that brief interventions (usually one or two face-to-face counselling sessions) can reduce tobacco and alcohol use identified by screening tests in primary health care settings, particularly when they capitalise on the results of the test. However, there is only suggestive evidence of similar effects in respect of illicit drug use, only recently has a culturally neutral screening questionnaire for all psychoactive substances, including illicit drugs, been available for use in primary care, and most studies were conducted in the USA, UK or Australia, limiting the international generalisability of the findings. To address these gaps the World Health Organization (WHO) developed the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Through a series of interview questions it screens for problem or risky use of tobacco, alcohol, cannabis, cocaine, amphetamine-type stimulants, sedatives, hallucinogens, inhalants, opioids like heroin, and “other drugs”. It first asks whether the patient has ever used these substances, then for those they have, how often in the past three months. Further questions in relation to each used substance ask about adverse consequences, urges to use, whether the individual has tried but failed to cut down, and whether others have shown concern over their substance use. Finally the patient is asked if they have injected drugs, if so when, and if recently, how often.

A risk score is calculated for each substance and categorised as low, moderate (harmful but not dependent use) or high (actually or probably dependent), in turn indicating whether no intervention is needed, a brief intervention to encourage the patient to cut back, or a brief intervention encouraging them to seek further and/or specialised treatment. ASSIST was primarily intended to identify patients at moderate risk who may otherwise go undetected and deteriorate.

To test this strategy, in 2003 to 2006, 845 potentially suitable patients were assessed by researchers and/or clinicians at health centres and other front-line medical care settings in Australia, India, the United States and Brazil. After completing the ASSIST interview, 731 adults were found to meet the study’s criteria and agreed to join the study; another 51 refused. To join they had to have scored as at moderate risk due to their use of either cannabis, cocaine, amphetamine-type stimulants, or opioids, but not at high risk from any substance except tobacco. Two thirds of study participants were men and 72% were employed. They averaged about 31 years of age.

Following assessment patients were randomly allocated to wait for three months before intervention (the control group), or to participate (they all did) in a single brief advice session offered by the same clinician/researcher who had conducted the assessment, focused on the drug which posed the greatest risk to the patient and/or over which they were most concerned. In a motivational interviewing style, during this session patients were offered written feedback on their ASSIST scores and the implications (eg, health risks) were explored. They left with a self-help guide on reducing substance use. On average ASSIST screening took eight minutes and the brief intervention 14 minutes.

86% of the patients were followed up about three months later when the ASSIST test was re-applied. At issue was whether the risk scores of those who participated in the brief intervention three months before had decreased relative to the control group. How they might have scored at the follow-up was estimated for the patients who could not be re-assessed.

Main findings

In general across all countries and in each separately, the brief intervention resulted in greater risk reduction, particularly in respect of the substance on which the intervention had focused.

Total ASSIST risk scores for substances other than alcohol and tobacco fell for both sets of patients, but significantly more so for patients who had been allocated to the brief intervention. Their scores fell from an average 36 to just under 30, while those of the control group fell from 36 to 32. This global picture was replicated in each of the countries (most sharply in Australia) except the USA, where control patients actually reduced their risk more than brief intervention patients, though not to a statistically significant degree. Patients who scored in the upper half of the moderate risk range reacted about as well to the intervention as those who scored lower; when the sample was divided in this way, neither intervention effect was statistically significant, though both neared this criterion.

For just over half the patients their main problem substance was cannabis, and this was the focus of the brief intervention for those allocated to this procedure. Among these patients, risk reduction in relation to the targeted drug (cannabis) was significantly greater among patients allocated to the brief intervention. In each country too risk reduction was greater among intervention patients, except again for the USA, where the order was reversed. Only the results for Brazil and India were statistically significant. For cannabis, only patients at the higher end of the moderate risk spectrum further reduced their ASSIST scores following intervention.

Across all countries, patients whose primary problem substance was a stimulant (cocaine or amphetamine-type drugs) also reduced their risk related to these substances more if they had been through the brief intervention. None were recruited in India and the country-specific statistically significant results were from Brazil and Australia. In respect of these drugs, only patients at the lower end of the moderate risk spectrum further reduced their ASSIST scores following intervention.

Only in India were there appreciable patients whose main problem substances were opioids. Opioid-related risk reduction was significantly greater among brief intervention patients than among control patients.

Finally the analysts explored whether there was any evidence that while on average patients reduced their cannabis use in response to the cannabis-specific brief intervention, they ‘compensated’ by increasing use of other substances. No statistically significant effects on other substances were found, and there was actually some reduction in risk related to drinking. Similarly, when the intervention targeted substances other than cannabis, cannabis use was unaffected.

The authors’ conclusions

This study has shown that a brief intervention lasting on average a quarter of an hour and linked to the results of the ASSIST screening test reduced illicit substance use and associated risk significantly among non-dependent patients identified across a range countries in different types of front-line health care settings. Risk related to the target drug was reduced without patients ‘compensating’ by increasing their risky use of other substances. Except for the USA, the pattern of extra risk reduction after brief intervention was maintained in each of the four countries. It was also apparent in patients with both a moderately high and a moderately low risk.

In both developing and developed countries, there is a compelling need for a comprehensive approach capable of addressing use of a range of illicit drugs and of tobacco and alcohol in primary care settings. The findings from this project indicate that the ASSIST screening test and linked brief intervention can at least partly meet this need, promising to help reduce the burden of disease associated with substance use and substance use disorders.

Why results differed in the USA is unclear. Possibly the relatively lengthy (10–15 minutes) interview required to establish the patient’s consent to join the study ‘overwhelmed’ the intervention. Possibly too the patients, around 30% of whom had been treated for drug or alcohol problems, were less responsive to a brief intervention. The authors also point out that screening and intervention was generally conducted by specially trained clinical research staff rather than the centres’ usual staff, and that these same staff also generally conducted initial and follow-up assessments, raising the possibility of bias. The puzzling divide between the prominence of research on brief interventions for drinkers, and the lack of similar investigations among users of other drugs, makes this rare large-scale study particularly welcome. Especially in the Australian (so perhaps too in the UK) context, it holds out the prospect that this divide is not due to differing efficacy, but a prospect clouded by questions over real-world applicability and impacts on health.

Though the study recorded statistically significant reductions in drug use severity after research procedures and screening, and significant extra reductions from the intervention, questions have been raised about the clinical significance of the findings. After the entire package overall illicit drug use risk fell by 6.6 points on a scale whose maximum was 336, only 2.6 points greater than the decline in the control group. Similarly for cannabis, on a scale reaching 39 the overall reduction was 3.1, just 1.4 greater than in the control group. Among patients whose drug use may or may not have put them at risk of health problems, the impact of such small reductions on their future health is unclear. The study excluded the highest risk patients most likely to be identified by doctors and of greatest concern, so could say nothing about how well the recommended brief intervention plus referral procedure works among these priority patients. As in some alcohol studies (1 2), a very minimal intervention, such as handing over the booklets used in the current study, may have led to as great a reduction in drug use/problems as the motivational-style interview.

The fact that patients usually saw the same person for intervention and follow-up assessment means not only could the assessors know whether the patient had been in the brief intervention group (ie, they were not ‘blinded’ as recommended in such trials), but also that often they were assessing the results of their own work. No biochemical tests were conducted to objectively test for substance use. This raises the serious possibility that both parties had the opportunity and the motivation to amplify the impacts of their interaction. Given the overall small impact of the intervention, this could account for an appreciable part of its apparent effectiveness. In the USA about half the participants were instead re-interviewed by a different person, perhaps one reason why their responses did not indicate extra risk reductions from the intervention.

Some of the biggest effects were seen among opioid users in India, where nearly 10 points were sliced from opioid use severity scores (maximum 39) by the whole package, over twice the decline in the control group. Half the patients targeted for their opioid use were daily or near daily users and all but a few were recruited in India. Where, as in parts of that country, regular opioid use is normalised among socially included populations with family and work responsibilities, it seems that in certain cultures it is susceptible to even quite brief intervention. It seems possible however that participants were motivated to deny continuing drug use (especially in the case of brief intervention patients, to their counsellors), which compared to other countries they tended to see as contravening personal and family responsibilities.

As the authors hint, screening of this kind will probably be reserved for medical and other settings likely to attract unusually many illegal drug users. How willing they will be to own up to their use is unclear. In the validation studies for the ASSIST screening questionnaire, patients were interviewed by researchers and assured of confidentiality, even in respect of their doctors – important to at least some of the patients. In routine practice these doctors or their colleagues would be the ones asking the screening questions. Another departure from routine practice was that the study largely relied on specially trained clinical research staff rather than the centres’ usual staff, meaning the results may not apply where clinical research staff are not available.

Assuming the results do translate to everyday practice, there remains the issue of which type of practice. Among the settings were sexually transmitted disease clinics, a health centre associated with a drug treatment programme, a dental clinic primarily seeing poor patients in an emergency, as well as primary health and community health clinics. At best pooling these results reveals the impact of the intervention at settings with the characteristic they shared – being front-line medical services. At worst it jumbles apples with pears, perhaps one reason why there was a highly significant variation in results from different countries.

Puzzling opposition in results from Australia and USA

British readers may be most interested in the somewhat opposing results from the two westernised developed nations in the study, Australia and the USA. It should be stressed however that results from individual countries are subject to the idiosyncrasies of the study site, population and procedures in that country, variations partly ironed out in the amalgamated results. Results from Australia were particularly promising, but derived from STD clinics rather than generic primary care, and the unexplained variation between these two countries closest to UK conditions makes it impossible to predict what the consequences might be of a similar study in the UK, especially in GP surgeries and emergency departments, where brief intervention work is concentrated. Details below.

In Australia, three quarters of the largely young single population recruited at clinics for sexually transmitted diseases were identified as primarily having problems with what seems to have been mainly recreational stimulant use. Despite of all the nations averaging the highest risk score in relation to illegal drug use and the shortest intervention (typically just eight minutes), this country also recorded the strongest intervention effects. Possibly this was a particularly health-conscious population not representative of usual primary care patients in Britain.

The USA was the other westernised developed nation, and here results were at the opposite end of the scale – in the ‘wrong’ direction for illicit drugs in general and for cannabis and stimulants, in each case nearly to a statistically significant degree. This could simply be chance variation but the consistency of the findings suggests otherwise. If it did reflect a real and counterproductive effect, this pattern does not square with the intervention being overwhelmed by the consent procedure or by the patients’ previous experiences of treatment, influences which would have merely nullified the intervention. Adding to the puzzle is that according to their own accounts at the follow-up interviews, the US patients’ feelings about the brief intervention do not seem to explain why they failed to react to by reducing their substance use risks. For example, almost 80% who received the brief intervention reported attempting to cut down as a result, similar to other countries. For more see the WHO ASSIST web site where you can download the research report on the featured evaluation, manuals for the screening tool and the brief intervention, and the written self-help guide given to patients in the study.  Humeniuk R., Ali R., Babor T. et al.  Addiction: 2012, 107(5), p. 957–966. 

A new study by Canadian social scientists finds boys who display anti-social behavior in kindergarten will likely abuse drugs later in life — unless they receive intensive intervention in their “tween” years.

The study began in 1984, in Montreal. Some kindergarten teachers selected boys in their class who came from low-income households and showed anti-social behavior for a longitudinal study by the University of Montreal.

Of the 172 disruptive 5-year-olds chosen, 46 were channeled into an intensive intervention program over two years, starting when they were 7.

The boys were given social skills training to learn how to control emotions and build healthy friendships. They were also taught to use problem solving and communication instead of anti-social behaviors. Their families were involved in parts of the program, with parents learning skills to help their sons through difficulties.

Researchers studied two control groups: 42 boys got no intervention at all, and the remaining 84 received only a home visit. All the boys were followed until they were 17, with specific attention paid to their use of drugs or alcohol. Results published recently in the British Journal of Psychiatry indicate that the boys who received this intensive therapy were less likely than the rest to use drugs as teens.   Researcher Natalie Castellanos-Ryan, of the psychiatry department of the University of Montreal, said the boys who received the intensive interventions had much lower levels of anti-social behavior. They never caught up with the level of drug or alcohol use of the other boys in the study, who began substance use from early adolescence. Even the boys who received periodic in-home visits, but not intensive intervention, had a high rate of substance misuse during teenage years.

The study authors concluded that “adolescent substance use may be indirectly prevented by selectively targeting childhood risk factors that disrupt the developmental cascade of adolescent risk factors for substance use.”

Castellanos-Ryan said her team hopes to follow up with the same cohort of boys who are now 30 years old, to see if the intervention is still paying dividends.

Source:  16 Aug 2013

An intensive intervention programme for disruptive young children could help prevent drug and alcohol abuse in adolescence, according to a new study.

Canadian researchers writing in the British Journal of Psychiatry set out to examine whether a two-year prevention programme in childhood could stop substance misuse problems in later life.

Some 172 boys for poor socio-economic backgrounds and all with disruptive behaviour participated in the study. They selected 46 boys and their parents for the two-year intervention programme, when they were aged between 7 and 9 years old. The programme included social skills training for the boys at school, to help promote self-control and reduce their impulsivity and antisocial behaviour, as well as parent training to help parents recognise problematic behaviours in their boys, set clear objectives and reinforce appropriate behaviours. A further 42 boys received no intervention and acted as the control group.

The remaining 84 boys were assigned to an intensive observation group, which differed from the controls in that their families were visited in their homes by researchers, attended a half-day laboratory testing session, and were observed at school. All the boys were followed up until the age of 17, to assess their use of drugs and alcohol.

The researchers found that levels of drug and alcohol use across adolescence were lower in those boys who received the intervention. The reduction in substance use continued through the boys’ early adolescence right up to the end of their time at high school.

Researcher Natalie Castellanos-Ryan, of the Department of Psychiatry at Université de Montréal and Centre Hospitalier Universitaire Sainte Justine, Canada, said: “Our study shows that a two-year intervention aimed at key risk factors in disruptive kindergarten boys from low socioeconomic environments can effectively reduce substance use behaviours in adolescence – not only in early adolescence but up to the end of high school, eight years post-intervention. This finding is noteworthy because the effects are stronger and longer-lasting than for most substance use interventions that have been studied before.”

Dr Castellanos-Ryan added: “The intervention appeared to work because it reduced the boys’ impulsivity and antisocial behaviour during pre-adolescence – between the ages of 11 and 13. Our study suggests that by selectively targeting disruptive behaviours in early childhood, and without addressing substance use directly, we could have long-term effects on substance use behaviours in later life. More research is now needed to examine how these effects can generalise to girls and other populations, and to explore aspects related to the cost/benefit of this.

Source:  9th August 2023

Espada J.P., Griffin K.W., Pereira J.R. et al.

Uniquely this Spanish study eliminated either problem solving or social skills training from secondary school drug education to see if these really were active ingredients in reducing substance use. Probably they were was the conclusion, though there were no statistically significant differences between the full programme and the excised versions.


Training in social skills and in problem-solving skills feature in many contemporary drug use prevention programmes. The former aims to promote assertiveness, empathy and social negotiation strategies, the latter, self-reliance and coping skills. Commonly these components are taught as generic skills first and then applied to situations related to substance use.

An example is the Spanish school programme Saluda which aims to delay the onset of alcohol and drug use. Its problem-solving components aim to help pupils understand and appreciate the advantages of non-consumption and the disadvantages of drug abuse by first applying problem-solving methods to everyday situations, and then specifically to substance use scenarios. The social skills components aim to help pupils develop skills related to active listening, initiating, maintaining and concluding conversations, expressing opinions and positive feelings, and defending one’s personal rights, such as saying ‘No’ and coping with peer pressure. Both types of components are taught mostly via skill-focused activities. Each is the focus of two different sessions of the 10-session programme, offering the opportunity to try variations which omit one but not the other as a way of testing which components are needed to generate the programme’s impacts. This was the strategy adopted by the featured study, which replaced the missing sessions with general discussion sessions not involving any skills training activities.

The study recruited 341 of the 358 students in 14 classes in two secondary schools. Whole classes were assigned to the full Saluda programme, to the programme with social skills but not problem solving training, to one with problem solving but not social skills training, or at random to education as usual until the final follow-up assessments had been completed a year after the Saluda lessons had finished.

Main findings

At the start of the study there were no statistically significant differences between pupils assigned to the different options. However, by the end questionnaires completed by the pupils revealed that those offered any version of Saluda had over the last month drunk alcohol significantly less often than pupils in education-as-usual classes. Though the biggest impact was seen with the full programme, there were no statistically significant differences between the three versions of Saluda. Similar findings emerged in respect to willingness to use alcohol or illegal drugs (actual use of the latter was too rare to be analysed), except that this pattern emerged in the surveys taken immediately after the lessons had ended as well as a year later.

The study also assessed the impact on the relevant skills of omitting lessons focused on these skills. In respect of problem solving skills, after the lessons ended both versions of the programme which had included the relevant training led to better skills (as assessed by a questionnaire) than among pupils not offered the programme at all, but this difference persisted to the final follow-up only after the full programme. In respect of social skills as reflected in reported difficulties with family, peers, or the opposite sex, on no measure were there any statistically significant differences between the three versions of the Saluda programme. Other findings revealed no obviously consistent pattern.

The authors’ conclusions

In general, findings indicated that the three versions of the Saluda programme were all significantly more effective at curbing drinking and intention to use substances than usual education only, but not significantly different from each other. However, there were indications that effectiveness may diminish unless training in both social and problem-solving skills is retained in the programme.

As assessed by average scores at the final follow-up, the largest advantages over usual education in drinking and in problem solving were seen after the full programme. In respect of problem solving, the full programme also bettered the version which included the relevant training, suggesting that social skills training acts synergistically with problem-solving training to improve problem-solving skills.

In terms of effects on skills, the programme without social skills training produced inconsistent changes in the relevant skills, as did the programme without problem solving skills training. It should be cautioned however that non-random assignment to the education options means the results may be due to differences between the pupils.

This draft entry is currently subject to consultation and correction by the study authors and other experts.

Source: Prevention Science: 2012, 13(1), p. 86–95.  June 2013.

Prevention is often the best medicine, and that is not only true when it comes to physical health, but also public health. Case in point – young adults reduce their overall prescription drug misuse up to 65 percent if they are part of a community-based prevention effort while still in middle school, according to researchers at Iowa State University.

The reduced substance use is significant considering the dramatic increase in prescription drug abuse, said Richard Spoth, director of the Partnerships in Prevention Science Institute at Iowa State. The research published in the American Journal of Public Health focused on programs designed to reduce the risk for substance misuse. In a related study, featured in the March-April 2013 issue of Preventive Medicine, researchers found significant reduction rates for methamphetamine, marijuana, alcohol, cigarette and inhalant use.

Additionally, teens and young adults had better relationships with parents, improved life skills and few problem behaviors in general. The research is part of a partnership between Iowa State and Penn State known as PROSPER, which stands for Promoting School-Community-University Partnerships to Enhance Resilience. PROSPER administers scientifically proven prevention programs in a community-based setting with the help of the Extension system in land grant universities. The results are based on follow-up surveys Spoth and his colleagues conducted with families and teens for six years after completing PROSPER. Researchers developed the prevention programs in the 1980s and 1990s to target specific age groups.

Spoth said understanding when and why adolescents experiment with drugs is a key to PROSPER’s success. “We think the programs work well because they reduce behaviors that place youth at higher risk for substance misuse and conduct problems,” Spoth said. “We time the implementation of these interventions so they’re developmentally appropriate. That’s not too early, not too late; about the time when they’re beginning to try out these new risky behaviors that ultimately can get them in trouble.”

PROSPER administers a combination of family-focused and school-based programs. The study involved 28 communities, evenly split between Iowa and Pennsylvania. The programs start with students in the sixth grade. The goal is to teach parents and children the skills they need to build better relationships and limit exposure to substance use. “One of the skills students are taught through the school-based program is assertiveness, so that they feel comfortable refusing to do something that might lead to them getting in trouble,” Spoth said. “We try to help parents be more attuned to what their children are doing, who they’re with, where they’re going, effectively monitoring, supervising and communicating with their children.”

Parents say the program works. Michelle Woodruff will admit that being a parent is hard work. “Absolutely, underline and capital letters – it is hard,” said Woodruff, a mother of four sons who range in age from 13-21 years old. But the lessons learned through the PROSPER program, she believes, made her and her husband better parents and also brought out the best in their children. “It was a lot of little things that made us re-evaluate how we parented,” Woodruff said. “I think it makes children more responsible not only to themselves, but their parents and the community. They want to represent their families well, their schools well, their churches; I think it just makes them want to be a better person.” Woodruff is now a member of the PROSPER team in Fort Dodge, where she encourages and supports other parents who participate in the program. Facilitators of the family-focused program use games and role-playing to help parents and children improve communication and set expectations for behavior. Woodruff would like to see more families take advantage of the opportunity. “Do it, not only for the one-on-one time with your child, but also to meet other like-minded parents,” Woodruff said.

“We’re just trying to come together as a community to raise the best kids that we can possibly raise so that they’re successful members of society as adults.”

Community benefits . The ongoing community partnerships are evidence of the PROSPER program’s sustainability, Spoth said. The results extend beyond a reduction in prescription drug or marijuana use. Researchers know that substance abuse often leads to other problem behaviors, so prevention can have a ripple effect and cut down on problems in school and violent behaviors in general. The benefits are measured in economic terms as well as the overall health and outlook of the community. “There are things that can only happen over time if you have sustained programming, because more and more parents are exposed to programs that help them address all of the challenges in parenting,” Spoth said. “As a result, people feel like they’re making connections, their community is a better place to live, and they are positive about the leadership in their community.”

Read more at:

Source: American Journal of Public Health Preventive Medicine April 25, 2013 in Addiction (Medical Xpress)

A new study found that middle school students in small towns and rural areas who received brief interventions had lower rates of prescription drug abuse into late adolescence and young adulthood.

Prescription drug abuse is taking a medication without a prescription, or in ways or for reasons not prescribed. Abuse of prescription drugs can have serious and harmful consequences, including addiction, poisoning and even death from overdose. Surveys have found that prescription and over-the-counter medications are among the top substances abused by young people. Developing successful community-based interventions to prevent this abuse is an important public health goal.

A team led by Dr. Richard L. Spoth at Iowa State University conducted 3 studies to assess the effectiveness of brief community-based interventions among rural or small-town students in grades 6 or 7. The studies didn’t target prescription drug abuse specifically. Rather, all 3 studies used universal preventive interventions, which address general risk and protective factors for substance abuse. The work was funded by NIH’s National Institute on Drug Abuse (NIDA), National Institute on Alcohol Abuse and Alcoholism (NIAAA) and National Institute of Mental Health (NIMH).

Study 1 (conducted from 1993 to 2008) tested an intervention focused on families of 6th graders. Study 2(1998-2011) tested a combined family-focused intervention and a school-based life skills training program in 7th graders from 24 schools. Study 3(2002-2009) tested a family-focused intervention and school-based interventions in 6th graders from 28 school districts. Students were randomly assigned to an intervention or control group.

Students completed written questionnaires or phone interviews through ages 17 to 25. They were asked about lifetime use of drugs such as barbiturates, tranquilizers, amphetamines, narcotics, opioids and pain relievers not prescribed by a doctor for their use. The results appeared online on February 14, 2013, in the American Journal of Public Health.

In study 1, the intervention reduced the rate of prescription drug abuse by 65%. Of the youth who participated in the intervention, 5% reported lifetime prescription drug abuse at age 25, compared with 16% of those in the control group. In study 2, rates for prescription drug abuse were reduced 33-62% at different ages. In study 3, 23% of youth who participated in the intervention reported lifetime prescription drug abuse in the 12th grade, compared with 29% of those in the control group.

These findings show that brief interventions among 6th and 7th graders in small towns and rural areas can bring long-term reductions in prescription drug abuse.

“The intervention effects were comparable or even stronger for participants who had started misusing substances prior to the middle school interventions, suggesting that these programs also can be successful in higher risk groups,” Spoth says.

This study adds to growing evidence that brief intervention programs can have lasting effects on risky behaviors like drug abuse. Further research will be needed to better understand how best to design programs that target different high-risk populations.

Source: March 4th 2013

A new method of drug testing developed by researchers at RTI International makes it possible to detect a wider range of synthetically produced ‘designer’ drugs.

Designer drugs — which include the currently popular products known as “spice” or “bath salts” — are a new form of drugs that are easy to manufacture and difficult to recognize using traditional testing methods.
Traditional tests, which use targeted mass spectrometry to match a compound’s chemical makeup with that of a known drug, can’t identify many of these new synthetic drugs.
Because these substances are continually being developed, many of them are not yet classified as illegal, but they provide a similar high as the traditional substance they are imitating.
RTI’s new method has the potential to aid law enforcement in the detection and control of this growing area of drug abuse.
Instead of relying on an exact match, RTI’s approach looks more generally for compounds whose fractional mass — the compound’s molecular weight that lies to the right of the decimal point — is similar to that of a known drug.
“Detecting designer drugs is challenging because as bans on specific compounds go into effect, manufacturers can substitute a closely related substance, creating a constantly moving target,” said Megan Grabenauer, Ph.D., a research chemist at RTI and lead
investigator of the study. “But while the structure of designer drugs can be altered to avoid detection, the fractional mass stays relatively stable, making it a useful marker for identification.”
In a pilot study, published in the July 3 issue of Analytical Chemistry, researchers tested 32 herbal incense samples for synthetic cannabinoids, which produce psychotropic effects
similar to those of cannabis but with more common and severe side effects, which include agitation, hallucinations, seizures and panic attacks.
Using high-resolution mass spectrometry and mass defect filtering, the researchers analyzed the fractional masses of all components in each sample to determine if any of them were similar to that of JWH-018 (0.1858 Dalton), a banned synthetic cannabinoid.
The researchers found that each of the samples contained at least one synthetic cannabinoid and some contained multiple types. Several were unexpected new compounds that would have been missed by traditional tests.
“The benefit to this approach over traditional targeted analyses is that it gives insight into the identities of components of an unknown sample,” said Brian Thomas, Ph.D., senior director of Analytical Chemistry and Pharmaceutics at RTI and one of the paper’s co-authors. “Additional tests must be run for confirmation, but the method provides valuable information about the compound’s possible identity, and a starting place for selection of an appropriate reference standard.”

Source: RTI International (2012, July 12). Advanced drug testing method detects ‘spice’ drugs.

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

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: 8th Sept. 2011



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: 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.


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


• “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 ( 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

• 8,664 deaths/year involve alcohol (

• 81,400 deaths of people in England alone aged 35+ were attributable to tobacco (

• 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: 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:  3rd May 2011


A review of the existing literature on the occurrence of challenging behavior among children with prenatal drug exposure was conducted. While a large number of studies were identified that evaluated various outcomes of prenatal drug exposure, only 37 were found that directly evaluated challenging behaviors. Of the 37 studies, 23 focused on prenatal cocaine exposure, and 14 focused on prenatal alcohol exposure; most studies relied on broadband measures such as the CBCL for the assessment of challenging behavior. Among the 37 studies, a clear role for the postnatal environment on developing challenging behaviors was evident; however, prenatal alcohol exposure showed a much clearer independent effect upon challenging behaviors than was noted in the prenatal cocaine studies. Additionally, only 3 of the 37 studies addressed interventions for challenging behaviors, each of which showed an improvement in child behavior or parent-child interactions. As researchers have continued to show the importance of the postnatal environment, it is likely that interventions addressing specific environmental risk factors will be helpful to reduce or prevent challenging behaviors among this population.

Source:  Dec. 2008

Contact address: Fabrizio Faggiano, Department of Medical Sciences, University of Piemonte Orientale A. Avogadro, Via Santena 5 bis, Novara, 28100, Italy.
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.



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.
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.


(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.

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: and 2008

Two of the most widely recommended US school and family prevention programmes retarded growth in some forms of substance use, especially among youngsters who had already used by their early teens, but there are some methodological concerns over the findings.
Summary 36 secondary schools in the rural US mid-west were randomly allocated to either carry on as normal (the control schools) or to one of two prevention programmes. Both were delivered primarily in the seventh grade (ages 12–13), and both featured the LifeSkills Training (LST) drug education curriculum consisting of fifteen classroom lessons with later ‘boosters’. In one set of schools, these lessons were supplemented by the Strengthening Families Program: for Parents and Youth 10-14. This entails seven two-hour evening sessions plus four booster sessions in the following year, during which groups of about six or seven families focus in turn on particular parenting issues and skills. In the first hour of each session, parents and children learn in parallel; in the second, they come together to practice these skills with each other. Only a quarter of the families allocated to these (and 38% of those actively recruited) attended any of the family sessions, but results are reported for all the families offered the intervention, regardless of attendance.
Questionnaire responses from 1677 pupils surveyed about six months before the grade seven lessons formed the baseline to assess changes in substance use among the same pupils over each of the five years following the lessons. Typically by then aged 17–18, about three quarters of the starting sample responded to the final assessments. For the featured report the sample was narrowed down slightly to pupils who had provided the relevant outcome measures at least three times: at baseline; about a month after the seventh grade interventions; and during at least one follow-up. For these pupils, the analysis tested whether over the five and a half years:
• trends in the growth of substance use differed between the three sets of schools; and
• whether by the end levels of substance use also differed.
First the study assessed how many pupils had started to use alcohol, cigarettes or cannabis. Most consistently positive results were found for cigarettes; growth in the proportion who had tried smoking, and the final proportion who had used by age 17–18, were significantly lower in intervention schools compared to control schools. For cannabis, only the final proportion was significantly lower, and for alcohol, only the growth trend, and then only when the family intervention had supplemented the lessons. When these measures were combined in an index representing experience of all three substances, both the growth trend and the final outcomes favoured the interventions. Experience of getting drunk was also measured and, like drinking itself, only the growth trend favoured the interventions.
Similar analyses for current use on at least a monthly basis and other more serious patterns of substance use found no results favouring the interventions. However, there were such results among the fifth of pupils considered at high risk of developing substance use problems. These were the pupils who at the first survey point at age 12–13 had already used two of the three substances. Compared to their lower risk peers, among these pupils both interventions had consistently greater effects on overall levels of use across the follow-up years. Further analysis showed that among lower risk pupils, the interventions made no significant difference. But among the higher risk fifth, growth in the average frequency of smoking cigarettes or using cannabis was less than in the control schools, and so too was final average frequency of use. This was not the case for the frequency of drinking or of getting drunk; for these measures only two of the eight outcomes significantly favoured the interventions. Among the same higher risk pupils, indices of serious use patterns combining measures of current or past use of all three substances consistently favoured the intervention schools.
Summarising their findings, the authors noted that for all substance initiation outcomes, one or both intervention groups showed significant, positive differences compared with the control group in the final follow-up year, and/or significant differences in growth trends over the five years since the interventions. In contrast, across all the pupils, more serious substance use outcomes reflecting mainly current and frequent use were not significantly affected. However, these forms of substance use were curbed when the analysis was restricted to higher risk pupils. Though the two interventions often bettered education-as-usual, in no case did one outperform the other. The authors speculated that less convincing initiation-prevention results than in earlier studies might have been due to the family intervention being delayed a year, when more pupils had already initiated substance use. In terms of affecting more serious forms of substance use, pupils already advanced in their substance use patterns responded relatively well, possibly because the messages were more ‘real’ for them and for their parents. Despite randomisation, there remained some significant baseline differences between control and intervention pupils which might also have obscured intervention impacts, though attempts were made to adjust for these in the analyses.
The two programmes tested in the study enjoy among the most widely respected research records in substance use prevention (LST SFP). The featured study’s strengths include large samples, reasonable follow-up rates, randomisation by school and an analysis controlling for the influence of the school itself, and outcome measures probing not just experience of the substances concerned, but how serious and lasting this was. Nevertheless the most which can be said is that the LifeSkills Training element probably retarded the initiation of smoking, possibly cannabis use, but not drinking, had no cross-sample benefits in respect of the forms of substance use of greatest concern, but may have had such benefits among the minority of pupils already relatively advanced in their substance use before the interventions started. Other LifeSkills Training studies have also most consistently found beneficial outcomes in respect of smoking, the programme’s original target.
Focusing on the featured study’s positive findings might give the impression of more all round success, but in respect of the full samples, these consisted of at most 13 out of 44 findings, and possibly (if arguably more appropriate methodological conventions had been followed) seven or fewer. Greater and more consistent success among the higher risk pupils is a tentative finding because of differences between intervention and control schools, because the study was not set up to test this subsample, and because of some methodological issues. Impacts on the forms of drug use of greatest concern emerged solely from this analysis, meaning that the interventions’ ability to reduce these cannot be considered to have been demonstrated, though the possibility that this might prove to be the case is encouraging. Importantly, though many tests did not show the interventions were superior to education-as-usual, none indicated that they were inferior; the only significant findings favoured the interventions. For more on all these issues see background notes.
Disappointingly, and despite earlier findings from the study, there was no real hint that adding the family programme improved on the school lessons in terms of the substance use measures reported in the study, though there may have been other benefits. Remaining support for the family programme comes mainly from a study whose findings (impressive as they were) derived from just over a third of the mainly white and rural families asked to participate in the study. A similar limitation applies to a later study of a substantially revised version among poor black families. Because of the way they were designed, these trials could establish benefits only among the minority of families prepared or able to participate in the interventions and complete the studies; they cannot be considered a secure indication of how the interventions would perform if applied across the board. So far in the UK a small pilot study has established the programme’s feasibility among a small set of families.
This leaves two of the most thoroughly researched universal prevention programmes for children of secondary school age with mixed findings of uncertain relevance to how they might perform if truly applied across the board. At least part of the problem lies in not in whether the benefits of these programmes are (or at least, can be) real, but in the difficulty of showing they are real. Verdicts in respect of drinking that public health strategies built on education and persuasion are relatively ineffective compared to measures such as restricting availability and raising price, would not be altered by the featured study. For smoking, the case for education in schools as a public health strategy is considerably stronger. Universal prevention programmes in general, and school-based programmes in particular, have greater impacts on tobacco use than on use of the other two substances featured in the study.
Some evidence supports the modest effectiveness of school programmes in preventing cannabis use. But of the four studies on which this verdict was based, one was a primary school programme not focused on substance use at all but on classroom management, education and parenting, another was conducted only among pupils for some reason excluded from mainstream education, and the programme studied in a third has since failed in a more real-world study conducted by researchers not associated with its development. The remaining study was conducted in secondary schools and concerned LifeSkills Training, but the impact on cannabis use was not statistically significant. This line up does not offer much support to drug education in mainstream secondary schools as a means of preventing cannabis use.
Mixed findings of a prevention impact from school programmes targeting substance use do not negate the possibility that general attempts to create schools conducive to healthy development will affect substance use along with other behaviours, nor do they relieve schools of the obligation to educate their pupils on this important aspect of our society. As much as the limited research, such considerations led the UK’s National Institute for Health and Clinical Excellence (NICE) to recommend that alcohol education should be an integral part of national science and health education curricula, in line with government guidance.
Thanks for their comments on this entry in draft to Richard Spoth of Iowa State University, Andrew Brown of the Drug Education Forum and David Foxcroft of Oxford Brookes University. Commentators bear no responsibility for the text including the interpretations and any remaining errors.
Last revised 02 July 2009

Source: Spoth R.L., Randall G.K., Trudeau L. et al.
Drug and Alcohol Dependence: 2008, 96(1–2), p, 57–68.

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 and
Robert L. DuPont, M.D.

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


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:

Compared to teens who have frequent family dinners (five to seven per week), those who have infrequent family dinners (fewer than three per week) are more than twice as likely to say that they expect to try drugs in the future, according to The Importance of Family Dinners VI, a new report from The National Center on Addiction and Substance Abuse (CASA*) at Columbia University.

The CASA family dinners report reveals that nearly three-quarters (72 percent) of teens think that eating dinner frequently with their parents is very or fairly important. Compared to teens who have frequent family dinners, those who have infrequent family dinners are:

  • Twice as likely to have used tobacco;
  • Almost twice as likely to have used alcohol; and
  • One and half times likelier to have used marijuana.

The report found that compared to teens who talk to their parents about what’s going on in their lives at dinner, teens who don’t are twice as likely to have used tobacco and one and a half times likelier to have used marijuana.

“The message for parents couldn’t be any clearer. With the recent rise in the number of Americans age 12 and older who are using drugs, it is more important than ever to sit down to dinner and engage your children in conversation about their lives, their friends, school – just talk. Ask questions and really listen to their answers,” said Kathleen Ferrigno, CASA’s director of Marketing who directs the Family Day – A Day to Eat Dinner with Your Children initiative. “The magic that happens over family dinners isn’t the food on the table, but the communication and conversations around it. Of course there is no iron-clad guarantee that your kids will grow up drug free, but knowledge is power and the more you know the better the odds are that you will raise a healthy kid.”

The report also reveals that teens who have fewer than three family dinners per week are twice as likely to be able to get marijuana or prescription drugs (to get high) in an hour or less. Teens who are having five or more family dinners per week are more likely to say that they do not have any access to marijuana and prescription drugs (to get high).

This year the trend survey found that 60 percent of teens report having dinner with their families at least five times a week, a proportion that has remained consistent over the past decade.

Family Dinners and Having Friends Who Use Substances
Teens who have frequent family dinners are less likely to report having friends who use substances.

Compared to teens who have five to seven family dinners per week, those who have fewer than three family dinners per week are:

  • More than one and a half times likelier to have friends who drink regularly and use marijuana;
  • One and half times likelier to have friends who abuse prescription drugs (to get high); and
  • One and a quarter times more likely to have friends who use illegal drugs like acid, ecstasy, cocaine, methamphetamine and heroin.

“We have long known that the more often children have dinner with their parents the less likely they are to smoke, drink or use drugs. We can now confirm another positive effect of family dinners–that the more often teens have dinner with their parents, the more likely they are to report talking to their parents about what’s going on in their lives,” said Joseph A. Califano, Jr., CASA founder and chairman and former U.S. Secretary of Health, Education, and Welfare. “In today’s busy and overscheduled world, taking the time to come together for dinner really makes a difference in a child’s life.”

Family Ties
CASA’s 2010 teen survey took a close look at Family Ties, the bond between parents and their teens, and discovered that strong Family Ties are associated with a reduced likelihood that a teen will smoke, drink or use illegal drugs. The family dinners report found that teens who say they have an excellent relationship with their parents are less likely to use substances.

Compared to teens who have infrequent family dinners, teens who have frequent family dinners are three times likelier to say they have an excellent relationship with their father, almost three times as likely to say they have an excellent relationship with their mother, and more than twice as likely to say that their parents are very good at listening to them.

Among teens who don’t drink or use marijuana, those who have frequent family dinners are more likely to cite their parents as the reason why than teens who have infrequent family dinners.
The findings in this report come from The National Survey of American Attitudes on Substance Abuse XV: Teens and Parents, released on August 19, 2010. This year we surveyed 1,055 teenagers ages 12 to 17 (540 males, 515 females), and 456 parents of these teens via the Internet, from April 8 to April 27, 2010. Sampling error is +/- 3.1 for teens and +/- 4.6 for parents. We also conducted our usual telephone survey of 1,000 teens ages 12 to 17 (511 boys and 489 girls) in order to continue tracking trends from prior years, from April 6 to April 27, 2010. Sampling error is +/- 3.1.

Source:   Nov 2010

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)

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.
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.
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.
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.
Both children and parents reported having gained new knowledge about alcohol as a result of their involvement with the KAT programme.
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.
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.
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.
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.
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: 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:

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:  3rd 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:   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: 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 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: 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:

Source  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
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

In the first study to measure the prevalence of cannabis use disorders (CUD) among young adults attending college, researchers funded by NIDA found that in a group of students who had used cannabis 5 or more imes in the past year, 1 in 10 met the clinical Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV definition for cannabis dependence, and 14.5 percent met the definition for cannabis abuse. The researchers screened 3,401 first-year college students and recruited 1,253 to participate in the study.
Interviewers asked all participants about their use of 10 illicit substances. Students who had used cannabis 5 or more times in the past year (474 participants) were considered at risk for CUD and were asked to answer questions about problems they may have encountered in the past year because of their cannabis use. Of these students, 24.3 percent regularly put themselves in physical danger when under the influence, and 10.6 percent continued to use despite problems with family or friends. In addition, 40.1 percent reported concentration
 problems, and 13.9 percent reported missing class. In addition to the students who met the criteria for CUD, 12.6 percent met only one or two of the DSM-IV criteria for dependence (but not abuse) and were classified as diagnostic orphans, “suggesting that some cannabis-using college students might be at risk for cannabis-related problems even if they do not appear to be heavy users,” explain the authors. “The prevalence of CUD and other cannabis-related problems are not trivial, and if replicated, these findings highlight the need for improved screening and early intervention for drug-related problems among first-year college students,” they conclude.Source: Addict Behav. 2008;33(3):397–411.


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
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.
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

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¬ /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.

SOURCE: American Journal of Public Health, July 2004.

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.”

Source: Liverpool Echo, 18 August 2004

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.

Source American Journal of Preventive Medicine.Sept. 2004

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

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.

Source:Partnership for a Drug-Free America Tracking Study 2003

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.

SOURCE: American Journal of Psychiatry, April 2004. Published Reuters Health.April 27 2004

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.”

Source:The journal Molecular Psychiatry (2003, Volume 8, Number 5).

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.

Source: Colorado Daily Feb. 2004

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.

Source: Associated Press April 21.2004

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.” 

Source: Washington State Dept. of Health Sept.2004

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).

Pregnancy Outcomes
The rate of premature delivery among clients in treatment was 7.3 percent, representing a 70 percent risk reduction as compared to an 24 percent rate of premature deliveries among untreated or drug abusers. rate of low-birth weight delivery was 5.7 percent, an 84 percent risk reduction as compared to an expected 35 percent low birth weight rate among untreated alcohol or drug abusers.  The infant mortality rate for treatment clients infants was 0.4 percent, a 67 percent risk reduction as compared to the 1.2 percent infant mortality rate for previous client pregnancies.
The adverse pregnancy rates are not only much lower than those of untreated substance-abusing women, but are also lower than rates reported for all U.S. women. American women have an 11.4 percent premature delivery rate, a 7.5 percent low-birth weight rate and a 0.7 percent infant death rate, according to the report.

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.

Source: Alcoholism & Drug Abuse Weekly 13(35):3, 2001.




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.

Source: The study’s findings were presented at a National Institute of Justice’s Research &
Evaluation Conference in Washington, DC. Aug 2001.

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.

Source: Published in BMJ Vol 323 P 603 Sept 2001.

 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.

Source: July 2002.

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.

Source:  Penn, Schoen & Berland Associates, Washington, D.C. Feb 2001.

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.

Source: A Review of Alternative Activities and Alternative Programs in Youth Prevention,
CSAP Technical Report #13; 1996; HHS.

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.

Source:  Author Tony Loman et al published by Institute of Applied Research reported on JTO Online 2003

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.”

Source: Kim Housego The Associated Press Posted April 6 2004

A new research program established at the Mayo Clinic in Rochester, Minn., will focus on genetics to give health professionals the ability to predict and prevent alcohol and other drug addictions.

The first part of the genomics research project will be the identification of human genes that contribute to vulnerability to alcoholism. The next step will be to develop ways to use the genetic information to protect individuals from becoming addicted. The goal: to enable people at increased risk of becoming addicted to receive personalized therapy that could change their lives.

“We have known for years that alcoholism runs in families and that children of alcoholic parents are at very high risk of developing the problem,” said David Mrazek, M.D., chair of the Mayo Clinic department of psychiatry and psychology who will direct the research program. “We also know that a deep craving for alcohol is a core component of the problem, and that there is good evidence that these cravings have a genetic basis.

“Some genes already have been linked to alcoholism, but every relevant gene must be identified so we can learn how they interact,” said Mrazek. “This can lead to personalized therapies for people at risk for developing alcoholism and other addictions, involving effective methods of prevention and innovative treatments

Source: Press release Mayo Clinic April 2004

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.

Source: Reuters, May 20, 2005.

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.

Source: Camden County Tribune & Georgian June 24.2005

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.”

Source: Oct.2005

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.

Source:Matthew J. Peterson | March 22, 2005

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,

Source: Drug & Alcohol Findings Spring 2004
Hong Kong law requires graphic health warnings on cigarette packs, but antismoking advocates say Philip Morris is trying to obscure those warnings by marketing plastic sleeves that fit over cigarette packs, the Associated Press reported Nov. 6.

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.”

Source: Associated Press Nov. 2005

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.

Source: Associated Press June 9 2005
A new report says that a drop in state spending on youth tobacco prevention efforts in recent years corresponded with a leveling-off of youth smoking rates after previous declines.

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.

Source: The research appears in the Oct. 28, 2005 issue of the CDC’s Morbidity and Mortality Weekly Report.

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.”

Source: Atlanta Journal-Constitution June 23. 2005

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:

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

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.

SOURCES: Fidler, J. Tobacco Control; June 2006, Vol. 15: pp. 205-209. CDC, Morbidity and Mortality Weekly Report, May 26, 2006; Vol. 55: pp. 553-556. News release, BMJ Specialist Journals. News release, CDC.
Researchers at the Molecular Neurobiology Branch of the National Institute on Drug Abuse (NIDA), National Institutes of Health, have completed the most comprehensive scan of the human genome to date linked to the ongoing efforts to identify people most at risk for developing alcoholism. This study represents the first time the new genomic technology has been used to comprehensively identify genes linked to substance abuse.

“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

Source: CADCA Coalitions online. 31.08.06
A Scottish ban on smoking in public places has been hailed as a success after the first survey of its effects revealed a more than 99 per cent rate of compliance.

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.

Source: Cancer Research UK News Archive online June 2006

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.

Steve Gardiner, Division of Knowledge and Evaluation, CSAP at (301) 443-9110.Publ in Prevention Pipeline Sept/Oct 1998

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.

Source: Celia, D.F.; Tulsky, D.S.; Sarafian, B.; Thomas, C.R., Sr.; and Thomas, C.R., Jr.- Journal of School Health 62(8):377-360, 1992

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.

Source: Hendriks, VM.; Garretsen, H.F.L.; vande Goor, A.M. Substance Use & Misuse 32(6):679-697,

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.

Protective Factors: As there are many factors that place youth at increased risk for drug abuse, there also are factors that appear to inoculate or protect youth and strengthen their determination to reject the use of alcohol, drugs or other substances. Protective factors inhibit the self-destructive behaviors and avoid situations that encourage substance abuse.Researchers note three categories of protective factors:

• 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

Family Traits
Family history of alcohol and drug abuse Modelling of substance abuse behaviour by familymembers as well as genetic
predisposition for substance abuse.
Poor and inconsistent family management practices Low level of parental involvement in activities with their children, poor and inconsistent parental discipline, and low parental educational aspirations for children.
Family confilict Parental discord, recent family breakups, and family member disagreements and serious fighting.
Low bonding in family Lack of closeness and a lack of parental involvement in their children’s activities.
School traits
Academic failure Poor school performance and poor grades
Low degree of comittment to school Students dislike of school, little time spent on homework, low perceptions of relevance of course work, and truancy.
Peer rejection in elementary grades A student’s low acceptance by positive peers;  appears to increase a student’s risk of delinquency, criminality, and substance abuse.
Friendship Network
Deviant peer bonding Association with drug using peers has been shown to be the strongest predictor and also the final pathway to drug abuse amongst youth.
Personal Traits
Alienation and rebelliousness Intolerance for conventional values of society, lack of spiritual belief system, and rebelliousness.
Attitudes favourable to substance abuse Positive attitudes and beliefs by youth regarding substance abuse, onset and frequency of substance abuse, and beliefs and values about reasons for using substances.
Early onset of substance abuse A predictor of continued and increasing drug involvement.


Table 2
Strategies to increase Protective Factors

Prevention Strategy  Example
Early childhood education programs  Focus on intellectual and social development to reduce academic failure, childhood behavior problems, and family management problems—all substance abuse vulnerabilities for youth.
Family programs for parents of children and adolescents Focus on parenting skills training and family therapy to reduce family management problems and child behavior problems—risk factors for substance abuse in youth.
Social competence skills training Focus on social competence skill building that encourages anger control, mood management, and decisionmaking in social situations to overcome aggression and other problem behaviors of youth.
Social support enhancement Focus on expanding the social networks of youth to enhance their social bonds and potential social resources for help with school and enjoyment of pleasant recreational activities as alternatives to drug use and/or depression
Academic achievement promotion Focus on three strategies known to increase academic achievement:

  • Early childhood education as cited above.
  • Modifications in classroom instructional practices to increase school         achievement (particularly understanding of mathematics) and levels of commitment to school,  as well as to reduce suspensions and  expulsions from school. Innovative teaching methods that improve school climate include: interactive  teaching, proactive classroom management, and cooperative learning.
  • Tutoring on an individualized basis for low-achieving at-risk youth, accompanied by social competency-skills training to increase positive learning gains. 
Organizational changes in schools Focus on establishing and enforcing school substance abuse policies, holding teacher retreats, and recognizing teacher and student achievements to reduce substance abuse risk factors. A school challenged with high levels of substance abuse may have a difficult time implementing recommended prevention approaches without addressing organizational needs of the school. For example, a school principal may need to include in the teacher’s course load an indicated prevention program such as the Reconnecting Youth Program.
Youth involvement in positive activities  Focus on school-based activities, such as experience-based learning, tutoring programs, peer-group work, and skill mastery programs, which promote academic achievement and student involvement in school to reduce the likelihood of substance abuse vulnerability.
Comprehensive risk-focused programs  Address multiple risk factors that have been shown to be more effective than single-issue programs (Eggert et al. 1994a, 1994b; Eggert et al., in press).



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.

Alan Markwood, Illinois Dept of Human Services, 1997.

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].

Source: All reference resources are cited in: Parent Training is Prevention: Preventing Alcohol and Other Drug Problems Among Youth in the Family. U.S. Department of Health and Human Services, 1991.

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

Source: Editor 01/May-1997

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.

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.

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.

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.

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%.

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) –  – Apr/1999

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.

Source: Best practices in ATOD prevention: US Dept. of Health & Human Services, National Inst. Of Health. 1997

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

Source:The Times, 23 June 2000

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.

Source: Spoth, R.L. et al; Journal of Consulting and Clinical Psychology 69(4):627-642, 2001

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.

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.
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.
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.
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%.
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) – – 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.

Source: JTO online March 2004

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.”

Source:Journal of  Acquired  Immune Deficiency Syndrome 2004;36:743-749.

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.

Source:; Jan 2004

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.” 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

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.

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.

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.

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.
Primary prevention programmes are able to reach and influence high-risk adolescents in a non-stigmatizing manner.
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.
References: This paper derived from a publication by Alan Markwood: Best Practices in ATOD Prevention, pp51-54, pubd. Chestnut Health Services for Illinois Department of Human Services, 1997. – Benard, Bonnie (1996). Mentoring: New study shows the power of relationships to make a difference. Resiliency in Action, Fall, 1996. – Blum, Robert William & Peggy Mann (1997). Reducing the risk: Connections that Make a difference in the Lives of Youth. University of Minnesota. – Saito, Rebecca N. & Blyth, Dale A. (1995). Understanding Mentoring Relationships. Search Institute, Minneapolis, MN. – Tierney, Joseph P. Grossman, J.B. with Resch, N.L. Public/Private Ventures (1995). Making a Difference; an impact study of Big Brothers, Big Sisters (USA): 5 year evaluation.


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 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.

  References:   Available on request

The Process of Prevention

Since the 1920’s books have been published that show the diffusion of innovative change – almost 3,000 studies have been published that look at how communities  change.  As  a  result  of  this research we now know that change is very predictable – and there are six stages.  (Figure 1 ).   A classic example of this process is the situation in the USA with smoking (later replicated in Britain where we would appear to be between stages 4 and 5).

To be successful it is essential to go through all stages – research suggests that for an individual to change from level 3 to 5 takes about 8 years – culturally for society it will take longer. To succeed everyone has to be working together – and success can be measured over time with the numbers seen to be changing.

Currently those promoting illegal drugs have also been working to this model. They have, with the help of the media, been working at changing attitudes and awareness of drugs (level 1) They  have also been disseminating their own version of the ‘facts’ about drugs: ‘cannabis is less harmful than alcohol and nicotine’… ‘ it is normal for all young people to use drugs’…  ‘we are all drug users, if we take aspirin or coffee etc…’(which is Level 2 argument). The result is we now have a substantial minority of the population actively considering using drugs (which is Level  3).

The NDPA has an enormous task ahead to use the process of prevention and turn around the problem of youth drug use.  Our website will help us in this task  by creating more awareness of the need for  effective prevention, the successes  of good practice in prevention internationally, (level 1) and in disseminating up to date and accurate information at levels 3 & 4. Our communities do not have unlimited years to begin good local programmes; the problems are with us now.  We hope you will share with us any information you have about good prevention programmes – we will do our best to include this in our future issues.

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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