CAPT Presentation

Adolescent Risk Reduction

Focusing on Evidence-Based Strategies

Kim Dash, PhD, MPH, CAPT Scientific Advisor and Senior Research Scientist, Education

Development Center, Inc.

Presented at A Public Health Approach to Addressing Substance Misuse and Addiction, Region 5, Indianapolis, IN

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Roadmap

1. Background and Significance

2. Prevention Principles

3. Prevention Programs

4. Prevention Policy Solutions

5. Community-based Models

3

Background and Significance

Why should we be concerned about adolescent

substance use?

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Trends in Lifetime Use

Lifetime Prevalence of Use of Various Drugs in Grade 121

0

10

20

30

40

50

60

70

80

902

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0

20

01

20

02

20

03

20

04

20

05

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06

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07

20

08

20

09

20

10

20

11

20

12

20

13

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14

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15

20

16

Pe

rce

nt

Alcohol

Cigarettes

Any Rx Drug

Marijuana

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Trends in Initiation of Use

0

5

10

15

20

25

30

35

2001 2003 2005 2007 2009 2011

Pe

rce

nt

Age of Initiation Younger than 13 Years2

Alcohol

Marijuana

Cigarettes

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Adolescent Brain Development

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Consequences of Use3

• School failure

• Problems with family and friends

• Loss of interest

• Impaired memory

• Increased risk of contracting infectious disease

through risky sexual behavior or sharing

contaminated needles

• Overdose death

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Risk and Protective Factors4

Community

School

Relationship

Individual

•Poverty (-)

•Opportunities for positive social involvement (+)

•Drug availability (-)

•Anti-drug policies (+)

• Family conflict (-)

•Peer substance abuse (-)

•Parental monitoring (+)

•Peer academic competence (+)

•Early aggressive behavior (-)

• Self-control (+)

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Prevention Principles

What principles guide adolescent risk reduction?

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General Guiding Principles4

• Enhance protective factors and reverse

or reduce modifiable risk factors.

• Attend to all local substance abuse

problem/s.

• Address risks specific to population groups of interest.

• Intervene early to prevent risk and promote well-being.

• Focus on key transition points.

• Combine two or more effective programs.

• Present consistent, community-wide messages across

settings.

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Types of Prevention Interventions5

Universal

General population

Selective

Population at increased risk

Indicated

Involved in risky behavior

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Prevention Programs

What are examples of evidence-based prevention

programs for adolescents?

13

Prevention Programs

Program Population Unit of Practice Outcomes

The Good Behavior Game

Universal School, Classroom Less likely to use tobacco, cocaine, or heroin by grade 86

Raising Healthy Children

Universal School Less heavy alcohol use at 18 year of age7

Fast Track Universal, Selective

School Increased social competence; and fewer conduct problems8

Abecedarian Project

Selective School Less likely to smoke marijuana at age 219

Nurse-Family Partnership

Selective Family, home Less likely to use marijuana at 12 years of age10

Implemented Prior to Adolescence

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Prevention Programs

Program Population Unit of Practice

Substance Use Behaviors Affected

Keepin’ It Real Universal School Alcohol and marijuana use11

Iowa Strengthening Families: 10-14

Universal School, Family

Long-term alcohol, tobacco, and marijuana use;12 and prescription drug misuse13

Familias Unidas Selective Family Illicit drug use and alcohol dependence14

Project Toward No Drug Abuse

Selective School Alcohol15 and long-term hard drug use16

Positive Family Support

Universal, Selective, Indicated

School, Family

Alcohol and cigarette use;17,18 problematic marijuana use,19 and marijuana use disorder20

Implemented During Adolescence

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Prevention Policies

What policies are associated with reducing

adolescent substance abuse?

16

Prevention Policies

Program Youth Substance Use Behaviors Affected

Alcohol Advertising Restrictions

Alcohol use;21 binge drinking;22 alcohol-related, single-vehicle, driver traffic fatalities23

Alcohol Price Increases Alcohol use;24 harmful drinking;25 traffic fatalities26

BAC Limits Alcohol use;27 binge drinking;28 driving after drinking; alcohol-related traffic fatalities29

Social Host Liability Alcohol-related traffic fatality rates;30 harmful drinking;31 drinking and driving;31 drinking in private settings32

Compliance checks Retail sales of alcohol to minors; alcohol consumption, binge drinking;33 requests for identification from individuals attempting to purchase alcohol34

Minimum age of sale, purchase, and server

Alcohol use; binge-drinking (underage college students)35

Underage Drinking and Its Consequences

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Prevention Policies

Program Outcomes of Interest

PDMPs Doctor shopping (TN, NY); individuals with opioid prescription (TN, NY); prescriptions for all opioids (TN, NY); and dispensing of controlled substances (KY)36

System-wide prescriber education

Workers on disability compensation who received an opioid prescription, and overdose deaths among those individuals (WA);37 medication-related overdose deaths and inappropriate prescribing habits (UT);38

Model pain clinic regulations

Drug prescriptions; prescribers dispensing high volume of oxycodone prescriptions; overdose deaths; drug diversion39

Doctor-shopping laws

Pharmacy hopping and nonmedically-necessary tranquilizer prescriptions (NY)40

Nonmedical Use of Prescription Drugs

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Community-Based Models

What are effective processes for implementing

prevention programs?

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Prevention System Models

Program Adolescent Substance Use Behaviors Affected

Promoting School-Community-University Partnerships to Enhance Resilience (PROSPER)

Lifetime prescription drug misuse, lifetime opioid misuse, lifetime illicit substance use, past-year methamphetamine use, and marijuana use in 12th grade (5-year follow-up); adherence rate to EBP models41

Communities Mobilizing for Change on Alcohol (CMCA)

DUI arrests; alcohol use; providing alcohol to peers; alcohol sales to minors; age ID checks during alcohol transactions42

Communities that Care Alcohol use and cigarette use through grade 1043

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Effective Implementation

• Diverse, representative, cross-sector community

participation

• Responsiveness to local needs

• Fit, feasibility and cultural appropriateness

• Long-term sustainability

• Process and outcome evaluation

Facilitating Factors44

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Questions?

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Contact and Follow Up

If you have questions or comments, please don’t

hesitate to contact:

Kim Dash

CAPT Scientific Advisor

Senior Research Scientist

Education Development Center

kdash@edc.org

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This presentation was developed under the Substance

Abuse and Mental Health Services Administration’s Center

for the Application of Prevention Technologies task order.

Reference #HHSS283201200024I/HHSS28342002T.

The views expressed in this presentation do not necessarily

represent the views, policies, and positions of the Substance

Abuse and Mental Health Services Administration or the U.S.

Department of Health and Human Services.

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