Adolescent Substance Abuse What We Know … and How to Prevent It! Institute for Research, Education and Training in Addictions (IRETA), Regional Enterprise Tower, 425 Sixth Avenue, Suite 1710Pittsburgh, PA 15219, (412) Michael T. Flaherty, Ph.D. Executive Director/Clinical Psychologist

2 Some Background and Quick Premises  Addiction to illegal drugs is America’s No. 1, preventable, health problem.  Addiction to any drug (alcohol, tobacco, illicit drug) is a chronic illness requiring a continuum of care.  The abuse of alcohol and tobacco is a critically important, greatly under-funded, National problem % of adolescents in psychiatric care use substance abuse.

3 Some Background and Quick Premises (Continued)  Drug use is drug abuse and, however it begins, leads to dependence (psychological) and potentially addiction.  The solution of this problem in our society requires a greater partnership of the community with our schools, providers, policy makers, funders, scientists and media.

4 Adolescent Substance Abuse  Despite reports of leveling off (see PPG 1/5/03), substance abuse by adolescents remains high.  More than 90% of adults with current substance abuse problems began use before the age of 18 …one-half before the age of 15!  In a 2001 national survey, 23% of 8 th graders reported being drunk at least once.. with 21.5% reporting current alcohol use.

5 Adolescent Substance Abuse (Continued)  54% of all high school graduates in the U.S. have used illicit drugs by the time they graduate.  Among 8 th graders, illicit drug use is higher in Anglo-Americans than in African- Americans … in fact, suburban America is both at greater risk and a higher target for drugs.

6 The Treatment Continuum for Adolescents Outreach-School/Community/CJ Assessment-Public/Private/CJ Treatment-Public/Private/CJ

7 The Treatment Continuum for Adolescents (Continued) 1.Outpatient-Standard(1 x wk) -Intensive OP(3 x wk) -Partial Hosp.(3+ x wk) 2.Residential-Detox(1-2 days) -Rehab(1-4 wks) -Stepdown/Halfway(2-6 mos)

8 The Treatment Continuum for Adolescents (Continued) 3.Inpatient-Detox(2-3 Days) (Hospital)-Rehab(12-21 Days) 4.Aftercare-Up to 12 months in Continuum at progressively less restrictive care. Self-Help-AA, NA, Al-Anon, Al-Ateen (Not Treatment)

9 Scientific studies have now documented that adolescents are at-risk for illicit alcohol/ tobacco/drug use as a result of a unique trajectory of: Biology Environment Development

10 The above factors combine during the critical adolescent years to create a “heightened risk” period – often made obvious by increased externalized behavior and manifest opposition, secrecy and/or aggression. Ref: Maziade, M., “Should Adverse Temperament Matter to the Clinician?” in Temperament in Childhood, 1989, New York: Wiley

11 Who is Most At Risk Among Adolescents? 1.Low Self Esteem 2.Poor Coping Skills 3.Low Behavioral Self Regulation 4.Social Skills Deficits Ongoing interaction with the environment interacting with individual bio-behavioral aspects. Ref.: Tarter, et.al., Psychology of Addictive Behaviors, December, 2002

12 Who is Most at Risk Among Adolescents? (Continued) If any use* occurs as a result of a composite, unique interaction between environment, development and biology, and we know who is at most risk, can we prevent it? *Defined as Tobacco, Alcohol or Illicit Drug.

13 Yes! A review of the current literature indicates that we can best “intervene” or disrupt the drug use trajectory by:

14 1. Building Social Competence  Building self-understanding.  Owning one’s perspective.  Building social problem-solving skills.  Having quality child-environment interactions.  Teaching addiction/drug impact.

15 2. Developing School Bonding* and Achievement  Building a commitment to school/self.  Build methods that increase bond to school and the opportunity for academic success.  Build aspiration for success.  Motivate, motivate … motivate.  Be long-term. *Maladjustment in elementary school is a high predictor/risk factor for Substance Abuse. Low school engagement correlates to low self-esteem, low self-expectation and high association to deviant peers … all of which greatly increases likelihood of drub abuse.

16 3. Teaching Self-Regulation  Teach methods and reasoning for emotional regulation, anger management and impulse control.  Teach normative role modeling and problem solving skills.  Improve self-control/executive regulation.  Be age specific and culturally sensitive.  Be interactive.  Teach skills.

17 4. Support and Build Parental/ Adult Involvement  Nothing builds child and adolescent resiliency better than qualitative parental/child or adult/child relationship!  The absence of parental involvement highly predicts Substance Abuse use/psychological dysregulation. Parental/child conflict with low involvement highly predicts delinquency and illicit drug use.

18 Overall, addressing the above four interventions in a sustained manner proportionally reduces, in a significant manner, the likelihood of adolescent substance abuse, aggression and social deviancy. Ref:Tarter, R., “Predictor Variables by Developmental Stages: A Center for Sustained Abuse Prevention Multi-State Study” in Psychology of Addictive Behaviors, Vol. 16, No. 45, 2002.

19 Four Prevention Techniques with Adolescents 1.Building Social Competence 2.Developing School Bonding and Achievement 3.Teaching Self-Regulation 4.Supporting and Building Parental/Adult-Child Involvement

20 Other Sources of Help/Information  Allegheny County Treatment System Handout  Institute for Research, Education and Training in Addictions (IRETA); ;  National Institute on Alcoholism;  Making the Grade,  Join Together;  Center for Substance Abuse Prevention;  Community Anti-Drug Coalitions of America;