NIDA- National Conference on Drug Abuse Prevention Research. Introduction. National survey data show that drug use among our Nation's youth is increasing at an alarming rate. Some say that we are on the verge of a major epidemic. However, 2. 0 years of research have now provided the tools to change the current course of events and to reverse the increases in teenage drug use that began in 1. We know more about the causes of drug abuse than ever before, and we have learned a great deal about what works and what does not. We are beyond the point where we have to make uninformed choices about what might prevent or reduce teenage drug use. A major assumption in this work and a major theme of this NIDA conference is that prevention should be based on science - not on hunches, guesses, and wishful thinking. As General Barry Mc. Caffrey, director of the Office of National Drug Control Policy, has said, . The goal of identifying effective prevention approaches has been elusive. Although many approaches have increased knowledge about the adverse consequences of using drugs and some have increased antidrug attitudes, few programs have demonstrated an impact on drug use behavior. However, early prevention efforts were based largely on . As the field of drug abuse prevention has matured, there has been an increasing reliance on theory derived from empirical evidence of the causes of drug abuse. During this time, mounting empirical evidence from a growing number of carefully designed and methodologically sophisticated research studies clearly indicates that at least some approaches to drug abuse prevention work. The primary focus is on approaches that have been subjected to careful evaluation using acceptable scientific methods and whose results have been published in peer- reviewed journals. Clearly, one of the most productive areas of prevention research has involved the testing of approaches designed to be implemented in school settings. The reasons for the focus on school- based drug abuse prevention are rather obvious and straightforward. Most prevention approaches are designed to target school- age populations, with the greatest emphasis on middle/junior high school- age adolescents. Schools, therefore, serve as natural sites for both implementing and testing prevention approaches that target individuals in this age group. Schools provide relatively easy access to a large number of individuals who are the logical targets of prevention efforts. Schools are also the logical site of prevention efforts because they offer a structured setting within which prevention programs can be conducted and evaluated in a methodologically rigorous way. Notwithstanding the fact that this may amount to little more than one semester during the entire middle/junior high school years, it frequently provides a natural programming slot through which drug abuse prevention curriculums can be scheduled. Educators also are gradually beginning to recognize that both health and drug abuse prevention are important to the achievement of traditional educational objectives. The problem of drug abuse, therefore, has come to be seen as both a health problem and a barrier to educational achievement. Not On Tobacco (NOT) Significantly decreased smoking and increased smoking cessation among teenagers. Packaged and successfully disseminated to schools and community. The Office of Adolescent Health (OAH) coordinates adolescent health programs and initiatives across the U.S. Department of Health and Human Services related to. Prevention Preventing adolescent substance abuse. Pervasive, consistent messages to young people about drugs and alcohol can prevent substance abuse. Thus, educators have become increasingly receptive to the idea of setting aside some part of their academic schedule for drug abuse prevention. The most promising approaches have three distinguishing features: They are based on an understanding of what is known about the etiology of drug abuse, are conceptualized within a theoretical framework, and have been subjected to empirical testing using appropriate research methods. Although all three are critically important, the most fundamental element of any prevention program is an approach that is based on an understanding of the etiology of drug abuse. Instead, there are many different factors that appear to interact with one another to produce a complex, probabilistic risk equation. This makes prevention much more difficult, because instead of identifying a single cause and developing an intervention to target it, interventions must target multiple risk and protective factors. As Pandina (this volume) indicates, research on the etiology of drug abuse suggests that to be effective, prevention programs targeting children and adolescents must influence social factors as well as knowledge, attitudes, norms, skills, and personality. To the extent possible, consideration must also be given to the importance of biological, pharmacological, and developmental factors. Hamburg et al. 1. Most individuals begin by experimenting with alcohol and tobacco, progressing later to the use of marijuana. All of these substances are widely used in our society, and not surprisingly, the progression of drug use conforms exactly to the prevalence of each substance in our society. It is reasonable to conclude that smoking prevention programs should be. Tobacco prevention programs reduce smoking. To continue reducing smoking, states must increase funding for tobacco prevention and cessation programs. Recent Findings on Peer Group Influences on Adolescent. We conclude with implications for research and prevention programs. Adolescent smoking networks. Preventing Drug Abuse Through the Schools: Intervention Programs That Work. Professor and Director Institute for Prevention Research. Smoking Prevention and Control Strategies for. Smoking; Sexually transmitted. There are many examples of effective policies and programs that address adolescent health issues. Teen pregnancy prevention. Suggested Citation: 'Adolescent Decision Making: Implications for Prevention Programs.' Institute of Medicine and National Research Council. Correspondingly, these substances are also widely and easily available, frequently in the home. Because of their availability, inhalants are also used early in this sequence. Some individuals progress later to the use of other illicit substances such as stimulants, depressants, narcotics, and hallucinogens. This suggests that the focus of early prevention efforts should be on those substances used at the beginning of this sequence, that is, alcohol, tobacco, and marijuana. Another implication from the etiology literature for prevention is that prevention programs should target the gateway substances of tobacco, alcohol, and marijuana. The recent increase in inhalant use and its potential role as a form of gateway drug use suggest that it should also be the focus of prevention efforts. These and other conclusions drawn from etiology research provide useful information concerning the kind of drug abuse prevention program likely to be the most effective. Understanding the etiology of drug abuse also makes it easy to recognize why some prevention approaches have not succeeded. As indicated elsewhere (Botvin 1. Botvin and Botvin 1. This paper focuses primarily on the last two approaches, because the available evidence indicates that they are the most promising. The underlying assumption of these approaches is that the problem of drug abuse is caused by a lack of knowledge about the dangers of using drugs. Correspondingly, it is assumed that drug abuse can be prevented by making individuals aware of the appropriate facts about drug abuse. It is hoped that adolescents, armed with these facts, will make a logical and rational decision not to smoke, drink, or use illicit drugs. Closely related to information dissemination approaches is the use of fear- arousal techniques or scare tactics to dramatize the dangers of drug abuse and increase motivation to avoid drugs. Richards 1. 96. 9; Schaps et al. Swisher and Hoffman 1. These studies show that information dissemination approaches are effective in their efforts to increase knowledge and also frequently increase antidrug attitudes. However, they fall short where it counts most - having an impact on drug use behavior. This is not to say that knowledge is unimportant or irrelevant to prevention efforts. In fact, developmentally appropriate and personally relevant health information may indeed have a place in drug abuse prevention programs. Yet, it is clear that prevention approaches primarily designed to increase information are not effective. Affective education approaches were widely used during the 1. Typically, the focus of affective education approaches is on increasing self- understanding and - acceptance through activities such as values clarification and responsible decisionmaking; improving interpersonal relations by fostering effective communication, peer counseling, and assertiveness; and increasing students' abilities to fulfill their basic needs through existing social institutions (Swisher 1. The results of evaluation studies testing affective education approaches have been as disappointing as information dissemination and fear- arousal approaches. Although affective education approaches, in some instances, have been able to demonstrate an impact on one or more of the correlates of drug use, they have not been able to affect behavior (Kearney and Hines 1. Kim 1. 98. 8). These social influences arise from the media, peers, and the family. The original research in this area was conducted by Evans and colleagues (Evans 1. Evans et al. 1. 97. The prevention approach developed and tested by Evans was a major departure from previous approaches to tobacco, alcohol, and other drug abuse prevention. It is noteworthy not only because it was the first approach to produce an impact on behavior, but also because it contained several of the core components still used in the most successful drug abuse prevention approaches, which are briefly described below. The underlying concept is analogous to that of inoculation used in infectious disease control. To prevent individuals from developing positive attitudes about smoking, drinking, or illicit drug use (. For example, from this perspective, cigarette smoking is conceptualized as resulting from exposure to social influences (persuasive messages) to smoke from peers and the media that are either direct (offers to smoke from other adolescents or cigarette advertising) or indirect (exposure to high- status role models who smoke). Although psychological inoculation was the conceptual centerpiece of this research, it has received less emphasis in more recent variations on the social influence model. Other components of the approach developed by Evans have assumed greater importance, although in a somewhat different form. These include demonstrations of techniques for effectively resisting various pressures to smoke, periodic assessment of smoking with feedback to students to correct the misconception that smoking is a highly normative behavior, and information about the immediate physiological effects of smoking. After a decade of disappointing and frustrating research, there was finally evidence that prevention could work.
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