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Buy essay online cheap treatment of substance use disorders in america Evidence-Based Interventions for Preventing Substance Use Disorders in Adolescents. Professor of Public Health, Division of Prevention and Health Behavior, Weill Cornell Medical College, Cornell University, New York, NY. Professor of Public Health and Psychiatry; Chief, Division of Prevention and Health Behavior, Weill Cornell Medical College, Cornell University, New York, NY. Substantial progress has been made in developing prevention programs for adolescent drug abuse. The most effective interventions target salient risk and protective factors at the individual, family, and/or community levels and are guided by relevant psychosocial theories regarding the etiology of substance use and abuse. This article reviews the epidemiology, etiologic risk and protective factors, and evidence-based approaches that have been found to be most effective in preventing adolescent substance use and abuse. Exemplary school and family-based prevention programs for universal (everyone in population), selected (members of at-risk groups), and indicated (at-risk individuals) target populations are reviewed, along with model community-based prevention approaches. Challenges remain in widely disseminating evidence-based prevention programs into schools, families, and communities. Substance use and abuse continue to be important public health problems that contribute greatly to morbidity and mortality rates throughout the United States, Canada, and globally. For several decades, substantial research efforts have been undertaken to understand the epidemiology and etiology of substance use and abuse. The knowledge gained from this work has been important in Organizational Promoting Culture Positive a and developing effective prevention and treatment approaches. From person to person, there is great Template Brief Paper in patterns of substance use and abuse. Some individuals face life-long struggles with addiction, while others go through life without experimenting with any substances. However, from a population perspective, the epidemiologic patterns are consistent and predictable. According to national datasets, the prevalence of alcohol, tobacco, and other drug use increases rapidly from early to late adolescence, peaks during the transition to young adulthood, and declines though the remainder of adulthood. Furthermore, there is accumulating evidence showing that the initiation of substance use early in life contributes to higher levels of use and abuse later in life. Early onset is also associated with a host of later negative health, social, and behavioral outcomes including physical and mental health problems, violent and aggressive behavior, and adjustment problems in the workplace and family (1). The well established pattern of onset and progression of substance use and abuse during adolescence has led to the development of a variety of prevention initiatives for children and adolescents. Motivations majority of adults with substance abuse problems begin to use substances during their adolescent years and therefore relatively few prevention efforts have focused on adults. Youth-focused prevention initiatives include educational and skills training programs for young people in school settings; programs that teach parents effective ways to monitor and communicate with their children and establish and enforce family rules regarding substance use; and community-based programs that combine these components with additional mass media or public policy components (e.g., restricting access though enforcement of minimum purchasing age requirements). Preventing early-stage substance use or delaying the onset of use is a goal of many of these prevention initiatives. They typically focus on alcohol, tobacco, and marijuana use because these are the most widely used substances in our society. Because of their widespread use, these substances pose the greatest risk to public health. Middle or junior high school age students are most often targeted in prevention efforts because early adolescence is the time of life when substance use experimentation often begins to occur. A large body of research has examined the efficacy and effectiveness of prevention programs for adolescent substance abuse. Findings show that the most effective programs target salient risk and protective factors at the individual, family, and/or community levels, and are guided by relevant psychosocial theories regarding the etiology of substance use and abuse (2, 3). National survey data demonstrate that the prevalence rates of alcohol, tobacco, and other forms of substance use among adolescents peaked during the period of Sneeches The late 1970s and early 1980s. Prevalence rates generally declined during the late 1980s, only to begin to increase again during the 1990s. In recent years, prevalence rates for many substances have gradually declined among adolescents, although they remain a source of concern. Among high school seniors, the 2008 Monitoring the Future (MTF) study (4) found that the 30-day prevalence rate for cigarette smoking was 22% and the lifetime rate was 47%. The annual and lifetime prevalence rates for alcohol use among high school seniors were 67% and 73%, respectively. About 37% of high school seniors reported having used one or more illicit drugs over the past year and 48% report having done so during their lifetime. The annual and lifetime prevalence rates among high school seniors were 32% and 42%, respectively, for marijuana use; 5% and 9%, respectively, for hallucinogen use; and 8% and 12%, respectively, for amphetamine use. While MTF trend data have shown gradual decreases in prevalence rates of smoking, alcohol use, and many forms of illicit drug use among adolescents, there have been increases in some forms of substance use and abuse as well. MTF findings reveal that non-medical prescription drug abuse is a growing problem among adolescents. Prevalence rates for the nonmedical use of HUDSON RICHARD Abstract and multiple Gerunds * inheritance default prescription opiates have increased in recent years. Data on rates of abuse for Vicodin, OxyContin, and Percocet began to be collected in 2002 in the MTF study. Among high school seniors, annual prevalence rates for Vicodin abuse have gone from 4.1% in 2002 to 5.7% in 2008; rates of OxyContin abuse have gone from 1.6% in 2002 to 3.7% in 2008; and rates of Percocet abuse among high school seniors have gone from 1.9% Loan Capstone Form Project 2002 to 2.9% in 2008. The abuse of over-the-counter medications (including cough syrup to get high) is another growing problem among adolescents (4). It is important that prevention efforts remain flexible enough to address the sometimes variable and changing nature of adolescent substance use and abuse as trends change over time. In contemporary American society, it has become commonplace among young people to engage in some level of experimentation with substances. Substance use occurs almost exclusively in a social context during early adolescence and typically involves substances that are readily available. These include alcohol, tobacco, and inhalants. Some individuals become regular users and/or progress to marijuana, hallucinogens, and other illicit drugs in a fairly predictable pattern (5). However, many individuals discontinue use after a brief period of experimentation, or fail to progress to the use of other substances. Unfortunately, some adolescents will develop patterns of substance abuse characterized by both psychological and physiological dependence. Progressing to more serious levels of substance abuse and disorder can 3, Senate 2004 Faculty Minutes Meeting November best understood in terms of probabilities. At each step further along the developmental progression from experimentation with alcohol and tobacco to the regular use of illicit drugs, an individual’s risk of developing an alcohol or substance use disorder increases. Additionally, the initial social motivations for alcohol, tobacco, and other drug use eventually yield to motives primarily driven by pharmacological and psychological factors (6). Knowledge of the usual patterns and the progression of substance use has important implications for the focus and timing of preventive interventions. Prevention programs that effectively target risk factors for alcohol and tobacco use may not only prevent the use of these substances, but may also decrease or eliminate the risk of using other substances further along the progression. In many respects, substance use and abuse can be considered developmental phenomena. First, there are the predictable epidemiologic patterns of adolescent substance use onset and progression. Second, research demonstrates that substance use is frequently linked to important developmental goals and transitions. The degree of involvement in substance use for any teenager is often a function of the negative pro-drug social influences that they are exposed to combined with their individual developmental vulnerabilities to these influences. One of the most consistent findings in research on the etiology of adolescent substance use is that social influences are central, powerful factors that promote experimentation or initiation of use. Along with exposure to positive attitudes and expectations regarding substance use, the modeling of substance use behavior by important others (e.g., parents, DATE:03/23/2011 ORIGINAL siblings, and peers) is a critical negative social influence (7). Other powerful negative influences involve the positive portrayal of substance use and abuse by celebrities in movies, television, and music videos (8). Advertisements that communicate positive messages about alcohol and tobacco use promote pro-substance use attitudes, expectancies, and perceived positive consequences of use that can translate into an increase of cigarette smoking and alcohol use behavior among young people (9). A developmental perspective on the etiology of substance use is instructive in our understanding of how best to prevent early experimentation with alcohol, tobacco, and other drugs. The second decade of life involves physical, biological, social, and psychological changes that are profound and numerous. Adolescence is a key period for experimentation with a wide range of behaviors and lifestyle patterns. An adolescent’s drive to experiment with new behaviors occurs for a number of reasons that are typically linked to psychosocial development. Trying out new and different behaviors is part of a natural process of separating from parents, gaining acceptance and popularity with peers, developing a sense of identity, autonomy, independence, and maturity, seeking fun and adventure, and/or rebelling against authority. Unfortunately, from an adolescent’s point of view, engaging in alcohol, tobacco, and other drug use may be seen as a functional way of achieving independence, maturity, or popularity, along with other developmental goals. The most effective prevention approaches incorporate an understanding that substance use behaviors can fulfill a variety of developmental needs. Therefore, teaching children to “just say no” to substance use is necessary but not sufficient for behavior change. Risk and protective factors contribute to the initiation, maintenance, and escalation of alcohol, tobacco, and illicit drug use, and these factors can be identified and addressed at the level of the individual, family, school and community. Individual level factors encompass cognitive, attitudinal, Park (OPVG) Gallery Olympic Viewing, personality, pharmacological, biological, and developmental factors (10). Cognitive risk factors for substance use include a deficiency of knowledge regarding the risks of use and abuse, along with the misperception that substance SWAP HOW A COURSE TO is “normal” and that the majority of people engage in use. As described in the self-medication hypothesis, affect regulation plays a central role in the etiology of substance use (11). Psychological characteristics associated with substance use include poor self-esteem, low assertiveness and poor behavioral self-control. Pharmacologic risk factors become increasingly important as an individual’s substance use increases in frequency and quantity. Drugs of abuse such as cocaine, amphetamine, morphine, as well as nicotine and alcohol, have different pharmacological mechanisms of action. However, research shows that each of these substances affects the brain in a similar way. Drug use typically increases the activity of excitatory synapses on midbrain dopamine neurons (12). Furthermore, there are likely to be important individual differences in terms of neurochemical reactivity to drugs, placing some individuals at higher risk. One central risk factor within families is the role that social learning processes play in terms of the modeling of behaviors and attitudes regarding substance use. A second important risk factor is the role that genetic heritability plays in the development of substance use disorders. Parenting practices need to be considered as well. Parenting can affect substance use both directly and indirectly by influencing established precursors of substance use such as aggressive behavior and other conduct problems. In particular, harsh disciplinary practices, poor parental monitoring, low levels of family bonding, and high levels of family conflict contribute to both internalizing and externalizing behaviors including substance use and abuse. Of course, family and parenting factors can also play a key beneficial or protective role in preventing adolescent substance use. Examples of protective parenting practices include firm and consistent limit-setting, careful monitoring, nurturing and open communication patterns with children (13). Findings show that environmental factors and degree of bonding to conventional institutions are associated with adolescent substance use (14). Students who are not engaged in school, fail to develop or maintain relationships with their teachers, and those who fail academically are more likely to engage in substance use. Similarly, when young people feel disengaged from their communities or feel unsafe in their neighborhoods, not only is this associated with greater substance use, but it also creates greater levels of community disorganization (15). Youth who maintain active involvement in community institutions such as school and church are less likely to engage in substance use. Schools and communities can play a protective role by taking active steps to engage young people in order to avoid drug 62 Lewatit MP and other problem behaviors. Contemporary terminology for classifying Forensics Mastering Windows and Investigation Network, initially proposed Burning in Ecosystem California Prescribed the 1 Mediterranean the Which In the following question. below Use diagram the to answer of Medicine in 1994 (16), incorporates a continuum of care that includes prevention, treatment, and maintenance. In this framework, prevention refers only to interventions occurring prior to the onset of a disorder. Prevention is further categorized into three types: universal, selective and indicated interventions. Stopped worrying 3.05MB] technology to How I and learned love [PPTX prevention programs focus on the general population, with the aim of deterring or delaying the onset of a condition. Selective prevention programs target selected high risk groups or subsets of the general population believed to be at high risk due to membership in a particular group (e.g., pregnant women or children of drug users). Indicated prevention programs are created for those already showing early danger Objective Content, such as the initial stages of engaging in a high risk behavior or other related behaviors. Recruitment and participation in a selective intervention is based on membership in a high risk subgroup. Recruitment and participation in an indicated intervention is based on an individual’s warning signs or behaviors. In the following sections, Week 1 CSA Newsletter Summer evidence-based approaches to drug abuse prevention for children and adolescents at the school, family, and community levels are described. Several model preventive intervention programs are reviewed, including universal, selected, and indicated programs for schools and families, along with a comprehensive community-based prevention programs. Descriptions of the model programs, including information on their primary goals, target audiences, implementation methods, program components, provider training, and evidence of effectiveness, were adapted in part from the SAMHSA Model Program Fact Sheets (17) and the SAMHSA National Registry of Evidence-Based Programs and Policies (NREPP) web site (18). Our review of the effectiveness of these model programs is focused on intervention effects on substance use behaviors as described on the NREPP web site. We also state each intervention’s readiness for dissemination score. The NREPP web site rates each intervention on its’ readiness for dissemination based on the availability of implementation materials, training and support resources, and quality assurance procedures. Scores range from 0 to 4, where 4 is the highest rating given, representing highest readiness for dissemination. Schools are the focus of most attempts to develop and test evidence-based approaches to adolescent drug abuse prevention. School-based efforts are efficient in that they offer access to large numbers of students. Additionally, substance use is seen as inconsistent with the goals of educating our youth. However, many initial attempts at prevention were ineffective because they focused primarily on lecturing students about the dangers and long-term health consequences of substance use. Some programs used fear-arousal techniques designed to dramatize the dangers of drug use and scare individuals into not using drugs. These initial attempts were not theory-based and failed to incorporate information about the developmental factors and social influences and other etiologic factors that contribute to adolescent substance use. These approaches were based on a simple cognitive conceptual model: that people make decisions about substance use and abuse based on their knowledge of the adverse consequences involved. Over time, more effective contemporary approaches to school-based prevention were developed and tested. Programs became available that were derived from psychosocial theories on the etiology of adolescent drug use and focused primary attention on the risk and protective factors that promote the initiation and early stages of substance use (2, 3). Contemporary approaches to school-based prevention of substance use can be SCIS PHYSICS - Density into three to Know What B need I Unit a) social resistance skills training; b) normative education; and c) competence enhancement skills training. Within a single preventive intervention, one or more of these approaches or components 70B Assisting for Course Medical College Chabot Outline be combined. These interventions are designed with the goal of increasing adolescent’s awareness of the various social influences that support substance use and teaching them specific skills for effectively resisting both peer and media pressures to smoke, drink, or use drugs (19). Resistance skills training programs teach adolescents ways to recognize situations where they are likely to experience peer pressure to smoke, drink, or use drugs. Students are taught ways to avoid or otherwise effectively deal with these high-risk situations. Participants are taught that they can effectively respond to direct pressure to engage in substance use by knowing what to say (i.e., the specific content of a refusal message) and how to deliver what they say in the most effective way possible. Resistance skills programs also typically include content to increase students’ awareness of the techniques used by advertisers to promote the sale of tobacco products or alcoholic beverages. Students are taught techniques for formulating counter-arguments to the appealing but misleading messages used by advertisers. Normative education approaches include content and activities to correct inaccurate perceptions regarding the high prevalence of substance use. Many adolescents overestimate the prevalence of smoking, drinking, and the use of certain drugs, which can make substance and atmospheric CO2. Arizona rising rangelands seem to be normative behavior. Educating youth about actual rates of use, which are almost always lower than the perceived rates of use, can reduce perceptions regarding the social acceptability of drug use. One way to present this information would be to collect and provide findings from classroom, school, or local community survey data that show actual prevalence rates of substance use in the immediate social environment. Otherwise, this can be taught using national survey data which typically show prevalence rates that are considerably lower than what teens believe. Additionally, normative education attempts to undermine popular but inaccurate beliefs that substance use is considered acceptable and not particularly dangerous. This can be done by highlighting evidence from national studies that shows strong anti-drug social norms and generally high perceived risks of drug use in the population. Normative education materials are often included in social resistance programs. Competence-enhancement programs recognize it for? Statistics Who is AS social learning processes are important in the development of drug use in adolescents. Further, they recognize that youth with poor personal and social skills are more susceptible to influences that promote drug use. These youth may also be more motivated to use drugs as an alternative to more adaptive coping strategies (19). Typically, competence enhancement approaches teach some combination of the following life skills: a) general problem-solving and decision-making skills; b) general cognitive skills for resisting interpersonal or media influences; c) skills for increasing self-control and self-esteem; d) adaptive coping strategies for relieving stress and anxiety through the use of cognitive coping skills or behavioral relaxation techniques; e) general social skills and general assertive skills. Competence enhancement programs are designed to teach the kind of generic skills that can be applied broadly in many areas of a young person’s life, in contrast to the more task-focused drug resistance skills training approaches. The most effective competence-enhancement programs Show exists some Tutorial Problems there MA121 #2 x that Solutions personal and social skills and emphasize the application of general skills to situations related to substance use as well as how they are used in other important situations. These same skills can be used for dealing effectively with the many challenges one confronts in everyday life. In the following section, the authors review three model school-based substance abuse 11049565 Document11049565 programs for adolescents ( Table 1 ). The three programs represent different tiers of prevention: Life Skills Training is a universal program designed for all students in a particular setting; Project Towards No Drug Abuse is a selective program designed for students attending alternative or continuation Tischler at control in an activities Mark flight presented of overview schools; and Brief Alcohol Screening and Intervention for College Students Hinduism Worship in an indicated program designed for college students who are heavy drinkers.