Preventing Drug Abuse What Do We Know? (1993) / Chapter Skim
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2 Concepts of Prevention
2 Concepts of Prevention
Pages 45-75
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From page 45... ...
Concepts of Prevention To prevent drug abuse, the central question is: What individual and group factors need to be considered in designing interventions to be effective? To answer that question, a series of related questions have been investigated: What elements affect the probability of onset, progression, severity, and cessation of drug use, abuse, and dependence?
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From page 46... ...
The distribution of both predisposing and enabling elements tends to be associated with socioeconomic class and ethnicity. The relationship of predisposing and enabling elements may be critical to understanding why the rates of onset of drug use may be similar in different groups but then diverge into sharply different rates of drug abuse and dependence.
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From page 47... ...
with a criterion behavior or outcome in this case, with the onset of illicit drug use, some threshold level of consumption, or the clinical occurrence of drug abuse or dependence. This specification makes the risk factor model more empirical than theoretical.
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From page 48... ...
This approach particularly emphasizes the character and dynamics of interaction over time within the family during early childhood and within environments such as the school, especially grades 1-6. It shares with some risk factor theories a concern with early developmental deficits or predisposing factors.
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From page 49... ...
Cigarette smoking is the most thoroughly documented health-related behavior in social influence theory, and most interventions to increase resistance skills were originally developed and tested in the context of preventing the onset of smoking (Evans and Raines, 1982~. We have documented the relevance of smoking prevention to illicit drug use prevention in Chapter 1, in the discussion of gateway drugs and the sequence of progression of drug involvement.
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From page 50... ...
Communityspecific prevention is receiving major attention in various fields of public health, particularly in preventing cigarette smoking and in controlling risk factors for cardiovascular disease, cancer, AIDS, teenage pregnancy, and other major health or related social problems. The conceptual foundations of drug abuse prevention historically have been imported from behavioral and social science research on cigarette smoking reduction and public health promotion generally.
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From page 51... ...
The early onset of cigarette smoking is of special interest, and early alcohol and marijuana onset are also of concern, because these tend to be gateways to other drugs. Most studies of drug-related risk factors have been exploratory rather than substantive, that is, they have employed small samples, followed up for abbreviated periods, and have inadequate disaggregation and control for gender, race/ethnicity, and socioeconomic status.
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From page 52... ...
We first review some of the literature that has focused on single risk factors; the yield of this literature is rather low, so we have been highly selective in attempting to represent it, pointing out major conclusions of studies on the role of genetic and congenital factors, personality characteristics, and socioeconomic neighborhood characteristics. We then review the results of studies on multiple risk factors that focus attention on the issue of how these risk factors interrelate.
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From page 53... ...
In contrast, such factors as depression, suicidal thoughts, and low self-esteem, all of which seem very plausible and often serve as commonsense assumptions underlying the design of drug abuse prevention efforts, do not stand up well under empirical investigation. Zuckerman (1979)
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From page 54... ...
The belief is widely held and intuitively appealing that a strong sense of self-esteem is a protective factor and lack of it a risk factor for adolescent drug use. There is no doubt that most cases of adolescent drug abuse or dependence that come to clinical attention are individuals who are short on self-esteem.
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From page 55... ...
We suspect that the illicit drug use and trafficking that occur in economically disadvantaged communities, which are disproportionately black, Puerto Rican, and Mexican-American, occur for many of the same reasons as in other segments of the population, but that these reasons are more intense. In the most depressed portions of these communities, there is an additional dimension associated with greater numbers of drug abusing and dependent individuals and high levels of violence: namely, for many poor, young minority men and women, illicit drug markets are key sources of employment and are perceived as a route to economic mobility.
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From page 56... ...
Relationships Among Risk Factors Young people who engage in one form of health-compromising behavior are often engaged in other problem behaviors (Jessor and Jessor, 1977~. The co-occurrence of alcohol and other drug abuse with delinquency and criminal behavior is well established (Elliott et al., 1985; Hawkins et al.
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From page 57... ...
About 51 percent of the high school age sample had used marijuana at some time. But only 22 percent of those with none of the risk factors identified (low grade point average, lack of religious participation, poor relationship with parents, early alcohol use, low self-esteem, lack of conformity, sensation seeking, perception of ease of obtaining drugs, perception of neutral or favorable norms concerning drug use)
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From page 58... ...
WHAT DO WE KNOW? Research Needs The study of multiple risk factors and their interaction appears to present substantial advances over attention to single factors or limited clusters of factors.
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From page 59... ...
If parenting practices to which the child is subject do not improve, these patterns of poor family bonding become more violent and reciprocal as the child grows beyond preschool. Although family economic conditions do not directly determine parenting practices, high levels of stress and disorganization degrade parenting performance, and these levels of stress are more common when family economic resources are scarce and when the neighborhood environment is itself impoverished and disorganized.
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From page 60... ...
In major longitudinal studies, no more than 30-40 percent of the early elementary children who displayed behavior problems engaged in antisocial behavior, delinquency, or drug abuse in adolescence (Robins, 1978~. Parenting practices can improve or deteriorate over time, as family structures change through divorce or remarriage, parents mature, marital discord emerges, etc.
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From page 61... ...
It is probable that such conditions now prevail in extreme forms for many and in milder ones for most children, and that widespread experimentation with problem behaviors, including drug abuse in one form or another, may prove endemic, even though waves of such behavior will advance and recede. American schools have changed less in the past few generations than have the other major socializing institutions.
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From page 62... ...
Curricula heavily focused on developing basic cognitive skills and acquiring facts provide students few opportunities to demonstrate mastery, to see connections with "real life," or to develop the higher-order cognitive skills and social competencies they will need to experience satisfying interpersonal relationships, to resist dysfunctional social pressures, and to take on adult roles. Most schools rely on competitive evaluation systems and pervasive use of extrinsic rewards, practices that adversely affect many children's sense of compe tence, self-esteem, intrinsic motivation for learning, and actual performance (Deci and Ryan, 1985~.
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From page 63... ...
The school as a social institution has received much less attention in research on drug abuse prevention than have the characteristics of individual children, their families, and their peer groups. Psychological paradigms have dominated the prevention research in drug abuse; sociological paradigms have been less influential in this as in other fields of health behavior.
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From page 64... ...
, and the RAND Corporation's Project ALERT (Ellickson and Bell, 1990~. One might add to this last generation a series of more comprehensive school health curriculum evaluations directed not specifically at drug abuse prevention but including at
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From page 65... ...
Studies of social influence intervention studies have measured changes in information, in specifically instructed interactive skills, and in native expectations regarding alcohol, tobacco, and drug use. MacKinnon et al.
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From page 66... ...
SIC .erlIlg. SUMMARY Three principal approaches in drug abuse prevention research emerge from the recent past: the study of risk factors, the study of developmental sequences, and the study of social influence.
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From page 67... ...
Studies of risk factors are hobbled by measurement deficiencies with respect to environmental variables in particular, and methodological investments and improvements in this respect are needed. The developmental approach involves a more structured, sequential model of poor early parenting, school maladjustment, academic deficiency, and gravitation toward school-oppositional groups, which are seedbeds of illicit drug use and other disorderly and problem behaviors.
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From page 68... ...
Turner, and E.F. Mason 1985 Summary of findings of the school health education evaluation: health promotion effectiveness, implementation and costs.
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From page 69... ...
Berry 1991 Juvenile crime and drug abuse: a prospective study of high risk youth. Journal of Addictive Diseases 11:5-31.
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Iverson 1982 School health education. Annual Review of Public Health 3:321-338.
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From page 71... ...
Simcha-Fagan, and M Davies 1986 Risk factors for delinquency and illicit drug use from adolescence to young adulthood.
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Slinkard, and N Maccoby 1980 Pilot study of smoking, alcohol, and drug abuse prevention.
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Johnson 1986 Balancing program and research integrity in community drug abuse prevention: project STAR approach. Journal of School Health 56:389-393.
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From page 74... ...
Battistich 1991 Chapter in E Goplerud, ea., A Practical Guide to Substance Abuse Prevention in Adolescent.
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From page 75... ...
Maton 1992 Lifestyle and substance use among male African-American urban adolescents: a cluster analytic approach. American Journal of Community Psychology 20:121138.
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