Substance Abuse Prevention & Treatment Programs
Best Practices
Nonprofit
Development Institute
2500
(302) 656-1100
Alcohol and drug
abuse are destructive forces in today’s society. The negative effects of substance abuse
impact not only heavy users and their families but also the public and private
sectors. The financial burden is
heaviest for the federal government, state governments, and private sector
businesses (Autry, 1999). Alcohol and drug abuse are contributing factors to
crime, poverty, prison population, domestic violence, and child abuse rates.
Families experience many negative repercussions from the effects of alcoholism
in the family. Alcoholism and drug abuse
impact families by increasing rates of domestic violence, child abuse and
neglect, divorce, and poverty. According to the 1997 National Household Survey
on Drug Abuse the highest at-risk category for drug and alcohol abuse in this
country is part-time youth workers ages 18-25 years old. More than one-third of high school students
work during the school year, and many more are employed during the summer
months (Rubenstein, Sternbach, & Pollack, 1999). Without intervention, a large portion of the
population of part-time employed youths will develop into the population of
full-time working abusing adults.
To determine who is
in need of specific prevention and treatment interventions, mental health
professionals make distinctions about different levels of use. Nearly everyone uses alcohol or other drugs
(including caffeine or tobacco) at some point in their lives.
The ability to
successfully negotiate a transition is important for coping with the next stage
of a person’s life. Hence, the right
advice and support, and learning opportunities at the right time, can assist
healthy progress through the transition points of life (National Crime
Prevention, 1999). Adolescence is the phase of life wherein youths struggle
through the transition from childhood to adulthood. Youths are faced with forging individual
identities and finding their places within their communities; at the same time
they are just beginning to develop the skills to make adult decisions. Adolescence is a time of experimentation,
while most adolescents do not grasp the negative consequences associated with
abuse or feel indestructible. Part-time
jobs can be an opportunity for youths to gain skills such as time management
and responsibility and gain self-esteem.
However, employment also brings with it a heightened risk for drug or
alcohol abuse in the nation’s young.
Many factors
contribute to alcohol and drug abuse in youth.
The National Survey of American Attitudes on Substance Abuse VIII: Teens
and Parents reports that the risk of abuse in teens sharply increases if they
are highly stressed, frequently bored or have substantial amounts of spending
money; also reported was that teens with $25 or more a week in spending money
are nearly twice as likely as teens with less to abuse drugs. Increases in the cost of living have forced
numerous youth to work from the primary years of formation into adulthood. For many young people these part-time jobs
provide a vehicle for substance abuse.
The majority of young people employed part-time use their income for
recreational purposes. They have the
newfound freedoms associated with their status as young adults of driving cars,
relaxed family boundaries, and self-generated spending money. These freedoms often come without the
restraints of adult responsibilities such as home ownership and the demands of
a full-time occupation. Dollars are
often used to assist with extra-curricular activities. Although these activities should be school
related or constructive, after time the majority of working students take a
different and dangerous track.
Many youth lack
access to appropriate recreational activities, which elevates the risks of
substance abuse as reported by the National Survey. Without a healthy alternative, many youths
turn to experimentation with alcohol and/or drugs.
A lack of positive adult and
peer relationships can contribute, as these relationships help youth build the
skills and develop the self-discipline needed to resist alcohol and drugs. Parents provide the primary source for
emotional support for children and provide the foundation for youth’s social
and emotional development. Without this support children are put at high-risk
for substance abuse and other risky behavior.
It is unfortunate for our youth that the numbers of single-parent homes
and double-income homes steadily rise, as this means that more and more
children are spending less and less time with their parents at crucial times in
their development. The
The negative effects of substance abuse on youth are manifold. A young person who abuses alcohol or drugs is more likely to:
·
Be in a fatal car accident—Thirty seven percent of
youth traffic fatalities in 1996 were directly related to alcohol consumption
(NCADI, 2000).
·
Contract an STD--Many students report using
alcohol or drugs when they have sex, and 1 in 50 high school students reports
having injected an illegal drug. Surveillance data from the 34 states with
integrated HIV and AIDS reporting systems suggest that drug injection led to at
least 6% of HIV diagnoses reported among those aged 13-24 in 2000, with an
additional 50% attributed to sexual transmission (CDC, 2002).
·
Become violent—While there are many young
people who use drugs and do not become involved in violence, substance use and
involvement in violent behavior are clearly interrelated. There is a
correlation between the severity and frequency of drug use and the severity and
frequency of delinquency (
·
Risky behavior—Survey results form a
nationally representative sample of 8th and 10th graders
indicated that alcohol use was significantly associated with both risky
behavior and victimization (NIAAA, 1997).
·
Commit Suicide—The strongest risk factors
for suicides in youth are depression, drug abuse, and aggressive behavior (National Institute for Mental
Health, 2003)
·
Become pregnant—Sexually experienced teens
that average five or more drinks daily are three times less likely to use
condoms (Hingson, Struhin, Berlin & Heeren, 1990).
There is a clear correlation between employment status and substance abuse. Seventy percent of all substance abusers are employed full-time. Today’s full-time workforce is heavily comprised of alcohol and illicit drug users, with 6.3 million illicit drug users, 6.2 million heavy alcohol users and 1.6 million heavily abusing both (NHSDA, 1997). 7.4% of the part-time workforce uses illicit drugs (); the average among part-time workers is much lower than among full-time workers (OAS Chapter 8). Occupations with the highest use rates are also those most likely to employ youths—construction, food service, and other service occupations (NHSDA, 1997).
Occupations with highest usage rates are also those with the lowest rates of drug information and policy in the Workplace (NHSDA, 1997). Workplace prevention programs have proven to be successful in combating substance abuse problems on a broad scale. These programs “can increase Workplace safety and productivity and lower substance abuse and its human and economic costs” (Nelba Chavez, PhD., SAMSHA Administrator). Studies indicate that employees who receive drug and alcohol information, written drug and alcohol policies, and access to Employee Assistance Programs from their employers are less likely to abuse illicit drugs and alcohol (NHSDA, 1994). A 1994 study revealed that the greater effort put forth by employers toward substance abuse prevention, the fewer number off employees reported abuse of illicit drugs. Usage rates steadily decline as employer programs become more pro-active. For instance, 62.1% of employees reported illicit drug use at companies with information available on alcohol or drug use, whereas only 57.3% reported positively in companies that offered a written policy on alcohol or drug abuse. That percentage drops to just 34.5 when an employee assistance program is available. Thus as the implementation of workplace prevention programs has increased, the rate of illicit drug use among full-time workers has declined (NHSDA, 1997).
However, the majority of employer-assisted programs are not tailored to youths. As youth transition into the workforce it is vital that effective intervention and prevention programs are in place. These programs must address the obstacles specific to age and demographics in order to assist youths’ successful transitions into productive, contributing members of adult society.
The Public Health Model
One prevention goal is to create an environment in which individuals have the opportunity to make healthy choices. The Public Health Model can be used to understand a community, assess factors that contribute to unhealthy choices and lifestyles, and plan specific prevention programs that focus on healthier choices. The model can be applied to any health problem: dental cavities, the flu, tuberculosis, and HIV/AIDS, for example. In this course, the discussion focuses primarily on the use of the Public Health Model in substance abuse prevention efforts.
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This model promotes the concept
of a three-pronged, holistic attack on health problems by targeting three
components: host, agent, and environment.
The Public Health Model of prevention, using the science of epidemiology, stresses that problems arise through the relationships and interactions among host, agent, and environment. In the past, prevention programs often neglected to deal with the environment and focused exclusively on inoculating the host through educational efforts, expecting that information on the dangers of drugs would be sufficient to deter use. However, a public health approach requires not only an understanding of how host, agent, and environment interact, but must also include a plan of action for influencing all three.
The Public Health Model can serve
as an effective planning tool. A community-wide assessment should include the
following questions:
Risk Factors That Lead to Substance Abuse
Risk factors are the attitudes, beliefs, behaviors, and
circumstances that put individuals at risk for substance abuse. The stressors
that increase risk of alcohol and other drug use come from many sources.
The more risk factors that are present in the life of an individual, the more
likely it is that the individual will begin to use drugs. By reducing
risk factors, the individual becomes less vulnerable to substance abuse and
other problem behaviors such as early sexual activity, school dropout, and
unsafe driving.
Individuals with multiple risk factors are at the highest risk for
substance abuse, and they may be candidates for selective or indicated
prevention programs. However, while the presence of multiple risk factors
is predictive of drug problems, it remains unclear if particular risk factors
actually cause individuals to use alcohol or other drugs. What is clear
is that increasing protective factors can reduce the likelihood of individuals
becoming involved in drug use.
There are six categories or domains of risk factors:
While there are six categories of risk (and protective) factors,
five of those domains interact with the individual, who is at the center in the
Web of Influence model. All stimuli are processed, interpreted, and
responded to based upon the characteristics of the individual.
Some important risk factors associated with substance abuse can be
thought of as uncontrollable variables. Among important uncontrollable
individual variables is genetic predisposition. For example, individuals
with a strong family history of alcohol abuse may themselves be biologically
susceptible to abusing alcohol. Age is also important, and individuals
are considered to be most vulnerable to substance abuse from early adolescence
through young adulthood. Gender does not appear to be associated with
increased risk of using drugs. However, women who smoke tobacco, drink
alcohol, or use other drugs are at increased risk for harmful physical effects
from these substances.
Controllable variables include the attitudes, beliefs, skills, and
behaviors that reside within the individual. Some important controllable
variables that you might want to consider for your proposal are listed below.
Individual
Risk Factors
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Family Environment Risk Factors
The family is the strongest influence on the development of
individuals through late childhood. Family risk factors are the elements
of an individual’s home environment that increase the likelihood of becoming
involved with drugs.
Family Risk
Factors
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It is often assumed that children raised by a single parent are at
greater risk for substance abuse, but current evidence suggests that single
parenting in and of itself is not a risk factor. However, high levels of
stress frequently pervade the lives of single parents, who often struggle with
multiple roles and responsibilities. They may experience low levels of
well-being and self-esteem, have little support, and high levels of depression.
If the parent uses alcohol or other drugs or has poor parenting skills, then
the children are at risk.
The negative influence of peers is well established as one of the
most important factors contributing to drug use in youth and young
adults. The relationships and behaviors of an individual’s peer group can
substantially increase the risk of an individual becoming involved in substance
abuse.
Peer Risk
Factors
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Young people who associate with peers who use drugs are more
likely to use them. (Similarly, young people whose friends engage in any
problem behavior are more likely to engage in the same problem behavior.)
Even when young people come from well-managed families and do not experience
other risk factors, just "hanging out" with friends who use drugs
greatly increases a young person’s risk of use. On the other hand, young
people who experience few risk factors are far less likely to associate with
friends who are engaged in problem behaviors.
School is a central element in the lives
of most individuals from early childhood through adolescence. Experiences
in the school environment are a strong influence on people’s lives.
Individuals who have negative experiences in school, especially school failure,
are more likely to use alcohol and other drugs.
School Risk
Factors
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Beginning in the late elementary grades, academic failure
increases the risk of drug use, as well as other problem behaviors.
Programs that focus on building basic skills (such as reading) and reducing
academic failure can decrease this risk. Some students who continue to
experience academic failure cease to see the role of student as a viable one
for them and lose commitment to school. These students are at high risk
for drug use, as well as for school dropout, delinquency, and teen pregnancy.
The risk factors present in the larger community influence the
likelihood that an individual will become involved with drugs. People who
live in communities that are impoverished, disorganized, and apathetic are more
likely to use drugs than those living in socially cohesive communities.
These same communities are likely to experience high mobility, unemployment,
and crime rates, and drugs may be easy to access.
Community
Risk Factors
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Society-related Risk Factors
Societal Risk
Factors
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Relationships Among Risk Factors
Youth who are at risk for substance abuse, teenage pregnancy,
violence, and gang involvement share similar risk factors. In addition,
the Search Institute (a nonprofit research organization focused on the
generation and application of knowledge to promote the well-being of children
and adolescents) has used research findings to chart the interrelationships
between ATOD and other at-risk behaviors. For instance, a youth known to
be at risk for alcohol use has a 70 percent chance of being at risk in the area
of sexuality and an 86 percent chance of being at risk of not using a vehicle
safely.
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Patterns of Co-occurrence of Risk
Behaviors |
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If at-risk in
this area |
Then the likelihood of risk in the
following areas is: |
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Alcohol |
Tobacco |
Illicit Drugs |
Sexuality |
Depression/ Suicide |
Antisocial Behavior |
School |
Vehicle Safety |
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Alcohol |
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