Adolescent Neurological Development and its Implications for Adolescent Substance Use Prevention

Barbara Lopez; Seth J. Schwartz; Guillermo Prado; Ana E. Campo; Hilda Pantin


J Prim Prev. 2008;29(1):5-35. 

In This Article

Preventive Interventions for Adolescent Substance Use

In recognition of the deleterious consequences of substance use in adolescence, research has emphasized substance use prevention as an effective way of reducing substance use and the negative consequences associated with use (Skara and Sussman 2003). In recent years, there has been an increase in both the number and types of prevention programs designed and implemented--both in terms of the methods of implementation (e.g., family based, child-centered) chosen and in terms of the specific mediators of substance use targeted (e.g., increasing knowledge about consequences of substance use, decreasing intentions and attitudes to use drugs, improving family functioning) targeted. Whereas the first generation of adolescent substance use prevention interventions tended to focus on increasing knowledge and understanding of adverse consequences of substance use (e.g. Bruvold 1990; Duryea and Okwumabua 1988), more recent programs have begun to focus on multiple aspects of decision making associated with substance use (e.g., attitudes, beliefs, intentions; Botvin and Tortu 1988) and/or multiple social-ecological contexts (e.g., family, school, peer, community; e.g., Hogue et al. 2002; Pantin et al. 2003; Perry et al. 1996, 2002) that impact adolescent substance use.

As the field of substance use prevention has evolved, both the method of implementation and the range of goals selected have become more varied and diverse (see Lochman and van den Steenhoven 2002, for a review). Given the recent growth in the number and scope of prevention programs aimed at preventing adolescent substance use, researchers have begun to compile a set of program characteristics that have been found to produce the greatest reductions in adolescent substance use. Such knowledge is important because it helps to further the understanding of "what works" in substance use prevention. According to a recent review by Nation et al. (2003), effective interventions generally include several of the following characteristics: specific components designed to engage and retain study participants, parent training, youth skills training and normative education, changes in laws and policies, peer resistance skills, and media campaigns. The above-mentioned characteristics have been incorporated into interventions based on a number of methods of implementation (e.g., child-centered, family based, family based + child-centered, and multi-component interventions; see Table 1 for a review).

Child-centered interventions are delivered to youth, have generally focused on the intrapersonal context (e.g., attitudes, beliefs, intentions), and aim to prevent substance use by building youth competencies (resistance skills, self management, social skills, increase knowledge about substance use; Botvin and Griffin 2004). Specifically, these programs attempt to reduce motivation to use substances by increasing awareness of social influences that promote substance use, change normative expectations concerning substance use, teaching resistance skills for substance use, and developing decision making competencies (Botvin et al. 1995; Botvin and Griffin 2004).

In contrast, family-based interventions are usually delivered to parents and focus on improving family functioning (e.g., parent-child communication, parent involvement, parental monitoring). Family-based interventions may also include either child-only sessions or joint parent-child sessions or both. These child-only and parent-child sessions also focus on family functioning. Within family-based interventions, the family is viewed as the main source of the adolescent's protection from substance use. Family functioning reduces adolescent risk for substance use by increasing the likelihood that adolescents will choose to abstain from substance use and by preventing or reducing access to situations that increase the likelihood that substance use will take place. For example, open communication between parent and adolescent reduces risk for substance use by encouraging adolescents to internalize their parents' values and norms (Baldwin and Baranowski 1990; Whitaker and Miller 2000) and enhance their psychosocial competence as displayed by good self-control and resistance to substance use situations (Wills et al. 2003). Parental monitoring decreases risk for substance use by preventing or reducing adolescents' access to risk situations (e.g., unsupervised time with peers) where substance use is possible (Sieving et al. 2000; Simons-Mortan and Chen 2005).

A third type of intervention is one that combines aspects of both child-centered and family-based interventions (family-based + child-centered interventions). For example, Spoth et al. (2002, 2005) combined Life Skills Training (LST), a child-centered intervention, and Strengthening Families Program (SFP), a family-based + child-centered intervention. Another example is the Raising Healthy Children intervention, which included Preparing for the Drug Free Years (a family based intervention; Catalano et al. 1999) along with other child-centered components (e.g., after-school tutoring, classroom curriculum, summer camps, and social skills booster retreats: Brown et al. 2005). These combined interventions are more comprehensive than either one alone in that they address interpersonal and family risk and protective processes.

Multicomponent interventions are a fourth type of preventive intervention. These interventions address multiple contexts (e.g., intrapersonal, community, school, and family) through the addition of components such as child centered interventions, media campaigns, task forces, case management, academic tutoring, community activities, and parent education (e.g., Say Yes First: Zavela et al. 2004 and Project Northland: Perry et al. 1996). One should note that the parent education generally delivered in multicomponent interventions tends to differ from family based interventions in that parent education tends to be administered through non-interactive formats, such as written materials or brief information sessions, and sessions with parents are not conducted. One example of this type of intervention is Project Northland, which includes parent/child homework activities, written materials with information on alcohol use for parents, task forces to affect illegal sales of alcohol to minors, two classroom curricula (e.g., peer resistance skills, alternatives to substance use), peer activity programs to create alcohol free activities, and a theater production (see Perry et al. 1996, for descriptions of each component). These components address several risk and protective factors for adolescent alcohol use (e.g., functional meaning of alcohol use for adolescents, adolescent self-efficacy to resist alcohol use, peer influences, norms regarding alcohol use, and access to alcohol in the community).


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