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Reducing Teen Substance Abuse: What Really Works

December 04, 2015  |  Falmouth Enterprise

Dr. Michael Bihari

Last month, the Trust for America’s Health published a detailed health policy report Reducing Teen Substance Abuse: What Really Works. The Trust is a Washington, D.C. based non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority. 

According to the report, a significant number of teens try alcohol and other drugs; before entering or while in high school more than 65 percent of students have used alcohol and more than 40 percent used illegal drugs. And, more than 90 percent of adults who develop a substance use disorder began using drugs or alcohol before they were 18-years-old.

The authors of the report noted that, “While the number of teens who regularly misuse or develop substance use disorders has been decreasing over time, overall levels are still too high.”

The following are excerpts from the report: 

What Works and What Doesn’t Work

For decades, substance misuse strategies focused on individual willpower to “just say no” or intervening once a person already has a serious problem.

But, the evidence shows that if the U.S. is going to maintain a continued downward trend in substance use — it will require a greater emphasis on: 

  • preventing use in the first place
  • intervening and providing support earlier after use has started
  • viewing treatment and recovery as a sustained and long-term commitment

More than 40 years of research exists from the National Institutes of Health and other experts that supports this approach, but there has been a disconnect in implementing the science into real-world practice.

A prevention approach can decrease the chances of tweens and teens initiating, regularly using or developing an addiction to alcohol and/or drugs. This approach not only lowers the chances for substance misuse, but also has a bigger impact, since similar underlying causes have also been shown to contribute to increased likelihood of poor academic performance, bullying, depression, violence, suicide, unsafe sexual behaviors and other problems that can emerge during teenage years.

Crucial to a prevention approach is to reduce the risks and increase the conditions that help protect our kids and teens from using or becoming dependent on drugs and/or alcohol. 

Risk and Protective Factors

Research shows that the most effective prevention strategies focus on reducing risks and boosting protective factors starting early in a child’s life — and continuing through the tween, teen and early adult years. According to the National Institute on Drug Abuse, the following are the key risk and protective factors that need to be considered when developing a prevention approach: 

Some Key Risk Factors

  • Lack of nurturing by parents
  • Ineffective parenting
  • Chaotic home environment
  • Lack of a significant relationship with a caring adult
  • A parent or family member who misuses substances, suffers from mental illness or engages in criminal behavior
  • Classroom problems, such as aggression or academic failure
  • Poor social coping skills
  • Association with peers with problem behaviors, including drug misuse
  • Not understanding the extent and acceptability of drug-abusing behaviors in school, among peers and in the community

Some Key Protective Factors

  • A strong bond between children and their families
  • Parental involvement in a child’s life
  • Supportive parenting that meets financial, emotional, and social needs
  • Setting clear limits and expectations for behavior
  • Age-appropriate monitoring of social behavior, such as curfews, adult supervision, knowing a child’s friends, enforcing household rules
  • Success in academics and involvement in extracurricular activities
  • Strong bonds with pro-social institutions, such as school and community organizations
  • Acceptance of norms against drug misuse

10 Indicators for Teen Well-being and Substance Misuse Prevention

In the report, the Trust looked at a series of 10 indicators or programs that have been recommended by experts to help prevent substance abuse and improve the well-being of tweens and teens, some of which have been implemented around the country at the state level. Only two states — Minnesota and New Jersey — have put all 10 into action. The indicators include:

  • Supporting Academic Achievement (state has at least an 80% high school graduation rate)
  • Preventing Bullying (state has comprehensive bullying prevention laws)
  • Preventing Smoking (state has smoke-free laws that prohibit smoking in public places)
  • Preventing Underage Alcohol Sales (state has liability laws holding establishments accountable for selling alcohol to underage or obviously intoxicated individuals)
  • Screening, Intervention and Referral to Treatment Support (state has billing codes for screening, brief intervention and referral for treatment in their medical health programs, such as Medicaid or private insurance)
  • Mental Health Funding (state increased funding for mental health services for fiscal year 2015)
  • Depression Treatment (state has rates of treatment for teens with major depressive episodes at or above the National percentage of 38.1%)
  • Good Samaritan Laws (state has laws in place to provide some immunity from criminal charges or mitigation of sentencing of seeking help for an overdose)
  • Treatment and Recovery Support for Prescription Drug Misuse (state provides Medicaid coverage for all three FDA-approved medications for the treatment of painkiller addiction)
  • Sentencing Reform (state has taken action to roll back “one- size-fits-all” sentences for nonviolent drug offenses)

According to the report, Massachusetts scores 8, having failed to increase mental health funding and not having unique billing codes for screening, intervention and referral in MassHealth.

Read the Report

This article barely scratches the surface of the Trust’s report; It is a must-read for anyone interested in the prevention of teen substance abuse. The full report is available online, and although more than 80-pages long, it is informative and easy to read: Reducing Teen Substance Abuse: What Really Works 

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