Prevention & Education

(substance use and occupational injury) "We conclude that there is an association between substance use and occupational injury. This association is stronger for males and in certain industries, such as manufacturing and construction, and may also be stronger for younger workers, though future research is needed on this last point. The proportion of injuries caused by substance use, however, is relatively small. Instead, there is mounting evidence that harmful substance use is one of a constellation of behaviors exhibited by certain individuals who may avoid work-related safety precautions and take greater work-related risks. Thus, we suspect that it is more likely that risk-taking dispositions, often termed deviance proneness, and other omitted factors can explain most empirical associations between substance use and injuries at work."

(recommendations of the Latin American Commission on Drugs and Democracy) "Taking into account our continent’s experience in the fight against the narcotics trade and the seriousness of the problem, the Latin American Commission on Drugs and Democracy addresses the present statement to our countries’ governments and public opinion, to the United Nations and the international community, proposing a new paradigm based on three main directives:

"• Treating drug users as a matter of public health.
"• Reducing drug consumption through information, education and prevention.
"• Focusing repression on organized crime."
___________

"To translate this paradigm shift into concrete action, we propose the adoption by Latin America countries of the following initiatives in the framework of a global process of reframing the policies for fighting the use of illicit drugs:

"1. Change the status of addicts from drug buyers in the illegal market to that of patients cared for in the public health system

"2. Evaluate from a public health standpoint and on the basis of the most advanced medical science the convenience of decriminalizing the possession of cannabis for personal use

"3. Reduce consumption through campaigns of information and prevention that can be understood and accepted by young people, who account for the largest contingent of users.

"4. Redirect repressive strategies to the unrelenting fight against organized crime

"5. Reframe the strategies of repression against the cultivation of illicit drugs"

(risk behavior and adolescent substance use) "... adolescence is a period in which youth reject conventionality and traditional authority figures in an effort to establish their own independence. For a significant number of adolescents, this rejection consists of engaging in a number of 'risky' behaviors, including drug and alcohol use. Within the past few years, researchers and practitioners have begun to focus on this tendency, suggesting that drug use may be a 'default' activity engaged in when youth have few or no opportunities to assert their independence in a constructive manner."

(harm reduction objectives) "The hierarchy of harm reduction objectives is:

"• Enter into drug dependence treatment. Those offering long-term medications such as methadone maintenance are more effective.

"• If drug dependence treatment is not an option, switch from injecting to non-injecting drug use.

"• If injecting continues, always use sterile injecting equipment and do not share equipment or drug solutions.

"• If it is not possible to use sterile injecting equipment clean and reuse your own equipment and do not share it.

"• If sharing does occur, clean injecting equipment between each use (using bleach, for example). Do not share ‘cookers’, drug containers or filters
used for injecting, and do not use or share water for rinsing or mixing.

"• Avoid unprotected sex. Always use condoms."

(harm reduction definition) "Harm reduction encompasses interventions, programmes and policies that seek to reduce the health, social and economic harms of drug use to individuals, communities and societies. A core principle of harm reduction is the development of pragmatic responses to dealing with drug use through a hierarchy of intervention goals that place primary emphasis on reducing the health-related harms of continued drug use (Des Jarlais, 1995; Lenton and Single, 2004). Harm reduction approaches neither exclude nor presume a treatment goal of abstinence, and this means that abstinence-oriented interventions can also fall within the hierarchy of harm reduction goals. We therefore envisage harm reduction as a ‘combination intervention’, made up of a package of interventions tailored to local setting and need that give primary emphasis to reducing the harms of drug use. In relation to reducing the harms of injecting drug use, for example, this combination of interventions may draw upon needle and syringe programmes (NSPs), opioid substitution treatment (OST), counselling services, the provision of drug consumption rooms (DCRs), peer education and outreach, and the promotion of public policies conducive to protecting the health of populations at risk (WHO, 2009)."

(prevention of cannabis, tobacco, and alcohol use by adolescents) "The profiles of young cannabis users, at least in the early stages of consumption, do not differ from those of young alcohol or tobacco users. This supports the idea that universal prevention for young people should not focus on cannabis alone, but should be aimed at preventing use of alcohol and tobacco too."

(prevention - early life stress, abuse and neglect) "Exposure to early life stress, even to more severe forms such as physical and sexual abuse and emotional neglect, is common in the general population. The degree of risk for adult psychopathology tends to be correlated with the severity of childhood maltreatment and the number of childhood SLE [stressful life events]. An important causal pathway that links early life stress to the onset of psychiatric disorders is the altered homeostasis in the HPA [hypothalamicpituitary-adrenal] axis and the altered stress response circuitry that underlies many disorders including anxiety, depression, PTSD, and addiction. There appears to be a direct pathway from chronic stress exposure in prepubertal children via adolescent problem drinking to alcohol and drug dependence in early adulthood that is independent of family history. Of course, this can only occur in individuals exposed to the availability of alcohol or drugs. Early life stress may increase vulnerability to addiction through permanent effects on the expression of genes within the mesolimbic dopamine reward pathway. Early onset of problem drinking in stress-exposed children may exacerbate the deleterious effects on the developing brain. Since a large proportion of stress-exposed children do not go on to develop addiction, clearly resilience factors, including gene–environment interactions, are important. This review of the literature indicates that prevention should focus on early intervention in problem families to forestall maltreatment. Adolescence is a critically vulnerable time for the development of risky drinking habits, and this is an area where prevention, through the development of positive family, peer, and neighborhood-mediating factors, is vital. A holistic approach to the treatment of alcohol and drug dependence is essential since treatment is unlikely to be effective unless underlying impediments such as early life stress are recognized and addressed."

(adolescent behaviors and substance abuse) "Models of change often noted among underlying rationales for alternatives programming include the beliefs that alcohol and drug use results from youth alienation and anxiety, low self-esteem, or external locus of control. It should be noted, however, that research shows little or no relationship between these factors and substance abuse (Bachman 1975; Jessor and Jessor 1973; Jessor and Jessor 1977; Oetting et al. 1989). On the other hand, there is much research support for models of change based on the notions that attachment to social institutions (e.g., school, church), academic achievement, high educational aspirations, self-control, social competency, and attitudes unfavorable to alcohol and drug use are all generally inconsistent with the use and abuse of alcohol and drugs."

(effective adolescent prevention programs in Europe) "Interactive programmes based on the model of social influence or life skill competence have been shown to be effective in schools, but individual measures carried out in isolation (for example, only communication of information, affective education or other non-interactive measures) have been negatively evaluated (Bühler and Kröger, 2006). For organisational reasons, school-based prevention is usually the responsibility of local authorities ..."

(cannabis and academic performance) The World Health Organization noted that, while some studies indicate that adolescents who use marijuana might be more likely to drop out of high school and experience job instability in young adulthood, "The apparent strength of these relationships in cross-sectional studies ... has been exaggerated because those adolescents who are most likely to use cannabis have lower academic aspirations and poorer high school performance prior to using cannabis than their peers who do not."

(overdose prevention) "A first priority for prevention must be to reduce the frequency of drug overdoses. We should inform heroin users about the risks of combining heroin with alcohol and other depressant drugs. Not all users will act on such information, but if there are similar behavioral changes to those that occurred with needle-sharing overdose deaths could be substantially reduced. Heroin users should also be discouraged from injecting alone and thereby denying themselves assistance in the event of an overdose."

Prevention - Data

(2010 - youth participation in prevention programs) "In 2010, approximately one in eight youths aged 12 to 17 (11.5 percent) reported that they had participated in drug, tobacco, or alcohol prevention programs outside of school in the past year. This rate was similar to the 12.0 percent reported in 2009, but was lower than the rate reported in 2002 (12.7 percent). In 2010, the prevalence of past month use of illicit drugs, marijuana, cigarettes, or past month binge alcohol use among those who participated in these prevention programs outside of school was not significantly different (9.5, 6.8, 8.1, or 7.3 percent, respectively) from the prevalence among those who did not (10.1, 7.4, 8.3, or 7.9 percent, respectively)."

(2010 - family) "Compared to teens in families with strong Family Ties, teens in families with weak Family Ties are:

"• Four times likelier to have tried tobacco;

"• Four times likelier to have tried marijuana; and

"• Almost three times likelier to have tried alcohol."

(2010 - youth exposure to prevention messages) "In 2010, 75.9 percent of youths aged 12 to 17 reported having seen or heard drug or alcohol prevention messages in the past year from sources outside of school, which was lower than the 77.0 percent reported in 2009 and the 83.2 percent reported in 2002 (Figure 6.6). In 2010, the prevalence of past month use of illicit drugs among those who reported having such exposure (10.1 percent) was not significantly different from the prevalence among those who reported having no such exposure (10.0 percent)."

(2009 - federal funding and grants for drug free coalitions) "The FY 2009 resources of $90.0 million will support the development of community drug-free coalitions throughout the United States. The program provides up to $125,000 per year in grant funding to local drug-free community coalitions which must be matched at a minimum 1:1 ratio by local communities. These grants are awarded through peer-reviewed annual competitions."

(2008 - adolescents - family dinners) "As frequency of family dinners increases, reported drinking, smoking and drug use decreases. Compared to teens who have five to seven family dinners per week, those who have fewer than three family dinners per week are more than twice as likely to have used tobacco or marijuana, and one and a half times likelier to have used alcohol."

(2008 - federal drug free coalition grants) "In August 2008, the national competition for grants resulted in the award of 199 new grants to coalitions, bringing the current total of DFC grantees to 769."

(2007 - parental approval and substance use) "In 2007, most youths aged 12 to 17 believed that their parents would strongly disapprove of their having one or two drinks of an alcoholic beverage nearly every day (89.6 percent), smoking one or more packs of cigarettes per day (92.1 percent), and using marijuana or hashish once a month or more (93.3 percent).

"Youths’ perceptions of parental disapproval of their substance use as well as parental involvement generally decreased with age; for example, 95.8 percent of 12 or 13 year olds compared with 93.4 percent of 14 or 15 year olds and 87.4 percent of 16 or 17 year olds thought their parents would strongly disapprove of their smoking one or more packs of cigarettes per day."

(2004 - parental conversations about substance use) "In 2004, 60.3 percent of youths aged 12 to 17 reported that they had talked at least once in the past year with at least one of their parents about the dangers of drug, tobacco, or alcohol use; this rate represents an increase from the 2003 rate of 58.9 percent and the 2002 rate of 58.1 percent. Among youths who reported having had such conversations with their parents, rates of current alcohol and cigarette use and past year and lifetime use of alcohol, cigarettes, and illicit drugs were lower than among youths who did not report such conversations. For example, past month binge drinking was reported by 10.5 percent of youths who had talked with their parents about drug, tobacco, or alcohol use compared with 12.0 percent of those who had not. Past month use of illicit drugs other than marijuana was reported by 4.6 percent of youths who had such conversations with their parents compared with 6.3 percent of those who had not."

(2004 - out-of-school prevention messages) "Out-of-school exposure to drug or alcohol prevention messages in the past year was reported by 83.0 percent of youths aged 12 to 17 in 2004, a percentage similar to that in 2002 and 2003. Most indicators of current alcohol and drug use were similar for youths exposed to such out-of-school messages and those reporting no such exposure. However, past month use of illicit drugs was lower among those who were exposed than among those not exposed (10.3 vs. 11.8 percent)."

(1999 - substance abuse prevention messages in the media)
"• Exposure to prevention messages in the media was significantly associated with lower odds of past year marijuana use for whites and Hispanics, but not for blacks or youths in the 'other' category.

"• Higher levels of parental communication about substance use were significantly associated with lower odds of past year marijuana use among Hispanic youths, but not among youths of other racial/ethnic groups.

"• Within the school domain, strong sanctions against illegal drug use were significantly associated with lower odds of past year youth marijuana use among whites, Hispanics, and youths in the "other" category, but not for blacks.

"• Exposure to prevention messages in school was associated with lower odds of past year marijuana use for whites and Hispanics, but not for blacks or youths in the 'other' category."

(1998 - alcohol - youth exposure to prevention messages) In the "Drug Use Among Youths, by Exposure to Prevention Messsages" section of its 1998 National Household Survey on Drug Use, SAMHSA concluded, "youths’ exposure to prevention messages outside school, such as through the media, was fairly widespread but appeared to be unrelated to illicit drug use or being drunk on 51 or more days in the past year. Nearly 80% of youths who used illicit drugs and more than three-fourths of youths who were drunk on 51 or more days in the past year reported being exposed to prevention messages outside school."

(1998 - economics - state & local - spending on substance abuse prevention) "Only $513.3 million in state funds is spent nationwide on substance abuse prevention. This includes $223 million through the department of health, $210 million through the department of substance abuse and $80 million in prevention in elementary and secondary education. Most spending for prevention through the schools is federally funded and that amount is not included here."

(1998 - prevention messages and substance use) "Youths who used illicit drugs in the past year were significantly less likely than youths who had not used drugs to report that they received prevention messages in a special class about alcohol or other drugs at school or as part of another regular class, such as a health class, although these differences were not large. Nearly half of youths who used illicit drugs in the past year reported that they received education or information about alcohol or other drugs as part of a regular class at school, and nearly 30% of youths who used illicit drugs reported being in a special class about alcohol or other drugs at their schools. Youths who were drunk on 51 or more days in the past year did not differ significantly from their counterparts with regard to receipt of alcohol or other drug education as part of a special class.

"In addition, findings from Table 13.8 suggest that youths’ exposure to prevention messages outside school, such as through the media, was fairly widespread but appeared to be unrelated to illicit drug use or being drunk on 51 or more days in the past year. Nearly 80% of youths who used illicit drugs and more than three-fourths of youths who were drunk on 51 or more days in the past year reported being exposed to prevention messages outside school."

Drug Abuse Resistance Education (DARE)

(DARE - effect on drug use) A federally funded Research Triangle Institute study of Drug Abuse Resistance Education (DARE) found that "DARE's core curriculum effect on drug use relative to whatever drug education (if any) was offered in the control schools is slight and, except for tobacco use, is not statistically significant."

(DARE - outcomes) "Our results are consistent in documenting the absence of beneficial effects associated with the DARE program. This was true whether the outcome consisted of actual drug use or merely attitudes toward drug use. In addition, we examined processes that are the focus of intervention and purportedly mediate the impact of DARE (e.g., self-esteem and peer resistance), and these also failed to differentiate DARE participants from nonparticipants. Thus, consistent with the earlier Clayton et al. (1996) study, there appear to be no reliable short-term, long-term, early adolescent, or young adult positive outcomes associated with receiving the DARE intervention."

(DARE - long term effects) Dr. Dennis Rosenbaum, a professor at the University of Illinois at Chicago, completed a six-year study of 1,798 students and found that "DARE had no long-term effects on a wide range of drug use measures"; DARE does not "prevent drug use at the stage in adolescent development when drugs become available and are widely used, namely during the high school years"; and that DARE may actually be counter productive. According to the study, "there is some evidence of a boomerang effect among suburban kids. That is, suburban students who were DARE graduates scored higher than suburban students in the Control group on all four major drug use measures."

Youth Anti-Drug Media Campaign

(Congressional passage of media campaign act) "The media campaign [National Youth Anti-Drug Media Campaign] was authorized by the Drug-Free Media Campaign Act of 1998. This law, less than two pages in length, instructed the Director of the Office of National Drug Control Policy (commonly referred to as the 'Drug Czar') to 'conduct a national media campaign ... for the purpose of reducing and preventing drug abuse among young people in the United States.'”

(2008 - Youth Ant-Drug Media Campaign - incremental value) "The [Youth Anti-Drug Media] Campaign’s Media Match program has generated more than $1.22 billion in incremental media value for the Media Campaign since its inception. During FY 2008, the advertising contractor was able to negotiate more than the one-for-one match requirement. Interactive and Radio media placements generated the greatest additional impact for the Campaign by providing more than 10% above the match requirement."

(2008, 2009, 2010 - Youth Anti-Drug Media Campaign - annual budget) The 2008, 2009, and 2010 budgets for the National Youth Anti-Drug Media Campaign were respectively $60 million (Final), $70 million (Enacted), and $70 million (Requested). For all years since inception, Congressional appropriations for campaign total more than $1.7 billion.

(2006 - Youth Anti-Drug Media Campaign - evaluation) "A well-designed and executed multiyear study of the impact of the ONDCP [Office of National Drug Control Policy] anti-drug media campaign on teen initiation of drug use, or cessation of drug use, shows disappointing results for the campaign. The study provides no evidence that the campaign had a positive effect in relation to teen drug use, and shows some indications of a negative impact."

(2006 - Youth Ant-Drug Media Campaign - funding) "As part of the Treasury and General Government Appropriation Act of 1998,⁷the Drug Free Media Campaign Act of 1998 required, among other things, the Office of National Drug Control Policy to conduct a national media campaign for the purpose of reducing and preventing drug abuse among young people in the United States.⁸"

"From fiscal year 1998 through fiscal year 2004, Congress appropriated $1.225 billion to support the campaign (table 1)"

"For fiscal year 2007, the President’s budget requested $120 million for campaign activities. The 2007 request represents an increase of $21 million above the fiscal year 2006 budget authority."

(2006 - Youth Anti-Drug Media Campaign - evaluation) "GAO's [Government Accountability Office] review of Westat's evaluation reports and associated documentation leads to the conclusion that the evaluation provides credible evidence that the campaign was not effective in reducing youth drug use, either during the entire period of the campaign or during the period from 2002 to 2004 when the campaign was redirected and focused on marijuana use."

(2006 Youth Anti-Drug Media Campaign - evaluation) "Westat's analysis of the relationship between exposure to campaign advertisements and youth self-reported drug use in the NSPY [National Survey of Parents and Youth] data for the entire period covered by its evaluation -- assessments that used statistical methods to adjust for individual differences and control for other factors that could explain changes in self-reported drug use -- showed no significant effects of exposure to the campaign on initiation of marijuana by prior nonusing youth. Westat's analysis found significant unfavorable effects -- that is, a relationship between campaign exposure and higher rates of initiation -- during one round of NSPY data and for the whole period of the campaign among certain subgroups of the sample (e.g., 12-1/2- to 13-year-olds and girls). Westat found no effects of campaign exposure on rates of quitting or use by prior users of marijuana."

(2006 - Youth Anti-Drug Media Campaign - evaluation) "The evaluation of the media campaign reinforces the lack of linkage between the media campaign and teen drug use behavior."

(2006 - Youth Anti-Drug Media Campaign - evaluation) "Unfavorable preliminary findings from the evaluation were reported by Westat in 2002. Beginning in 2002, ONDCP [Office of National Drug Control Policy] took a number of steps that were intended to strengthen the power of the campaign to achieve positive results. These steps included more rigorous ad copy testing and a concentration on anti-marijuana messages. However, the post-2002 results yielded no evidence of positive impacts and some evidence of negative and unintended consequences in relation to marijuana use. Specifically, exposure to advertisements during the redirected campaign was associated with higher rates of marijuana use initiation among youth who were prior nonusers of marijuana."

(2006 - Youth Anti-Drug Media Campaign - evaluation) "In light of the fact that the phase III evaluation of the media campaign yielded no evidence of a positive outcome in relation to teen drug use and congressional conferees’ indications of their intentions to rely on the Westat study, Congress should consider limiting appropriations for the National Youth Anti-Drug Media Campaign beginning in the fiscal 2007 budget year until ONDCP is able to provide credible evidence of the effectiveness of exposure to the campaign on youth drug use outcomes or provide other credible options for a media campaign approach."

(2003 - Youth Anti-Drug Media Campaign - evaluation by Westat and the Annenberg School of Communication) "In the previous reports, based on both favorable trends over time and cross-sectional associations, there was evidence supportive of Campaign effects on talking with children; on beliefs and attitudes regarding monitoring of children; and, in the case of the cross-sectional associations, on doing fun activities with them. These results still hold when Wave 7 parent reports are added, although youth reports of monitoring and talking behaviors are not consistent with parent reports and thus call into question the favorable changes in behavior that may be associated with the Campaign."

(2003 - Youth Anti-Drug Media Campaign - evaluation) "The NSPY [National Survey of Parents and Youth] did not find significant reductions in marijuana use either leading up to or after the Marijuana campaign for youth 12 to 18 years old between 2002 and 2003. Indeed there was evidence for an increase in past month and past year use among the target audience of 14- to 16-year-olds, although it appears that the increase was already in place in the last half of 2002, before the launch of the Marijuana Initiative. It will be worthwhile to track whether the nonsignificant decline from the second half of 2002 through the first half of 2003 is the beginning of a true trend. There was a significant decrease in lifetime marijuana use among youth 16 to 18 years of age from 2002 to 2003; however, since this significant decrease was not replicated in either the directly relevant past year or past month time periods, it is difficult to ascribe the change to the campaign."

(2003 - Youth Anti-Drug Media Campaign - evaluation by Westat and the Annenberg School of Communication) In its evaluation of ONDCP's Anti-drug Media Campaign, researchers from Westat and the Annenberg School of Communication concluded: "In sum, the analysis of the NSPY data does not support a claim that use among the target audience of 14- to 16-year-olds has declined with the initiation of the Marijuana Initiative. Contrarily, it appears to have increased in the past year compared to prior measurement, although the increase appears to have occurred before the start of the Marijuana Initiative and was only maintained during the first half of 2003. The MTF [Monitoring the Future survey] data does show declines, particularly for 8th and 10th graders. However, these declines cannot be confidently attributed to the operation of the Campaign."

(2001 - Youth Anti-Drug Media Campaign - evaluation by Westat and the Annenberg School of Communication) "In summary, thus far there is relatively little evidence for effects of the Campaign on youth. While there are scattered positive results, they are balanced by scattered negative results. There are some anomalies in the evidence presented that are suggestive in one way or another. However, once one steps back and examines the entire evidence base, it is hard to be confident that any of these results are reliable."

(2001 - Youth Anti-Drug Media Campaign - evaluation) Regarding exposure to ONDCP's National Anti-Drug Media Campaign and marijuana use by 12-18 year olds, a report prepared for NIDA by Westat and the Annenberg School of Communication determined: "The conclusion then is that there is no supportive evidence that campaign exposure, however measured, is associated either positively or negatively with any of the four cognitive outcomes for the full sample of 12- to 18-year-olds." (The four cognitive outcomes are: Intentions to Use Marijuana; Attitude/Belief; Social Norms; and Self-Efficacy to Refuse Marijuana.)

(2001 - Youth Anti-Drug Media Campaign - evaluation) "Neither the overall results nor the subgroup analyses show consistent evidence supportive of a Campaign effect."