Expand and Improve Support for Youth Outreach and Leadership

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Introductory Paragraph

A positive relationship between peer drug use and drug use among adolescents is well-established in scientific literature.[1][2][3][4][5] Recently, a study of teen and adult drivers showed that the reward-processing areas of the brains of teens are more active when their behavior is observed, suggesting that the "presence of peers is sufficient in itself to make risks feel more worthwhile to teens," including using drugs.[6]

One of the best tools to utilize in any prevention effort is early prevention education. Individuals who start using substances as youth have been shown to be much more likely to abuse them later in life. Students have been shown to be most likely to begin substance use during the adolescent years. According to the National Institute on Drug Abuse: “ Collection of data from the National Survey of Drug Use and Health (NSDUH) on age at first use of illegal drugs across the U.S. begins at age 12 years, with data from 2014 indicating that 3.4 percent of 12- to 13-year-old children have used an illegal drug in the past month (including inappropriate use of prescription drugs), 2.1 percent are current alcohol users, and 1.1 percent are current tobacco users (CBHSQ, 2015). In 2015, NIDA’s annual Monitoring the Future (MTF) survey of adolescent drug use and attitudes showed that, by the time they are seniors, 64 percent of high school students have tried alcohol, almost half have taken an illegal drug, 31 percent have smoked a cigarette, and 18 percent have used a prescription drug for a nonmedical purpose.” [7] This is why it is so important to place an emphasis on proper prevention education in today’s youth. If they are properly implemented programs can help to provide real barriers to the first use and possible future abuse of substances.

Key Information

As children grow older, their social network expands vastly and new influences come in daily. They are highly susceptible to the influence of peers and adults they value, which is why surrounding them with proper education about drugs is a vital, communal effort. Providing well-round prevention efforts that bolster the much-needed autonomy of the youth in a positive manner can curb the lure of substance use. Outreach Community outreach efforts can play a huge role in mitigating youth substance use by employing various strategies. Outreach can be conducted through various avenues (21, 22, 23):

  • Providing information on the impact of adolescent drug use
  • Parent support and skills classes
  • Youth centers and summer clubs that focus on skill building
  • Community awareness events (fundraisers/seminars/booths at fairs/ 5k fun runs, etc)
  • Youth outreach services (counseling, education, confidential support)
  • Before/after school programs for youth
  • Teacher skill education/support

The Gateway Provider Model focuses on community outreach efforts for “deep-end” youth, those who have an SUD and juvenile criminal record, and are less likely to actively participate in treatment (24). The GPM outreach service systems include: juvenile justice, child/adolescent mental health, school-based counseling and programs, emergency and primary medical care, and youth-related child welfare services (shelters/facilities serving runaways and homeless children) (24). Education A recent study out of the University of Illinois found that the strongest predictor for adolescent substance use is the beliefs that youth hold about drug use, whether they find them to be abhorrent, risky, enticing, etc (16, 17). As parents, school officials, and community leaders look for effective prevention tactics, predictive factors such as this mustn’t be overlooked. The study shows that youth attitudes and beliefs about drugs have a strong correlation with both past and present substance use (16, 17). This indicates a great need for youth-centered education about the impacts of substance use on their present and future. Knowing that their attitudes and beliefs are a main contributor to whether or not they participate in substance use allows the adults and community leaders the foresight to begin youth education themselves to prevent or combat existing, dangerous views about drug and alcohol use. They key takeaway: if they aren’t getting the right information, they’ll get the wrong information. See the “Educate Parents On the Use of Prescription and Non-Prescription Drugs” wiki for in-depth statistical data on drug use and the importance of early education efforts. Leadership As noted above, peer influence and interaction weighs heavily in adolescent decision making. It’s been scientifically noted that natural peer leaders who engage in substance use have “disproportionate power to affect the behavior and social choices,” of their peers (18). This same concept can be utilized for the good of youth when these leaders are given appropriate roles to guide their peers in a positive direction. It is important to tailor participation efforts to the age/stage of the target audience, as each youth stage has its own distinctive risk and protection factors (20). When done effectively at each stage, youth participation and leadership in substance use prevention can be meaningful and sustainable in each subsequent stage of life. Providing leadership opportunities for youth utilizes that natural socialization process in a positive manner that allows the youth to educate, empower, and exert influence on both themselves and their peers (20). Adolescents crave the ability to have autonomy and a sense of power; engaging them in productive leadership feeds these needs in a manner that is healthy for them and a positive influence for their peers. Potential benefits for the peer leaders involved in prevention activities also include improvements in (20):

  • Academic achievement
  • Student engagement in school life
  • School attendance
  • Prosocial peer associations
  • Emotional resilience
  • Alcohol and drug use
  • Violence
  • Teen pregnancy

The Handbook on Youth Participation in Drug Prevention Work provides a framework for ethical youth leadership participation, using Roger Hart’s Ladder of Participation as a visual aid for adults (20).

  • Youth can be a valuable asset in prevention planning at every step, as they provide unique and personal insight into substance use knowledge and issues in their peer communities (20). They can help:
  • Identify needs for prevention and perspectives on subpopulations of youth not addressed (minorities, outliers)
  • Develop programs that are responsive to specific groups, cultures, and are likely to generate participation/buy-in
  • Provide unique engagement ideas
  • Provide a relevant and successful implementation of educational resources & prevention strategies through both insight and active participation
  • Provide insight into efficacy through both collection and provision of data (surveys, focus groups, notes, etc)

Youth leadership can take place in many areas, including schools, family outreach, media, and online environments, political discussions, and community prevention outreach. It is a matter of providing mobilization opportunities for adolescents in these capacities.

Prevention SAMHSA’s evidence-based guide to Substance Misuse Prevention for Young Adults notes that effective childhood and youth prevention programs include the following elements (19):

  • Behavioral modification and management
  • Classroom management
  • Schools that provide comprehensive academic, social, and health services for students, family members, and community
  • Home visiting services that foster parental education and family support
  • Parenting skills education
  • Social and emotional skills education
  • Cognitive restructuring
  • Community mobilization
  • Social norms campaigns or education - focus on positive, healthy behaviors
  • Environmental changes
  • Policy enforcement of laws and regulations regarding substance
  • Screening and brief intervention
  • Wraparound services

A major component of prevention is identification, being able to assess for current substance use and those at-risk. As the largest, natural avenue to youth, schools can play a primary role in identification and intervention (24). Identification can occur in teacher observation of behaviors (changes, deviations), implementing youth assessment tools, and school-parent collaboration (24). Proper identification can lead to appropriate intervention and prevention efforts. There is a multitude of effective, evidence-based prevention tools that are family and school-focused. Youth.gov provides core components of these programs to help institutions choose the right one for their intended audience/purpose (25). SAMHSA has a comprehensive list of links for evidence-based prevention programs as well (26). The key is evaluating programs that will be impactful for your specific situation.


Relevant Research

  • Illinois’s bi-annual epidemiological survey showed groundbreaking results that youth beliefs and attitudes are one of the strongest predictors of past and present substance use. This should be used to guide efforts in education & prevention.

https://www.tandfonline.com/doi/full/10.1080/10826084.2022.2034877

  • Assertive Outreach Strategies for Narrowing the Adolescent Substance Abuse Treatment Gap: Implications for Research, Practice, and Policy (24) - provides examples of evidence-based outreach strategies and gaps in treatment regarding youth with comorbidities and barriers to access.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2807895/

  • Hawke, et al (2019) review literature focusing on impactful mental health and substance use services that are youth-friendly.

https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-019-4066-5

  • “Preventing, Identifying, and Treating Substance Use Among Youth in Foster Care” - this handbook presents relevant data on substance use in foster care, identification, support, and collaboration

https://www.childwelfare.gov/pubPDFs/bulletins_youthsud.pdf

Impactful Federal, State, and Local Policies

State Profiles of Underage Drinking Laws: https://alcoholpolicy.niaaa.nih.gov/underage-drinking/state-profiles

SAMHSA’s Youth Engagement Guidance: information for federal staff/contractors conducting federal government-sponsored meetings: https://youth.gov/feature-article/samhsa-youth-engagement-guidance

Directory of Federally Funded Prevention Programs: https://obamawhitehouse.archives.gov/ondcp/federally-funded-prevention-programs

Available Tools and Resources

SAMHSA’s evidence-based guide, “Substance Misuse Prevention for Young Adults” - evaluation of evidence-based practices, implementation, and guidance on prevention programs https://store.samhsa.gov/sites/default/files/d7/priv/pep19-pl-guide-1.pdf

Handbook on Youth Participation in Drug Prevention Work - provides conceptual definitions, benefits of youth participation, successful implementation of youth participation efforts, how to improve accessibility, and much more! https://www.unodc.org/res/prevention/youth-initiative/resources-new_html/Handbook_on_Youth_Participation.pdf

School Based Prevention

Social Resistance Skills

In this type of training, students are taught how to recognize situations in which they are likely to face peer pressure and are given strategies to deal with these situations including formulating counterarguments.[8] This approach alone does not counteract peer pressure but can be effective when used in conjunction with normative education.[9][10]
 

Normative Education

This approach attempts to counteract inaccurate perceptions of drug and alcohol abuse. According to Griffen and Botvin (2010) "Many adolescents overestimate the prevalence of smoking, drinking, and the use of certain drugs, which can make substance use seem to be normative behavior. Educating youth about actual rates of use, which are almost always lower than the perceived rates of use, can reduce perceptions regarding the social acceptability of drug use."[11] Studies have shown that normative education alone and in conjunction with social resistance training can be effective in reducing alcohol, cigarette, and marijuana use among adolescents.[12]


Competence Enhancement/Life Skills Training (LST)

This approach focuses on the social learning processes that play a role in the development of drug use in adolescents. Students are taught some combination of the following life skills.

  •   general social skills and general assertive skills[13]
  •   adapting coping strategies for relieving stress and anxiety through use of cognitive coping skills or behavioral relaxation techniques 
  •   general cognitive skills for resisting interpersonal media influences
  •   skills for increasing self-control and self-esteem

LST is effective in reducing use of alcohol, tobacco, marijuana, and other psychoactive drugs and is estimated to save $38 for every dollar invested.[14]

Promising Practices

Peer Leadership Intervention - Social networks and peer influence can be utilized for intervention efforts. Golonka, et al. (2018) innovatively combined the psychological principles of influence with evidence-based prevention techniques to test the effects of peer leadership in substance use prevention (18). Knowing that youth leaders are influential to peers and more susceptible to substance use, Golonka, et al. identified these adolescents and tasked them with using their voices to actively educate their peers on the risks of substance use. The chosen at-risk leaders showed improvement in their attitudes and behaviors toward substance use and has the potential for a “trickle-down” effect on their peers. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5516545/


Above the Influence

A national awareness campaign aimed at preventing youth from misuse of substances.

Parental Involvement

High levels of parental disapproval of drug use may mitigate the negative influence of drug-using peers.[15]

Sources

  1. ↑ [1]Santor, D. A., Messervey, D., & Kusumakar, V. (2000). Measuring Peer Pressure, Popularity, and Conformity in Adolescent Boys and Girls: Predicting School Performance, Sexual Attitudes, and Substance Abuse. Journal of Youth and Adolescence, 29(2), 163–182. https://doi.org/10.1023/A:1005152515264
  2. ↑ [2]Dielman, T. E., et al.
  3. ↑ [3]Brooks-Russell, A., Conway, K. P., Liu, D., Xie, Y., Vullo, G. C., Li, K., … Simons-Morton, B. (2015). Dynamic Patterns of Adolescent Substance Use: Results From a Nationally Representative Sample of High School Students. Journal of Studies on Alcohol and Drugs, 76(6), 962–970. https://doi.org/10.15288/jsad.2015.76.962
  4. ↑ [4]Tucker, J. S., Ewing, B. A., Miles, J. N. V., Shih, R. A., Pedersen, E. R., & D’Amico, E. J. (2015). Predictors and consequences of prescription drug misuse during middle school. Drug and Alcohol Dependence, 156, 254–260. https://doi.org/10.1016/j.drugalcdep.2015.09.018
  5. ↑ [5]McDonough, M. H., Jose, P. E., & Stuart, J. (2016). Bi-directional Effects of Peer Relationships and Adolescent Substance Use: A Longitudinal Study. Journal of Youth and Adolescence, 45(8), 1652–1663. https://doi.org/10.1007/s10964-015-0355-4
  6. ↑ [6]Chein, J., Albert, D., O’Brien, L., Uckert, K., & Steinberg, L. (2011). Peers increase adolescent risk taking by enhancing activity in the brain’s reward circuitry. Developmental Science, 14(2), F1-10. https://doi.org/10.1111/j.1467-7687.2010.01035.x
  7. ↑ National Institute on Drug Abuse. “Chapter 1: Why Is Early Childhood Important to Substance Abuse Prevention?” NIDA, www.drugabuse.gov/publications/principles-substance-abuse-prevention-early-childhood/chapter-1-why-early-childhood-important-to-substance-abuse-prevention#adolescent-drug-use.
  8. ↑ [7]Griffin, K. W., & Botvin, G. J. (2010). Evidence-Based Interventions for Preventing Substance Use Disorders in Adolescents. Child and Adolescent Psychiatric Clinics of North America, 19(3), 505–526. https://doi.org/10.1016/j.chc.2010.03.005
  9. ↑ [8]Hansen, W. B., & Graham, J. W. (1991). Preventing alcohol, marijuana, and cigarette use among adolescents: Peer pressure resistance training versus establishing conservative norms. Preventive Medicine, 20(3), 414–430. https://doi.org/10.1016/0091-7435(91)90039-7
  10. ↑ [9]Clayton, R. R., Cattarello, A. M., & Johnstone, B. M. (1996). The Effectiveness of Drug Abuse Resistance Education (Project DARE): 5-Year Follow-Up Results. Preventive Medicine, 25(3), 307–318. https://doi.org/10.1006/pmed.1996.0061
  11. ↑ [10]Griffin, K. W., & Botvin, G. J. (2010). Evidence-Based Interventions for Preventing Substance Use Disorders in Adolescents. Child and Adolescent Psychiatric Clinics of North America, 19(3), 505–526. https://doi.org/10.1016/j.chc.2010.03.005
  12. ↑ [11]Hansen, W. B., & Graham, J. W. (1991). Preventing alcohol, marijuana, and cigarette use among adolescents: Peer pressure resistance training versus establishing conservative norms. Preventive Medicine, 20(3), 414–430. https://doi.org/10.1016/0091-7435(91)90039-7
  13. ↑ [12]Griffin, K. W., & Botvin, G. J. (2010). Evidence-Based Interventions for Preventing Substance Use Disorders in Adolescents. Child and Adolescent Psychiatric Clinics of North America, 19(3), 505–526. https://doi.org/10.1016/j.chc.2010.03.005
  14. ↑ [13]Botvin, G. J., & Griffin, K. W. (2014). Life skills training: Preventing substance misuse by enhancing individual and social competence. New Directions for Youth Development, 2014(141), 57–65. https://doi.org/10.1002/yd.20086
  15. ↑ [14]Chan, G. C. K., Kelly, A. B., Carroll, A., & Williams, J. W. (2017). Peer drug use and adolescent polysubstance use: Do parenting and school factors moderate this association? Addictive Behaviors, 64, 78–81. https://doi.org/10.1016/j.addbeh.2016.08.004
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