Expand and Improve Support for Youth Outreach and Leadership

Introductory Paragraph

This article brings together three inter-related themes for substance use prevention - the challenge of early onset of use and the significance of early prevention, the strong influence of peers on adolescent decision-making, and the potential of youth leadership to motivate norm change.

• Early Onset. According to the National Institute on Drug Abuse (NIDA), the age of first use of illegal drugs across the U.S. begins at age 12 years. Individuals who start using substances as youth have been shown to be much more likely to abuse them later in life, and students have been shown to be most likely to begin substance use during the adolescent years. This makes early prevention education extremely important.
• Peer Pressure. It is well-established in scientific literature that drug use among adolescents is correlated to the use of drug use by their peers. One 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.
• Youth Leadership. Research indicates that natural peer leaders who engage in substance use have “disproportionate power to affect the behavior and social choices,” of their peers . 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.

Key Information

Prevention Education Targeting Early Onset. According to NIDA, 3.4 percent of 12- to 13-year-old children have pst-month use of an illegal drug or inappropriate use of prescription drugs, 2.1 percent use alcohol, and 1.1 percent are current tobacco users. These percentages increase significantly throughout the middle and high school years -- by the time they are high school seniors, 64 percent have tried alcohol, almost half have taken an illegal drug, 31 percent have used nicotine, and 18 percent have used a prescription drug for a non-medical purpose.” 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.

A recent study by 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. As parents, school officials, and community leaders look for effective prevention tactics, they need to understand that youth attitudes and beliefs about drugs have a strong correlation with both past and present substance use. This indicates a great need for youth-centered education about the impacts of substance use. Knowing that their attitudes and beliefs are the main contributors 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. The key takeaway: if they aren’t getting the right information, they’ll get the wrong information. See the SAFE Solutions wiki “Educate Parents On the Use of Prescription and Non-Prescription Drugs” for in-depth statistical data on drug use and the importance of early education efforts.

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

• 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

Identification is major component of prevention. This includes assessment of current substance use and those at-risk. As the largest, natural avenue to youth, schools can play a primary role in identification and intervention. Identification can occur in teacher observation of changes in behavior, implementing youth assessment tools, and school-parent collaboration. Proper identification can lead to appropriate intervention and prevention efforts.

Peer Pressure. 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-rounded prevention efforts that bolster the much-needed autonomy of the youth in a positive manner can curb the lure of substance use. Community outreach efforts can play a huge role in mitigating youth substance use by employing such strategies as:

• 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

In training of social resistance skills, 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.

Youth Leadership. Providing leadership opportunities for youth utilizes that natural socialization process in a positive manner which allows them to educate, empower, and exert influence on both themselves and their peers. Adolescents crave the ability to have autonomy and a sense of power. Engaging them in productive leadership feeds these needs in a manner which is healthy for them and a positive influence on their peers. 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.

It is important to tailor leadership efforts to the age/stage of the target audience, as each youth stage has its own distinctive risk and protection factors. 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. Peer leaders involved in prevention activities benefit in a wide spectrum of domains:

• 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. 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. 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, and 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)

Students can be a powerful force in norm change within their schools. A normative education approach attempts to counteract inaccurate perceptions of drug and alcohol abuse. According to Griffin 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." 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.

Relevant Research

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

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

• “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.

Impactful Federal, State, and Local Policies

The Office Of National Drug Control Policy (ONDCP) is under the executive office of the President. ONDCP coordinates the nation’s drug policy and is responsible for the development and implementation of the National Drug Control Strategy. . ONDCP coordinates 19 federal agencies and oversees a $41 billion budget as part of a whole-of-government approach to address addiction and the overdose epidemic. ONDCP also provides hundreds of millions of dollars through the High Intensity Drug Trafficking Areas Program and the Drug-Free Communities Program.

Alcohol Policy Information System (APIS) provides state-by-state summaries of statutes and regulations related to underage drinking and access to alcohol. For each state, summaries are provided for twelve policy topics that are particularly relevant to underage drinking.

Available Tools and Resources

SAMHSA offers a variety of tools and resources including:

• “Substance Misuse Prevention for Young Adults,” a guidebook on evidence-based practices and the implementation of prevention programs.
• A list of links for evidence-based prevention programs. )

SAFE Project:

• SAFE Choices is a program within SAFE Project that focuses on fostering resiliency in youth development through collaborative and diversified approaches that reduce risk of substance addiction and mental health challenges while empowering SAFE Choices in all stages of youth development.
• The Collegiate Recovery Leadership Academy (CRLA) is an academic year-long fellowship program for students who are passionate about the intersection of addiction and mental health recovery, leadership, and advocacy. Students who are accepted into the CRLA will implement a recovery focused impact project on their campus, receive advocacy training, attend two in-person events, and be part of a supportive cohort of peers from around the country.
• "Just the Facts: Peer Pressure." This SAFE Project article is one from a greater series focused on substance use and mental health written for young adults and their parents. It’s easy to understand and judgment-free, giving young adults just the facts they need to help them make informed choices. This specific article focuses on the intersection of peer pressure and substance use.
• See the wiki titled "Expand School-Based Prevention Programs" for more detailed information on how the school setting for children/adolescents can be used as protective factor from the adverse effects of substance use, misuse, and abuse.

"Handbook on Youth Participation in Drug Prevention Work" - provides conceptual definitions, benefits of youth participation, successful implementation of youth participation efforts, and how to improve accessibility.

Above the Influence - A national awareness campaign aimed at preventing youth from misuse of substances.

Life Skills Training (LST) is a curriculum which focuses on the social learning processes. LST has been proven to be effective in reducing use of alcohol, tobacco, marijuana, and other psychoactive drugs and is estimated to save $38 for every dollar invested. Students are taught some combination of the following life skills:

• general social skills and general assertive skills
• 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

Promising Practices

The Gateway Provider Model (GPM) focuses on community outreach efforts for “deep-end” youth, those who have a SUD and juvenile criminal record and are less likely to actively participate in treatment. 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).

Peer Leadership Intervention utilizes social networks and peer influence for intervention efforts. Golonka, et al. (2018) combined the psychological principles of influence with evidence-based prevention techniques to test the effects of peer leadership in substance use prevention. Knowing that youth leaders are influential to peers and more susceptible to substance use, they identified a sample of 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 which opens the potential for a “trickle-down” effect on their peers.