Perspectives On Adolescent Substance Use
Perspectives on Adolescent Substance UseA DefinedPopulation StudyThomas N. Robinson, MPH; Joel D. Killen, PhD; C. Barr Taylor, MD; Michael J. Telch, PhD; Susan W. Bryson, MS;Keith E. Saylor, PhD; David J. Maron, MD; Nathan Maccoby, PhD; John W. Farquhar, MDWe asked 1447 tenth graders to complete a survey on physical activity, nutrition,stress, and substance use and to undergo basic physical assessments. In amultiple regression analysis, increased level of substance use by both boys andgirls was most strongly predicted by friends' marijuana use. For boys, this wasfollowed by perceived safety of cigarette smoking; poor school performance;parents' education; and use of diet pills, laxatives, or diuretics for weight control,accounting for 44% of the overall variation in substance use. For girls, friends'marijuana use was followed by poor school performance; self-induced vomitingfor weight control; perceived safety of cigarette smoking; use of diet pills,laxatives, or diuretics for weight control; parents' education; perceived adultattitudes about cigarettes; and nonuse of seat belts, accounting for 53% of theoverall variance. Separate multiple regression analyses for each substanceproduced similar results. The homogeneity of the study population precludedethnic comparisons. These findings suggest that for many purposes substanceuse may be considered a single behavior regardless of the specific substance(s)used and that substance use may exist as part of a syndrome of adolescentproblem behaviors. In addition, the potent influence of perceived social environment suggests that a social influence resistance model may represent the mostsuccessful preventive strategy.(JAMA 1987;258:2072-2076)THE DECLINE in adolescent drug usethat began in 1980 may have come to ahalt. Recent data suggest that afterfour years of steady decline in illicitdrug use by high school seniors, preva lences of marijuana and LSD use stabi lized in 1985, while cocaine, phencyclidine hydrochloride (PCP), and opiateuse actually increased.1 These data sug gest that substance abuse will continueto be a significant problem amongAmerican youths and that successfulpreventive interventions have yet to bewidely implemented. Although a largebody of research literature has identi fied many factors associated with ado lescent substance use, most studies re-likeliness to elicit negative sanctions.Problem-behavior theory suggests thattendency to problem behaviors can beaccounted for by the interaction of de mographic, psychological, social envi ronmental, and behavioral variables.Psychological variables include atti tudes, values, beliefs, knowledge, andexpectations relative to the behavior inquestion. Social environmental varia bles represent the influences of sur rounding peers and adults. Behavioralvariables represent the degree of in volvement in other problem behaviorsand in socially approved behaviors.The problem-behavior model hasdemonstrated efficacy in predicting cig aretteFor editorial commentseep 2110.port isolated findings that are difficult tointo a coherent risk factormodel. Problem-behavior theory2 rep resents one useful framework for study ing factors that may promote adoptionand maintenance of substance use.Problem behaviors are defined by theirdeparture from social norms and theirintegrateFrom the Center for Research in Disease Prevention,Department of Medicine, Stanford (Calif) UniversitySchool of Medicine. Dr Teich is now with the Department of Psychology, University of Texas at Austin.Reprint requests to Adolescent Heart Health Project,Stanford Center for Research in Disease Prevention,Health Policy and Research Bldg, Room 9, Stanford,CA 94305 (Mr Robinson).smoking,3,4 problem drinking,5and marijuana use6 as well as adolescentsexual activity,2,7 general deviant be havior,2 and seat belt use.8 These find ings suggest that common patterns ofrisk factors may exist for a large groupof problem behaviors. In addition, theproblem-behavior model may be rele vant to health risk behaviors not previ ously defined as problem behaviors.9The consideration of substance use aspart of a syndrome of problem behaviorscould provide a focus for the develop ment of intervention strategies.In a defined population study wetested the following hypotheses: (1)Substance use may be considered a sin gle behavior regardless of the specificDownloaded From: http://jama.jamanetwork.com/ by a Harvard University User on 04/17/2014substance(s) used. (2) Substance use ispart of a syndrome of adolescent prob lem behaviors. (3) Social influences rep resent the strongest predictors of in volvement in adolescent substance use.In addition to standard problem-be havior variables, health risk variablesrelating to physical activity, nutritionand weight regulation, stress, and per sonal risk taking were included in ourinvestigation.SUBJECTS AND METHODSDuring September 1985, tenth grad ers (N 1447) enrolled in four northernCalifornia high schools were asked tocomplete a survey designed to detectthe presence of physical characteristicsand behaviors related to risk for coro nary heart disease. Of these students,1344 (92.9%) responded to items query ing frequency of use of at least onesubstance. Response rates were be tween 90% and 92% for each of theindividual substance use items. Aver age age was 15 years. Self-reportedethnic distribution was as follows:69.0% white, 2.0% black, 13.1% Asian,6.4% Latino, 0.3% American Indian,0.4% Pacific Islander, and 8.9% other.Fifty percent of the students' fatherscompleted four or more years of college.Assessments were performed bytrained staff over two days in each ofthefour schools. Boys and girls were sepa rated into two classrooms and com pleted self-administered questionnairesand underwent physical measurementin groups of 40 to 50. School personneldid not participate in any part of thedata collection. Predictor VariablesPredictor variables were modeledafter the problem-behavior theoryframework utilized in past research.2,5,6In addition, we extended the model byadding psychological, behavioral, andphysical variables that have been theo retically or empirically related to sub stance use by other investigators.Demographic VariablesParents' education was measured asthe mother's or father's education level,whichever was higher. Age is not afactor in this population, and sex wascontrolled for. The predomination of
whites inourmeaningfulethnicpopulation precludescomparisons.Psychological VariablesFive psychological variables assessedstudent attitudes, beliefs, knowledge,and expectations with regard to sub stance use. These variables all repre sent indexes created by calculating themean of responses to several items.Predicted substance use under socialpressure assesses the strength of peerinfluence on substance use behaviors.Students were provided with ten hypo thetical situations involving social pres sures to smoke cigarettes, drink alco hol, smoke marijuana, use stimulants,or use cocaine. To each situation theyresponded on a five-point scale indicat ing whether they would use the sub stance specified. To assess students' at titudes toward cigarette smoking, threevariables were devised. Negative andpositive attitudes about cigarette smok ing were measured with students' re sponses to statements concerning per sonal beliefs and values about smoking,smokers, and the functionality of smok ing. Perceived safety of cigarette smok ing was assessed with responses tothree statements about the health out comes of smoking with respect to dura tion of smoking habit, not inhaling, andquitting. Knowledge about the phys iologic effects of smoking was measuredwith six true/false or multiple-choicequestions.psychological variables thatdo not directly concern substance usewere also assessed. Intention to attendcollege and importance of parental ap proval were each measured on five-pointscales with single items. A self-esteemindex was created from responses to thefollowing three items: "Other peoplewouldn't like me if they knew all myfaults." "I know that I am not as good asother people think I am." "I am suspi cious when others tell me they like me."A depressive symptoms index was cre ated by summing DSM-IIP" symptomschecked on a 13-item list. In addition,students reported the value of stressreduction, physical activity, and nutri tion in their lives, producing an impor tance of healthful behaviors index.SeveralSocial Environmental VariablesSocial environmental variables at tempt to characterize the students' per ceptions of their peer and adult environ ments. Perceived friends' cigarettesmoking, drunkenness, and marijuanause assess students' perceptions of sub stance use by their friends by askingwhat proportion (five-point scale rang ing from "none" to "all") smoke ciga rettes, have gotten drunk at least once,and smoke marijuana. Perceived peersmoking attitudes and perceived adultsmoking attitudes are indexes repre senting student perceptions of environ mental attitudes toward cigarettesmoking. These variables were as sessed with items concerning the per ceived images and popularity of smok ers and the desires of smokers to quit.Behavioral VariablesSelf-reported behaviors were as sessed to test the hypothesis that sub stance users also participate in otherproblem behaviors. Students wereasked how often they smoke cigarettes,drink alcohol, smoke marijuana, orbreak things to cope with stress asassessments of substance use to copewith stress and destructive coping be havior. Seat belt use was assessed forstudents driving alone, with friends,and with family. A general risk-takingbehaviors index included items relatingto automobile and bicycle safety, includ ing bicycle helmet use, willingness toride with a driver who had been drink ing or taking drugs, and ratings of theirown ability to drive a car after drinking.Frequency of self-induced vomiting anduse of diet pills, laxatives, or diureticsfor weight control were assessed asunhealthy weight regulation practices.A dichotomous regular aerobic physicalactivity variable was created from re ported participation in one or more offive aerobic activities for at least 20minutes three or more times a week.Heart-healthy dietary preferencesassessed by summing the numberwereof healthful choices made from a list of32 food pairs. School performance wasassessed on a nine-point scale for "usualschool grades."Physical VariablesAsanassessment of recentcigaretteair carbon monoxidewas measured with a carbon monoxidemonitor (Ecolyzer 2000, Energetics Sci ence, Hawthorne, NY). After holding adeep breath for 10 s, students expiredhalf of the air into the room and theremainder into a polyvinyl breath-sam ple bag. The bag was attached to thecarbon monoxide monitor through acharcoal filter. Concentrations were re corded to the nearest part per million ofcarbon monoxide.To investigate the hypothesis thatunhealthy behaviors, as reflected in an thropométrie and physiologic mea sures, are related to the level of sub stance use, additional physical variableswere included in the analysis. Bodymass index (weight/height2) is the pre ferred index of relative body weight asan estimate of adiposity.11,12 Height andsmoking, expiredDownloaded From: http://jama.jamanetwork.com/ by a Harvard University User on 04/17/2014were measured on a standardbalance-beam scale, and students worelightweight gym clothing with overgar ments and shoes removed. Height wasrounded down to the nearest inch, andweight was rounded down to the nearestpound. Subcutaneous skin-fold thick nesses were measured with Harpendencalipers (British Indicators Ltd, St Albans, England) according to establishedguidelines.13 Two sites were measured,triceps and subscapular, on the rightside of the body. Resting blood pressureand heart rate were measured with anautomated blood pressure device (Cardiovan 9200, Paramed Technology Inc,Palo Alto, Calif). Before measurementswere started, students sat quietly forthree minutes. Measurements weremade on the right arm at the approxi mate level of the heart. Heart rate andmean arterial, systolic, and diastolicblood pressures were measured threetimes at one-minute intervals. Themeans of the second and third measure ments were used in the analyses.weightSubstance UseStudents reported frequencies of usefor each of the following substances:tobacco cigarettes; clove cigarettes;chewing tobacco; marijuana; alcohol; co caine; and LSD, PCP, or heroin. Sixfrequency levels were provided: never,at least once in my life, at least once amonth, at least once a week, almostevery day, and every day. Students alsoreported frequency of drunkenness anddrinking before or during school.There is a lack of consensus on whatlevel of substance use constitutes prob lem use.1,14 For this reason we have notattempted to define problem and nonproblem use. To test the hypothesis thatall substance use can generally be consid ered a single behavior regardless of thesubstance(s) used, we grouped all sub stances together. We classified level ofsubstance use as the greatest frequencyof use of any single substance. Thisclassification scheme produces six cate gories of users: (1) those abstaining fromall substance use, (2) those who haveexperimented with one or more sub stances at least once in their lives, (3)those who use one or more substancesat least once a month but less than oncea week, (4) those who use one or moresubstances at least once a week, (5)those who use one or more substancesalmost every day, and (6) those who useone or more substances every day.Statistical MethodsAll predictor variables were sub jected to a factor analysis to help in theselection of orthogonal variables for themultiple regression procedure. Rotated
factor analysis of variables grouped aspsychological, social environmental, be havioral, and physical produced 12 sig nificant factors. Representative varia bles were then selected from each factorfor inclusion in a multiple regressionmodel to explain variations in level ofsubstance use. It was our goal to iden tify variables that may be useful toclinicians and educators. For example,negative attitudes about cigarettesmoking, positive attitudes about smok ing, perceived safety of smoking, andknowledge of the effects of cigarettesmoking all loaded maximally on thesame factor, indicating the intercorrelation of these variables. Of these fourvariables, perceived safety of cigarettesmoking was selected for use in theregression analysis. Similarly, per ceived friends' use of marijuana, ciga rette smoking, and drunkenness alsoloaded as a single factor. In this case,friends' marijuana use was chosen forthe analysis. Predicted substance useunder social pressure, substance usefor coping with stress, and expired aircarbon monoxide were not included infactor or regression analyses becausetheir similarities to the dependent vari able make assessment difficult in nonanonymous clinical and community set tings. Stepwise multiple regressionprocedures were performed separatelyfor boys and girls and for all sub jects together. Spearman correlationcoefficients were calculated betweenall variables and level of substanceuse.RESULTSPrevalence of Substance UseSelf-reported rates of substance useare presented in Table 1. Alcohol is themost commonly used substance in thispopulation, with 47% of the boys and45% of the girls reporting current use tobe monthly or more frequent. In addi tion, 32% of boys and 29% of girls reportgetting drunk at least monthly, al though fewer than 2% of boys and 1% ofgirls report drunkenness almost everyday or more. Drinking before or duringschool is reported by about 5% of theboys and 4% of the girls. Tobacco ciga rettes are the next most commonly usedsubstance overall. About 22% of boysreport smoking tobacco cigarettes,while 30% of girls report smoking atleast monthly, with half of them smok ing every day or almost every day. Aslightly greater percentage of boyssmoke marijuana than tobacco ciga rettes. Other substances are being usedby less than 10% of the population over all.Students were assigned to one of sixlevels of substance use based on thecriteria outlined above. The results areTable1.—Self-reported Substance Use for Boys and GirlsUse, %No. ofSubstanceTobacco cigarettesRespondentsNeverAt LeastOnceAt LeastMonthlyDaily orEvery DayAlmostP*0003Boys 673 34 5 43A 13 8JSGirls 599 3jU} 347 15 ]52Marijuana.003Boys 672 54 2 22J3 WA 8 6Girls 601 57JÎ 22JJ 15JÎ 3JAlcohol.32Boys 665 13J 403 44J3 2J3Girls 604 1 4 409 437 1 0Cocaine.97Boys 672 85J 02 4 4 050.5Girls 603 Ü52. 1O0 4 LSD, phencyclidinehydrochlorlde, orheroin.02Boys 668 904 7J3 1 2Girls 607 93J3 6 4 030.0Chewing tobacco .0001Boys 680 64J3 25 0 6jJ 3 9Girls 612 95V 4J 02 00Clove cigarettes.008Boys 677 7 1 7 109 7 4 1 0609Girls"Differences between patterns of62.9use08by boys and girls were measured by x2 tests, df 3.displayed in Table2. Classification tolevels of substance use does not differsignificantly between boys and girls(x2 5.6, P .34). Of those who use oneor more substances every day, 71%smoke tobacco cigarettes, 20% smokemarijuana, 12% smoke clove cigarettes,7% drink alcohol, and 4% or fewer use 9.926.4Table 2.—Levels of Substance Use*Greatest ReportedLevel of Useof One orMore Substances, chewing tobacco, cocaine, LSD, PCP,or heroin. Among those who use oneor more substances almost every day,55% smoke cigarettes, 36% smoke mari juana, 11% smoke clove cigarettes, 7%drink alcohol, and 4% or fewer usechewing tobacco, cocaine, LSD, PCP, orheroin. The group of those who use oneor more substances at least once amonth but less than once a week con sists of 68% alcohol drinkers, 33% ciga rette smokers, 20% marijuana smokers,9% chewing tobacco users, 6% whosmoke clove cigarettes, and 2% or fewerwho use cocaine, LSD, PCP, or heroin.The remaining categories include in creasing percentages of alcohol drink ers.Correlates of Substance UseSpearman rank correlation coeffi cients were calculated between all pre dictor variables and level of substanceuse. Statistically significant correla tions are reported in Table 3. Variablesthat do not correlate significantly withlevel of substance use include self-es teem; participation in regular aerobicphysical activity; heart-healthy dietarypreferences; resting heart rate andmean arterial, systolic, and diastolicblood pressures; and triceps and subscapular skin-fold thicknesses. ExpiredDownloaded From: http://jama.jamanetwork.com/ by a Harvard University User on 04/17/2014%Level of UseEvery day (n 613)9.813.137.336.522.122.213.412.67.85.79.9 NeverAt least once(but less than monthly)At least monthly(but less than weekly)At least weekly(but less than almost daily)Almost every day(but less than dally)GirlsBoys(n 693)9.6 5.6, P .34. air carbon monoxide levels correlate(r .44) with reported daily or almostdaily tobacco cigarette smoking.Intercorrelations of BehaviorsTo test the hypothesis that problembehaviors covary, Spearman rank cor relation coefficients were calculated be tween all pairings of the behavioral vari ables included in Table 3. Significantintercorrelations (r .07 to .35, P .05)exist between all variables except forthe following three pairs: self-inducedvomiting and school performance; selfinduced vomiting and breaking thingsto cope with stress; and diet pill, lax ative, or diuretic use and seat belt use. Prediction of Level of Substance UseA stepwise multiple regression analy sis was performed to test the hypothesisthat a selection of the above variables
Table 3.—Correlations of Demographic, Psycho logical, Social Environmental, Behavioral, andPhysical Variables With Reported Level of Sub stance UseVariable r*DemographicParents' education levelPsychological.05t-Predicted substance useunder social pressureNegative attitudes about.73.41cigarette smokingPositive attitudes about-.40cigarette smokingIntention to attend collegePerceived safety ofcigarette smokingImportance of parental approvalKnowledge of effects ofcigarette smokingDepressive symptomsImportance of healthful behaviorsSocial environmentalPerceived friends' drunkennessPerceived friends' use of marijuanaPerceived friends' ysicalExpired air carbon monoxideBody mass index (weight/height2)asMultipleVariable R2BoysFriends' use of marijuanaPerceived safety of cigarette smokingSchool performanceParents' educationUse of diet pills, laxatives, ordiuretics for weight controlGirlsFriends' use of marijuanaSchool performanceSelf-induced vomiting forweight controlPerceived safety of cigarette smokingUse of diet pills, laxatives, ordiuretics for weight controlParents' educationPerceived adult attitudes aboutcigarette smokingSeat 0.53use-.63.61.53peers' negativesmoking attitudesPerceived adult negativesmoking attitudesBehavioralSubstance use to cope with stressSchool performanceRisk-taking behaviorsDestructive stress coping behaviorUse of diet pills, laxatives, ordiuretics for weight controlSeat belt useSelf-induced vomiting forweight controlTable 4.—Stepwise Regression of VariablesPredictors of Level of Substance Use.25-.06t-.71-.35.31.24.22.20-.15.34.12*Spearman rank correlation coefficients. P .0001except where noted.tP .05.tP-c.005.could account for a large fraction of thevariation in level of substance use. Re gressions were performed separatelyfor boys and girls (Table 4). A stepwiseregression performed for boys and girlstogether results in a similar model.Perceived friends' marijuana use entersthe model first, accounting for 41% ofthe variance, followed by school per formance; perceived safety of cigarettesmoking; use of diet pills, laxatives, ordiuretics for weight control; parents'education; seat belt use; and self-in duced vomiting for weight control.These seven variables account for 48%of the variance in level of substance usefor boys and girls together. Separateregressions were also performed toidentify predictors of levels of use ofindividual substances. The results werevery similar to those for level of overallsubstance use.COMMENTOver 50% of the tenth graders in thispopulation report current monthly ormore frequent substance use. However,while 46% of the students report drink ing alcohol, only 5% are using cocaine,and fewer than 2% report using LSD,PCP, or heroin. Despite these largeprevalence differences, we found thatoverall level of substance use, irrespec tive of the specific substances used,could be predicted by a model previ ously used to predict involvement withsingle substances. The ability to ac count for 48% of the variation in level ofsubstance use is comparable to resultsfor single substances.5,6,15 These findingsare consistent with those of inves tigators using other composite indexesof substance use.16,17 In addition, thevariables found to predict levels of use ofindividual substances were almost iden tical to those predictive of overall levelof use. Although we do not deny thatinvolvement with any single substancemay be associated with unique risk fac tors, our findings do suggest that allsubstance-use behaviors may share acommon set of risk factors. Our find ings support the hypothesis that formany purposes substance use may beconsidered a single behavior regard less of theused.particular substance(s)In this adolescent population, de structive coping behavior; risk-takingbehaviors; school performance; use ofdiet pills, laxatives, or diuretics forweight control; self-induced vomitingfor weight control; and seat belt use allcorrelate significantly with level of sub stance use. In addition, significant in tercorrelations exist between nearly allpairs of these behavioral variables.These results support the suggestionthat substance use is part of a syndromeof adolescent problem behaviors. Ado lescents at risk for involvement withsubstance use might also be at risk forparticipating in other problem behav iors; this is the case in our population.Level of substance use is associatedmost strongly with perceptions offriends' substance use. This finding isconsistent with those from almost allDownloaded From: http://jama.jamanetwork.com/ by a Harvard University User on 04/17/2014studied adolescent populations,6,18,19 in cluding samples of adolescents out ofschool.16,20 In addition, adolescents mostoften cite social factors as their reasonsfor using substances.1 The importanceof perceived substance use among peersis also reflected in the strong associationfound between level of substance useand predicted use in hypothetical socialpressure situations. A single reportedperception of how many friends usemarijuana was able to account for about40% of the variance in substance useamong both boys and girls. Additionalvariables that contribute significantlyto the regression models explain nomore than 9% of additional variance.These findings strongly support the hy pothesis that social environmental fac tors exert the most profound influenceon substance use involvement.The influence of the social environ ment also provides an explanation forthe vastly different use prevalences ob served for different substances. Riskfor involvement with a particular sub stance is primarily due to perceptions ofsocial pressures for use and the numberof environmental models using that sub stance. Under this construct, changesin use prevalences for individual sub stances over time or between sub stances at one point in time are notresponses to unique characteristics ofthe users but to social influences in theenvironment. This model is consistentwith the hypothesis that substance usecan be considered a single behaviorregardless of the specific substance(s)used. Furthermore, a common set ofpsychosocial risk factors may exist forall problem behaviors, but actual par ticipation in those behaviors may beprimarily the result of social influences.The only psychological variable thatcontributed significantly unique vari ance to the regression models was per ceived safety of cigarette smoking. Thisvariable entered early into both theboys' and girls' models. This finding isconsistent with those from analyses ofsingle substances.5,6,16 In addition,trends in perceived safety have previ ously been found to correspond totrends in substance use prevalences.1Although increased substance usehas been previously noted among ado lescents utilizing unhealthful weightcontrol strategies,21 the appearance ofdiet pill, laxative, or diuretic use in theregression model for both girls and boysand self-induced vomiting in the girls'model was unexpected. These results,in addition to the finding that seat beltuse contributes unique variance to themodel for girls, represent the identifica tion of significant new risk factors in thesubstance use literature. These findingsmay encourage others to search for ad-
ditional risk factors that are consistentwith the problem-behavior model.The usefulness of our findings is de pendent on the validity of self-reports ofsubstance use. Although questions in evitably arise about the validity of ado lescent self-reports, strong correlationswith biochemical and observationalmeasures have been consistently re ported.2224 Extensive efforts were un dertaken to assure confidentiality to allparticipating students. This is reflectedin the high response rate to all sub stance use items. We also included a val idation measure in the form of expiredair carbon monoxide, a useful measureof recent tobacco cigarette use.25,26 Thecorrelation between expired air carbonmonoxide levels and frequent cigarettesmoking suggests generally accurate re porting. In addition, similarities betweenour resultsand those from other nationalregional samples1,15,27 strengthen thepersuasiveness of our findings.Due to the cross-sectional design oforanalysis we cannot make causalregarding adoption of sub stance use. However, strong associational relationships suggest that per ourinferencesceived social influences have a strongimpact on adolescents' participation insubstance use and other problem be haviors. The overwhelming influence ofthe perceived social environment sug gests that interventions concentratingon self-esteem and other psychologicalvariables may not be effective in produc ing desired large-scale changes in sub stance use by adolescents. The mosteffective preventive strategy may con sist of skills training for resisting socialinfluences. This strategy concentrateson helping adolescents identify and re sist specific social pressures to adoptbehaviors by informing them abouthealth and social consequences; identi fying peer, media, and other environ mental influences; modeling responsesto these influences; role playing; andgoal setting. This strategy has alreadyproven successful in preventing adoles cents from adopting cigarette smok ing.28"30 In addition, the high prevalenceof substance use reported in this popula tion underscores the importance ofstarting preventive interventions priorto the tenth grade.In this study we have also identified aset of easily assessable self-report vari ables as independent correlates of levelof substance use: friends' marijuanause, school performance, perceivedsafety of cigarette smoking, parents'education, and seat belt use. The addi tional variables, use of diet pills, lax atives, and diuretics for weight controland self-induced vomiting for weightcontrol, may prove most useful in clini settings. When encountered in ateenager, these characteristics shouldtrigger one's awareness of possible druguse. Substance use is frequently underdiagnosed by physicians.31,32 Formalscreening instruments have been devel oped,33,34 and recommendations forassessment, treatment, and referral ofadolescent substance users are availa ble.35"38 We encourage all physicianscaring for adolescents to consult theseresources and actively promote commu nity-based prevention efforts.calThis research was supported by a Public HealthService grant to Dr Farquhar (HL32185) and aPublic Health Service National Research ServiceAward to Dr Saylor (T32 H
The consideration of substance use as part ofa syndrome ofproblem behaviors could provide a focus for the develop ment of intervention strategies. In a defined population study we tested the following hypotheses: (1) Substance use may be considered a sin gle behavior regardless of the specific substance(s) used. (2) Substance use is part of .
for Adolescent Substance Use Disorder Zachary W. Adams, Ph.D., HSPP. Riley Adolescent Dual Diagnosis Program. Adolescent Behavioral Health Research Program. Department of Psychiatry. . NIDA Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide. www.drugabuse.gov.
Adolescent Substance Use Disorder Treatment Zachary W. Adams, Ph.D., HSPP. . Identify drivers of substance use problems and implement evidence- . NIDA Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide. www.drugabuse.gov. NIDA for Teens.
report a desire to discuss substance use during clinic . Adolescent Substance Abuse Research, Children's Hospital Boston, 300 Longwood Ave, Boston, MA 02115, U.S.A., (617) 355-5433, www.ceasar.org. References: 1. Knight JR, Shrier LA, Bravender TD, Farrell M, Vander Bilt J, Shaffer HJ. A new brief screen for adolescent substance abuse.
Center for Substance Abuse Treatment (CSAT) funded the Adolescent Treatment Models (ATM) program, in which ten exemplary adolescent treatment programs in the United States were evaluated. The goals of the CSAT ATM Project Cooperative Agreement are listed below: 1. Identify currently existing potentially exemplary models of adolescent substance
Development plan. The 5th "Adolescent and Development Adolescent - Removing their barriers towards a healthy and fulfilling life". And this year the 6th Adolescent Research Day was organized on 15 October 2021 at the Clown Plaza Hotel, Vientiane, Lao PDR under the theme Protection of Adolescent Health and Development in the Context of COVID-19.
Adolescent substance abuse is a major problem facing the world today. In order to understand the reasons for adolescent substance abuse behaviour, various theoretical perspectives were utilised and strategies to curb substance use were also identified. The study was conducted in the rural areas of Zeerust, North West province of South Africa.
Substance Abuse 2019 10 NIDA Principles for Adolescent Treatment 1. Adolescent substance use needs to be identified and addressed as soon as possible 2. Adolescents can benefit from a drug use intervention even if they are not addicted to a drug 3. Routine annual medical visits are an opportunity to ask adolescents about drug use 4.
When recording archaeological finds using illustration, it is vital that you look very closely at the features visible on the objects. It is also important to look at colours, textures and materials. The ‘potato game’ is designed to get children looking at everyday objects that are usually taken for granted and spotting small features that make them unique. The game will also develop .
