Essay Grade

Twelve‐Step Groups
What is Alcoholics Anonymous?
“Alcoholics Anonymous is a fellowship of men and women who share their experience, strength and
hope with each other that they may solve their common problem and help others to recover from
alcoholism. The only requirement for membership is a desire to stop drinking” (Alcoholics Anonymous,
2012).
What is Al‐Anon?
“At Al‐Anon Family Group meetings, the friends and family members of problem drinkers share their
experiences and learn how to apply the principles of the Al‐Anon program to their individual situations.
They learn that they are not alone in the problems they face, and that they have choices that lead to
greater peace of mind, whether the drinker continues to drink or not” (Al‐Anon Family Groups, 2012).
What is Gamblers Anonymous?
“Gamblers Anonymous is a fellowship of men and women who share their experience, strength and
hope with each other that they may solve their common problem and help others to recover from a
gambling problem. The only requirement for membership is a desire to stop gambling” (Gamblers
Anonymous, 2012).
What is Narcotics Anonymous?
“The group atmosphere provides help from peers and offers an ongoing support network for addicts
who wish to pursue and maintain a drug‐free lifestyle” (Narcotics Anonymous, 2012).
What is Overeaters Anonymous?
“Overeaters Anonymous offers a program of recovery from compulsive eating using the Twelve Steps
and Twelve Traditions of Overeaters Anonymous. Worldwide meetings and other tools provide a
fellowship of experience, strength, and hope where members respect one another’s anonymity.
Overeaters Anonymous is not just about weight loss, weight gain or maintenance, or obesity or diets. It
addresses physical, emotional, and spiritual well‐being. It is not a religious organization and does not
promote any particular diet” (Overeaters Anonymous, 2012).
References:
Alcoholics Anonymous. (2012). Information on A.A. Retrieved from
http://www.aa.org/lang/en/subpage.cfm?page=1
Al‐Anon Family Groups. (2012). About Al‐Anon family groups meetings. Retrieved from http://www.al‐
anon.alateen.org/about‐group‐meetings
© 2014 Laureate Education, Inc.
Page 1 of 2
Gamblers Anonymous. (2012). About us. Retrieved from
http://www.gamblersanonymous.org/ga/node/1
Narcotics Anonymous. (2012). Information about NA. Retrieved from http://www.na.org/?ID=PR‐index
Overeaters Anonymous. (2012). OA program of recovery. Retrieved from http://www.oa.org/
© 2014 Laureate Education, Inc.
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353
Chapter 16 Substance Abuse Prevention Programs Across the Life
Span
Abbé Finn
Florida Gulf Coast University
THE NEED FOR PREVENTION PROGRAMS ACROSS THE LIFE SPAN
The National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) has identified
alcohol, tobacco, and drug abuse as leading causes of serious health problems, disability, and premature
death (2002). People are exposed to drugs and alcohol along every stage of development across the life
span. People can suffer addiction from womb to tomb.
Many people are exposed to dangerous intoxicating substances before they are born. These are the
youngest and most innocent victims. Even though these substances have been used for many, many
years, the study of their impact on a developing fetus is comparatively recent. The impact of cigarette
smoking on the fetus has only been studied since the 1960s (Becker, Little, & King, 1968
1968), alcohol and
opiates since the 1970s (Finnegan, 1978; Jones & Smith, 1973
1973), and other illicit substances since the 1980s
(Chasnoff, Burns, Schnoll, & Burns, 1985
1985). In spite of massive education regarding the risks of prenatal
exposure to alcohol, tobacco, and other drugs, findings from the National Survey on Drug Use and Health
indicate that approximately 4.5–5% of pregnant women continue to use these substances. There is a
disturbing finding that pregnant teenagers are even more likely to use drugs than their nonpregnant
counterparts (22% vs. 13.4%) (Substance Abuse and Mental Health Services Administration [SAMHSA],
2013a). Prenatal exposure to these substances can have the immediate effect of premature delivery with
2013a
the long-term complications pertaining to health, growth, and neurological development, and the longterm effect of congenital defects, learning difficulties, impaired learning and language development, and
neurological defects with learning and behavioral implications (Behnke, Smith, & Committee on
Substance Abuse and Committee on Fetus and Newborn, 2013
2013). Prevention programs that target
pregnant women have the added value of intervening in the mother and the child’s health and welfare.
They even have an impact on the development of future children. It is truly the gift that keeps on giving
because treatment for the mother reduces the need for care and special services for the future children.
In 2012, approximately 23.9 million Americans from 12 years of age and older had used illicit drugs
within the past 30 days. This represents 9.2% of the population aged 12 or older, with the greatest use
among 18- to 20-year-olds at 19.9% using illicit drugs within that 30-day time period. This is roughly the
same population as people living in the state of Michigan. (See Figure 16.1.)
16.1 In 2012, an estimated 22.2
million persons aged 12 or older met the criteria for substance dependence or abuse in the past year.
This comes to 8.5% of the U.S. population. Individuals numbering 2.8 million were classified with
dependence on or abuse of both alcohol and illicit drugs. Another 4.5 million were diagnosed with
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dependence on or abuse of illicit drugs (other than alcohol), and 14.9 million were dependent on alcohol
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but not illicit drugs (Centers for Disease Control and Prevention [CDC], 2012
2012).
FIGURE 16.1 Number of Americans Reporting Use of Illicit Substances During the Previous 30
Days
Source: Substance Abuse and Mental Health Services Administration. (2013
2013). Results from the 2012 National Survey
on Drug Use and Health: Summary of national findings (NSDUH Series H-46, HHS Publication No. [SMA] 13-4795).
Rockville, MD: Author.
FIGURE 16.2 Binge Alcohol Use Among Adults Aged 18 – 22, by College Enrollment: 2002–2012
Source: Substance Abuse and Mental Health Services Administration. (2013
2013). Results from the 2012 National Survey
on Drug Use and Health: Summary of national findings (NSDUH Series H-46, HHS Publication No. [SMA] 13-4795).
Rockville, MD: Author.
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Substance abusers usually initiate use during childhood or adolescence, negatively impacting the rest of
their lives. The peak ages for alcohol abuse are between 18 and 29 years old. For 65%, the initial drug
used was cannabis, with 25% starting with medications prescribed to someone else (SAMHSA, 2013b
2013b).
Full-time enrolled college students show higher rates of alcohol use and abuse than their noncollege
peers, 60.3% versus 40.1% (Dawson, Grant, Stinson, & Chou, 2004
2004; Johnston, O’Malley, & Bachman, 2003
2003;
Slutske et al., 2004
2004; Slutske, 2005
2005; SAMHSA, 2013a
2013a). Twenty percent of college students meet the
diagnostic criteria for alcohol abuse—twice the rate of the average population (Dawson et al., 2004
2004;
Knight et al., 2002
2002; National Center on Addiction and Substance
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Abuse at Columbia University [CASA], 2007
2007; SAMSHA, 2013a
2013a; Slutske, 2005
2005). (See Figure 16.2.).
16.2 College
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students who are members of fraternities and sororities have the highest rate of binge alcohol abuse and
are most likely to be diagnosed with alcohol addiction (Knight et al., 2002
2002). During a 10-year period, the
proportion of students abusing controlled prescription drugs has increased exponentially. For example,
the abuse of pain killers (Percocet, Vicodin, and OxyContin) has increased by more than 300%; stimulants
(Ritalin and Adderall) by 90%; and daily marijuana use by 110% (CASA, 2007
2007). The CASA (2007
2007) report
concluded that the rate of combined alcohol and substance abuse by American college students threatens
the well-being of the current generation and the capacity of the United States to maintain its lead in a
global economy.
Approximately 20% of college students meet the diagnostic criteria for alcohol abuse—twice the rate of
the average population. Alcohol and drug abuse are also predictive of high-risk sexual behaviors, which
may lead to HIV. Almost 80% of juveniles in the American criminal justice system were under the
influence of a psychoactive substance when they committed their first crime.
In addition, alcohol and drug abuse are also predictive of high-risk sexual behaviors, which may lead to
HIV, a major killer of young adults (NCCDPHP, 2002
2002; CASA, 2007). However, effective drug prevention
programs can reduce the risk for all three behaviors (LaBrie, Lewis, Atkins, Neighbors, Zheng et al., 2013
2013;
McCoy, Lai, Metsch, Messiah, & Zhao, 2004
2004) and increase the health, productivity, and life expectancy of
adolescents and young adults.
The variety of abused substances is increasing as new drugs are invented. Some young people abuse
chemicals such as gasoline or spray paint rather than drugs. These chemicals and products, which were
never intended for human consumption, are intentionally inhaled for the purpose of intoxication. In
2012, 500,000 people older than 12 years of age admitted that they had used inhalants (SAMSHA, 2013a
2013a).
In the vernacular, this is a process known as “huffing.” These substances are potentially lethal,
carcinogenic, and toxic to the liver. There can be irreversible brain damage or death from a single use. It
is difficult to monitor the use of these substances, since many are found in products available in every
home, market, or school.
Among the young adult and adult population, alcohol, prescription drug abuse, and tobacco use for
active military and recently discharged veterans is much higher than the civilian population. Twentyseven percent of recently discharged combat veterans meet the criteria for substance abuse (Institute of
Medicine [IOM], 2013
2013). These addictions become life-long social, medical, and legal concerns. The report
indicates that 1,000 troops were hospitalized for drug overdoses in 2010.
In the United States, the problem of substance abuse is enormous, with dire consequences for the quality
of life of millions of people. For example, almost 80% of juveniles in the American criminal justice
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system were under the influence of a psychoactive substance when they committed their crime (CASA,
2004).
2004
In 2007 (the most recent date for these estimates), the composite projected cost for the manufacturing
industry, social service organizations, the criminal justice system, and the health care industry from
substance abuse in the United States was estimated to be more than $193 billion (National Drug
Intelligence Center, 2011
2011). These figures are computed by estimating the cost to manufacturing industry
due to the loss of productivity caused by on-the-job injuries, accidents, and increased health benefit costs
of substance-abusing employees; expenses caused by absenteeism; and damages caused by impaired
workers on the job. Health care cost estimates include the expense of treating patients suffering physical
consequences of substance abuse, such as increased rates of liver disease, or medical treatment of
traumatic injury incurred while under the influence of intoxicants.
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356
As expensive as these numbers appear, the greatest toll cannot be assigned a monetary value. It is the
cost borne by those who love and depend on the substance abuser. Long before drugs take the life of the
addict, they damage lives and destroy the addict’s relationships with others (van Wormer & Davis, 2003
2003).
These consequences include partner violence, sexual violence, property crimes, child abuse and neglect,
loss of life (Executive Office of the President, 2001
2001), and destruction of relationships with employers,
family, and friends.
In addition, the younger the onset of drug abuse, the greater the negative consequences to the person’s
cognitive, interpersonal, and educational development. There is evidence that children and adolescents
are particularly vulnerable to physical problems associated with exposure to alcohol, drugs, and tobacco
products. There is additional evidence that drug and alcohol use during adolescence, when the brain is
continuing to develop, causes irreversible damage to the brain’s higher order cortical function (Volkow &
Li, 2005
2005; Wuetrich, 2001
2001). The incomplete development of the prefrontal cortex increases susceptibility to
high-risk behavior because this part of the brain is responsible for judgment, decision making, and
emotional control (Gogtay et al., 2004
2004).
The younger the onset of drug abuse, the greater the negative consequences to the person’s cognitive,
interpersonal, and educational development. In 10 years, the number of emergency room admissions
due to complications from recreational use of prescription narcotics (oxycodone or hydrocodone)
increased by 352%. In the past 12 years, the rate of opioid and benzodiazepine prescription drug abuse
has risen 344% and 450%, respectively. Over the last 5 years, the number of people who used heroin
doubled from 373,000 in 2007 to 669,000 people in 2012 (SAMSHA 2013a
2013a).
While use of some illicit substances by young people has recently been declining, the illegal use of
prescription drugs, such as benzodiazepines and narcotic pain killers, and the use of medical and
nonmedical inhalants have shown a sharp increase (Johnston, O’Malley, Bachman, & Schulenberg, 2005
2005;
Kurtzman, Otsuka, & Wahl, 2001
2001; Sung, Richter, Vaughan, Johnson, & Thom, 2005
2005). The rates of illicit drug
and alcohol use by adolescents and young adults are on the rise, with the percentage increasing from
27% in 1992 to 40% in 1996 (Johnston, O’Malley, & Bachman, 1996
1996). Specifically, use of opioids has risen
to 9.4% of high school seniors illegally using narcotics during the past year (Johnston et al., 2003
2003). In 10
years, the number of emergency room admissions due to complications from recreational use of
prescription narcotics (oxycodone or hydrocodone) increased by 352%. Sung et al. (2005
2005) describe typical
adolescent opioid abusers as poor Black females with drug-abusing environmental role models. On the
other hand, McCabe, Boyd, and Teter (2005
2005) describe typical adolescent opioid abusers as White male
cigarette and marijuana smokers who drink alcohol. The accurate profile of young opioid users is hazy,
but it is clear that opioid abuse by adolescents is becoming a new epidemic in need of effective
prevention programs (Compton & Volkow, 2006
2006; McCabe et al., 2005
2005; Sung et al., 2005
2005). A new media
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campaign warns parents and grandparents of the increased risk of prescription drug abuse by their
children or grandchildren, through theft of their prescription medications, and trains adults in the safe
disposal of unneeded prescription medications (Compton & Volkow, 2006
2006; McCabe et al., 2005
2005; Office of
National Drug Control Policy, 2002
2002; Sung et al., 2005
2005).
On college campuses, the rate of substance use and abuse has been growing at an alarming rate. For
example, between 1995 and 2007 the abuse of prescription opioid pain medications increased by 344%.
During that same period, there was a 450% increase in abuse of a class of
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depressants known as benzodiazepines, including drugs commonly known as Valium and Ativan. There
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357
is an increased health risk because college students are combining these medications with alcohol,
leading to rapid intoxication and overdoses, some of which lead to premature death (CASA, 2007
2007).
In addition to the risks of addiction due to substance abuse, half of newly diagnosed HIV patients are
under the age of 25, indicating that they contracted the virus while adolescents or young adults. Onethird of people infected with HIV contracted the disease through intravenous drug use (IDU) (CDC, 2005
2005).
Drug users who do not use intravenous drugs also show a much higher rate of HIV infection than
nondrug users (McCoy et al., 2004
2004), because substance use increases the likelihood of other high-risk
behaviors such as unsafe sexual practices with multiple partners while it inhibits the likelihood of
protected sex (CDC, 2005
2005). Therefore, preventing drug use has the added value of decreasing the risk of
contracting HIV/AIDS, other sexually transmitted infections, unplanned pregnancies (CASA, 2007
2007), and
reducing the likelihood of fetal drug and alcohol exposure.
The extent of the problem of drug abuse among the elderly is unknown because there have been very
few studies conducted targeting this population. Wu and Blazer (2011
2011) reviewed the literature from 1990
to 2010 and found that people from 50 to 64 years old were more likely to abuse illicit and prescription
drugs than did people older than 65. However, the rate for abuse is expected to rise as this cohort ages
(Simoni-Wastila & Yang, 2006
2006). However, older adults are much less likely to seek treatment and have
little insight regarding the seriousness of their problem. Unfortunately, none of the screening
instruments are validated for use with the elderly (Culberson & Ziska, 2008
2008). Simoni-Wastila and Yang
(2006
2006) found that illicit drug use among the elderly is increasing and that it contributes to the loss of
cognitive functioning, social isolation, and reduction in the level of functioning. The National Survey on
Drug Use and Health indicates that the use of illicit drugs and the abuse of prescription medications
increased from 5.1% in 2002 to 9.2% in 2007 for adults older than 50 years old. Han, Gfroerer, Colliver,
and Penne (2009
2009) projected that substance abuse among senior adults will double from 2.8 million
(annual average) in 2002–2006 to 5.7 million in 2020. Culberson and Ziska (2008
2008) found that a fourth of
prescription medications are used by the elderly. Of these, it is predicted that 11% of the elderly abuse
substances. Given this information, it is surprising that there is so little research on this topic and there is
no information regarding prevention programs designed directly for older adults. The only prevention
programs found for older adults are aimed at medical practitioners and health care professionals.
PUBLIC HEALTH PREVENTION PROGRAM MODEL
According to the public health model of disease prevention, substance abuse prevention programs fall
into three general types: primary, secondary, and tertiary. Some programs are designed to include all
youth; others are designed to focus on targeted vulnerable groups (James & Gilliland, 2001
2001).
Primary Prevention Programs
Primary prevention programs target problem behaviors before symptoms occur. Participants are
selected because they fall into an at-risk category. The purpose of these programs is to stop the problem
before it begins. An example of this type of prevention program would be one that targets elementary
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school children for education regarding the risks involved with tobacco use. This is a reasonable target
group because research shows that most people who become addicted to tobacco
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began use during middle or high school; and because tobacco products are so highly addictive,
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358
experimentation can easily lead to addiction (McDonald, Roberts, & Descheemaeker, 2000
2000).
Primary prevention programs target problem behaviors before symptoms occur. Secondary prevention
programs are designed for people who have already demonstrated problematic behaviors. The goal of a
tertiary prevention program is to reduce the risk of further harm.
Secondary Prevention Programs
Secondary prevention programs are designed for people who have already demonstrated problematic
behaviors. The goal is to stop the behavior before it escalates to a serious problem with dangerous
consequences. Some secondary prevention programs can be described as a harm reduction model. For
example, when it comes to alcohol, some programs focus on responsible drinking rather than abstinence
(Marlatt & Witkiewitz, 2002
2002; van Wormer & Davis, 2003
2003).
Tertiary Prevention Programs
Juvenile Drug Court (JDC) diversionary programs are examples of tertiary prevention programs. Their
goal is to divert drug offenders to treatment and recovery programs rather than jail, thus breaking the
cycle of addiction and recidivism within the criminal justice system. Other examples include the
mandated counseling programs for students convicted of violating alcohol and drug use policies on
campus (Carey, Henson, Carey, & Maisto, 2009
2009) and the relapse prevention program that is part of most
drug-abuse recovery programs (Compton et al., 2005
2005).
EVIDENCED-BASED PREVENTION PROGRAMS
Effective substance use and drug prevention programs share the following five elements. These are:
identification of and addressing both risk and protective factors of particular populations. In order to
accomplish this, needs assessments must be conducted to measure levels of risk, protective factors, and
substances of abuse in this population. All levels of risk are prioritized and addressed as appropriate.
The target population within the needs assessment must be defined by discreet factors such as age,
grade, rank, socioeconomic status, education, location, workplace, and school.
The interventions have research data to substantiate the effectiveness. These programs do the following:
(1) reduce either the supply or demand for substances of abuse, (2) strengthen the norms or attitudes
toward healthy living, (3) strengthen healthy life skills and drug refusal skills, (4) strengthen functioning
of the family or unit, and (5) make certain that the intervention is culturally appropriate.
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These interventions must be implemented when developmentally appropriate and are timely responses
to needs and events. The program curriculum and activities are delivered in appropriate settings in an
efficient manner. These programs are initiated early in the problem behavior to reduce harm, and the
curriculum is planned so that there are repeated exposures to “boost” the impact of the curriculum
(Office of National Drug Control Policy, 2001
2001). For a prevention program to be effective, it must be
designed especially to address the community needs. It is better to prevent people from becoming
addicted than to try to treat them after the problem has emerged. To stop drug abuse in adults, it is
important to prevent the experimentation and use by adolescents of identified gateway drugs.
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359
Program Needs Assessment
For a prevention program to be effective, it must be designed especially to address community needs.
These assessments identify the types of drugs being abused or likely to be abused in the future,
community services that are already in place or need to be developed, community and institutional
goals, and resources necessary for the implementation of a proposed substance abuse prevention
program. The four types of needs indicators are “drug use indicators, problem-behavior indicators,
psychological or developmental characteristics, and social or economic conditions” (Sales, 2004
2004, p. 82).
Drug use indicators identify the types of drugs, prevalence rate of use, and the number of people
secondarily impacted. Drug use indicators are comprised of arrest records, survey responses,
incarceration rates, school disciplinary actions, and treatment data. Problem-behavior indicators are
behaviors associated with and caused by addictions. These could include children in foster care due to
parental substance abuse, neglect, or parental drug-related incarceration; school dropout rates; and
positive HIV secondary to drug use. Psychological and developmental vulnerabilities also contribute to
the risk factors. These include many correlated factors such as age-related developmental factors; family
structures and interaction styles; and individual characteristics such as a history of physical and/or
sexual abuse, low self-esteem, homelessness, and/or mental or psychiatric disorders. Social, economic,
and environmental factors include poverty, high crime rates, community tolerance for violence and drug
distribution and use, substandard housing, blighted communities resources, and disadvantages
associated with discrimination (Sales, 2004
2004).
Some of this data is available through community and governmental agencies, or can be collected from
surveys and/or interviews. The National Association on Substance Abuse has several instruments that
can be modified or used in their original forms for needs assessment.
The most effective substance abuse treatment programs target previously identified problems through
needs assessments; apply scientifically proven intervention methods for reducing substance abuse risk
actors; enhance resistance and resiliency factors; and monitor the impact of the programs (Arthur &
Blitz, 2000
2000).
TYPES OF SUBSTANCE ABUSE PREVENTION PROGRAMS
Clearly, preventing people from becoming addicted in the first place is better than trying to treat them
after the problem has emerged. The question is: What programs are best at preventing addictions? Many
types of programs have been tried. These programs have used scare tactics, social skills and peer
pressure resistance training, education regarding drug abuse facts, and parent and family training
regarding behavior management and communication skills (Catalano & Hawkins, 1996
1996; Dwyer,
Nicholson, Battistutta, & Oldenburg, 2005
2005; Hawkins, Catalano, & Arthur, 2002
2002).
Prevention Program Strategies
Prevention programs can be categorized along nine different strategies—each will be reviewed:
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1. School/college-based prevention programs focusing on education, peer mediation, and reduction of
negative peer pressure
2. Mass media campaigns reporting risks and consequences of drug use, and restriction of media
campaigns that glamorize the use of harmful substances
3. Early diagnosis and treatment of emotional problems
4. Improvement of personal and interpersonal skills
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5. Harm reduction programs
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6. Campaigns to reduce the access to drugs
7. JDC, drug court, and other diversionary programs
8. Approaches focusing on improving the family, improving parenting skills, and reduction of child
abuse
9. Multimodal programs using some features from all of the previous eight
PREVENTION PROGRAMS TARGETING ALL AGE GROUPS
Restriction of Access to Drugs
Amid a great deal of political fanfare, in 1971 President Nixon declared a “war on drugs.” Congress
pledged that the country would be drug free by 1995. Obviously, that pledge has not been fulfilled. There
has been an attempt to control the recreational and nonmedical use of prescription drugs and to restrict
the flow of drugs into the country. However, 13–18 metric tons of heroin is consumed yearly in the
United States (Department of Health and Human Services [DHHS], 2004
2004). In 2005, the U.S. government
budgeted $6.63 billion for U.S. government agencies directly concerned with restricting illicit drug use.
The U.S. government has attempted to restrict importation by strengthening the borders and interdicting
illegal substances before they enter the United States and has also attempted to reduce importation from
the supply side. It also uses foreign aid to pressure drug-producing countries to stop cultivating,
producing, and processing illegal substances. Some of the foreign aid is tied to judicial reforms, antidrug
programs, and agricultural subsidies to grow legal produce (DHHS, 2004
2004).
In an attempt to reduce drug supplies, the government has incarcerated drug suppliers. Legislators have
authorized strict enforcement of mandatory sentences resulting in a great increase in prison
populations. As a result, the arrest rate of juveniles for drug-related crimes has doubled in the past 10
years, while arrest rates for other crimes have declined by 13%. A small minority of these offenders (2
out of every 1,000) will be offered JDC diversionary programs as an option to prison sentences (CASA,
2004).
2004
The arrest rate of juveniles for drug-related crimes has doubled in the past 10 years while arrest rates for
other crimes have declined by 13%. Eighty percent of adjudicated youth are in jail due to drug crimes.
JDC programs are cost beneficial: Incarceration for each of the 122,696 drug-offending juveniles in prison
costs $43,000 per year. Because of the differing needs of children compared with adults, prevention
programs are usually designed with specific age groups in mind. Many of these will be explored in this
chapter.
SUBSTANCE ABUSE PREVENTION PROGRAMS FOR CHILDREN AND
ADOLESCENTS AND YOUNG ADULTS
Early Diagnosis and Treatment of Emotional Problems
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Practitioners working in psychiatric t