Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

25. Adolescent Substance Abuse 5671993; Crumley, 1990; Kaminer, 1996). Possible mechanisms for this relationshipsinclude acute and chronic effects of psychoactive substances. Adolescentsuicide victims are frequently using alcohol or other drugs at the time of suicide(Brent, Perper, & Allman, 1987). The acute substance use may produce transientbut intense dysphoric states, disinhibition, impaired judgment, and increasedlevel of impulsivity or may exacerbate preexisting psychopathology,including depression or anxiety disorders.A number of studies of clinical populations show high rates of anxiety disordersamong youth with SUDs (Clark et al., 1995; Clark & Sayette, 1993). Inclinical populations of adolescents with SUDs, the prevalence of anxiety disorderranged from 7% to over 40% (Clark et al., 1995; DeMilio, 1989; Stowell,1991). The order of appearance of comorbid anxiety and SUD appears to bevariable, depending on the specific anxiety disorder. Social phobia usually precedesabuse, whereas panic and generalized anxiety disorder more often followthe onset of a SUD (Kushner, Sher, & Beitman, 1990). Adolescents with SUDsoften have a history of posttraumatic stress disorder (PTSD) following acute orchronic physical and sexual abuse (Clark et al., 1995; Van Hasselt, Null, Kempton,& Bukstein, 1993). Bulimia nervosa is also commonly associated with adolescentshaving substance use disorders (Bulik, 2002). SUDs are very commonamong individuals diagnosed with schizophrenia (Kutcher, Kachur, & Marton,1992; Regier et al., 1990). Personality disorders (Cluster B in particular) amongadolescents with SUDs are highly prevalent (Grilo et al., 1995). Finally, as suggestedby studies showing language deficits in youth affected by or at high riskfor SUDs, learning disabilities or disorders may also show an increased incidenceof comorbidity (Moss, Kirisci, Gordon, & Tarter, 1994). Patients withcomorbid psychiatric disorders continue to be a challenge for clinicians andresearchers in the assessment and treatment domains.PREVENTIONEfforts to curtail substance abuse concentrate on activities designed for supplyand-demandreduction. It has been reported that the use of alcohol by youthsdeclines when either the price of alcoholic beverages or the legal drinking ageincreases (Coate & Grossman, 1987). Similarly, a reduction in car accidentsamong youth resulted from the increase of the minimum drinking age to 21(O’Malley & Wagenaar, 1991).The goal of primary prevention among children and adolescents is to deferor preclude initiation of gateway substances such as cigarettes, alcohol, andmarijuana. The traditional education program is a prevention strategy used toincrease knowledge of the consequences of drug use. Investigators (Schinke,Botvin, & Orlani, 1991) found the assumption that increased knowledgedecreases drug use to be invalid. Affective education, which increases self-