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

568 V. TREATMENTS FOR ADDICTIONSesteem and enhances responsible decision making, and alternative activitiesprograms for adolescents were found to be ineffective in the prevention of druguse based on meta-analysis of the literature (Bangert-Drowns, 1988; Tobler,1986). Furthermore, all the prevention strategies noted previously were reportedto increase interest in drugs among some of the participants (Schinke etal., 1991). A more advanced prevention strategy is based on a psychosocialapproach. These prevention programs are aimed at enhancing self-esteem(Schaps, Moskowitz, & Malvin, 1986), social skills, and assertive skills forresisting substance use (Botvin, Baker, Filazola, & Botvin, 1990). However,these techniques failed to be successful in enhancing secondary prevention(Pentz, Dwyer, & MacKinnon, 1989).A study by Botvin, Baker, Dusenbury, Botvin, and Diaz (1995) implementeda curriculum covering life skills training (LST) and skills for resistingsocial influences to use drugs. This curriculum included booster sessions duringthe 2 years after completion of the intervention. The investigators reported asignificant and durable reduction in drug use 6 years later. The generalizabilityof the LST prevention approach for African American and Hispanic youth hasbeen supported (Botvin & Griffin, 2001). Most middle schools however, useproven prevention programs that combine effective content and delivery.Universal prevention programs may delay onset of drinking among low-riskbaseline abstainers; however, there is little evidence supporting their utility forat-risk adolescents (Masterman & Kelly, 2003). Brief interventions such asmotivational interviewing within a harm reduction framework may be wellsuited to for many adolescents.The challenge for health care providers is to identify individuals at highrisk before or shortly after initiation of substance use and to intervene to reducetransitional risk. One of the largest subpopulations of children at risk are thosewith at least one biological parent diagnosed with alcohol or substance dependence.These individuals are at greater risk of developing the same disorder, fourfoldand 10-fold, respectively (Goodwin, 1985; Tarter, 1992). Children ofopioid-dependent parents were reported to have high rates of psychopathologyand significant dysfunction in the academic, family, and legal life domains(Kolar, Brown, Haertzen, & Michaelson, 1994; Wilens, Biederman, Kiely,Bredin, & Spencer, 1995). Contrary to public perception, there is a need for amore balanced view regarding the natural history of children of alcoholics(COAs) primarily because (1) regardless of popular models of dysfunctionalCOAs, the majority of offspring raised with a dysfunctional alcoholic parent donot develop alcoholism (Wilson & Crowe, 1991) and (2) the negative labelingof adolescent COAs regardless of their current behavior was reported to berobust and potentially harmful (Burk & Sher, 1990). Resilence and protectivefactors are also important to consider (Wolin & Wolin, 1996).The heterogeneity of adolescent subpopulations needs to be recognized tobetter understand substance use and its transition to substance abuse and