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

25. Adolescent Substance Abuse 569dependence. This recognition is followed by determining the level of interventionrequired, whether primary, secondary, or tertiary prevention. The preventioneffort must also address adolescent needs in all domains of life, includingattitudes, expectations, and interactions with the community.Implications for policy-related initiatives have to do with supply reduction.Effective prevention programs are cost-effective. For every $1 spent ondrug use prevention, communities can save $4–5 in costs for drug abuse treatmentand counseling. The National Institute on Drug Abuse (NIDA; 2001) hasestablished a set of prevention principles, based on research of effective modelprograms. These principles state that prevention programs should (1) enhance“protective factors” and reverse or reduce known “risk factors”; (2) target allforms of drug abuse, including the use of tobacco, alcohol, marijuana, andinhalants; (3) teach skills to resist drugs when offered, strengthen personalcommitments against drug use, and increase social competence (e.g., in communications,peer relationships, self-efficacy, and assertiveness), in conjunctionwith reinforcement of attitudes against drug use; (4) use interactive methods,such as peer discussion groups, rather than didactic teaching techniques alone;(5) include a parent or caregiver component that reinforces what the childrenare learning and opens opportunities for family discussions about use of legaland illegal substances, and family policies about their use; (6) last long termover the school career, with repeat interventions to reinforce the original preventiongoals; (7) use family-focused prevention efforts that have a greaterimpact than strategies that focus on parents only or children only; (8) use communityprograms that include media campaigns and policy changes, such asnew regulations that restrict access to alcohol, tobacco, or other drugs; (9) usecommunity programs to strengthen norms against drug use in all drug abuse preventionsettings, including the family, the school, and the community; (10)offer school-based opportunities to reach all populations and also serve asimportant settings for specific subpopulations at risk for drug abuse, such aschildren with behavior problems or learning disabilities and those who arepotential dropouts; (11) be adapted to address the specific nature of the drugabuse problem in the local community; (12) be more intensive for high-risk targetpopulations, and the earlier age it must begin; and (13) be age-specific,developmentally appropriate, and culturally sensitive.ASSESSMENTA significant step toward addressing the need for better therapeutic interventionsfor adolescents with SUDs has been the recognition of the assessment and treatmentof SUDs as potentially a multistep task. The expert committee of the Instituteof Medicine report (1990) of the adolescent assessment/referral system developedby the NIDA (Rahdert, 1991; Tarter, 1990) recommend a three-phase