300 British Journal of School NursingJulyAugust2015Vo.docx

300� British Journal of School
Nursing��July/August�2015��Vol�10�No�6
Mental Health
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Prevention and early detection
of substance abuse is key
Drug and alcohol abuse can have a serious and lasting impact on

the health and wellbeing
of young people. Stephanie Thornton explains what to do if you
or a member of school staff
suspect drug or alcohol abuse in a student.
A student who has always seemed fairly motivated, fairly
balanced starts to have problems
concentrating; he or she seems lethargic,
perhaps depressed, irritable, aggressive—
moody. Schoolwork falls off; perhaps there
is absenteeism. Does this reflect mental
health problems? Physical illness? Are
there problems at home? Or, is this a sign
of substance abuse?
Cause or effect?
In fact, it is likely to be a mixture of
things, one thing exacerbating another.
We know, for example, that teenagers
often begin drinking or trying drugs
after problems in the family—a parental
breakup, for instance (Roustit et al, 2007).
Problems in school, struggling with work,
bullying or social rejection are miseries in
themselves, and put the young at risk of
substance abuse. Mental health problems
are strongly associated with substance
abuse of all kinds—though it is not always
clear whether these problems are caused
by drugs and alcohol or are the reason
for using those substances, in an effort to
self-medicate.
There is good evidence that regular use
of cannabis is associated with aggression
in the young (Copeland et al, 2013), and

can cause or exacerbate depression, anxiety
(Patton et al, 2002) and other psychiatric
illness including major mental illness such
as psychosis (Johns, 2001). But the evidence
that alcohol abuse causes depression and
anxiety is more equivocal. Heavy drinking
is certainly associated with problems such
as depression (Sher, 2004), but it is unclear
Dr Stephanie Thornton,�chartered�
psychologist�and�former�lecturer�in�
psychology�and�child�development
functioning and substance abuse, it is
always worth considering whether a
troubled youngster is using drugs or
drinking. The point is underlined by
statistics on substance abuse in British
teenagers: such abuse is far from rare.
And, in fact we appear to have a greater
problem in this area than most of our
European neighbours.
As the media has noted, teenage drug
abuse has actually declined in the UK
in the past 20 years (Hibell et al, 2012).
Nevertheless, the most recent data report
that 25% of our 15–16-year-olds have tried
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Both drugs and alcohol abuse affect the ability to learn. For
example, cannabis can
cause a decline in memory function and concentration, and
alcohol can disrupt the
development of the teenage brain.
whether drinking causes depression or
depression causes drinking (Haynes et al,
2005). However, the evidence suggests that
both drugs and alcohol abuse affect the
ability to learn. Cannabis, for example, can
cause a decline in memory function and
concentration (Pope et al, 1994). Alcohol
can disrupt the development of the teenage
brain (Squeglia et al, 2009), potentially
causing lasting cognitive damage.
Incidence
Given these complex associations between
life problems, cognitive and emotional
July/August�2015��Vol�10�No�6��British Journal of
School Nursing� 301
Mental Health
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cannabis and 9% have tried other drugs,
usually amphetamines or ecstacy—both
figures significantly above the European
averages. 10% have abused inhalants—
about average (Hibell et al, 2012). Some
of these will have tried these drugs once
or twice and stopped. It is hard to say how
many are consistent users.
More shocking still is the incidence of
alcohol abuse, where British teenagers
come very near the top of the European
league (Hibell et al, 2012). Over half of our

15–16-year-olds report that they engage in
regular episodes of heavy drinking (52% in
the UK, whereas the European average is
39%). And, they drink more per binge than
their average European counterpart. Unlike
other nations (with the sole exception of
Finland), British girls report more such
drunkenness than boys. Levels of alcohol
abuse in UK teenagers have not changed
over the past 20 years (Hibell et al, 2012).
Why are British teenagers particularly
prone to substance abuse? We don’t know.
Factors that correlate with such abuse are
not more prevalent here than elsewhere. Is
access to drink or drugs easier here than
elsewhere in Europe? It seems unlikely. Is
such abuse more socially acceptable in the
UK? Or is there something protective in
other cultures that we are lacking?
Prevention and
early detection
Whatever the cause, the sheer scale of
substance abuse among our teenagers,
and the immediate and potential long-
term consequences of this pose a serious
challenge in our schools. Most schools have
active programmes to counter substance
abuse. In an ideal world, these would steer
the young away from such experiments,
and identify and support all those who
do go down that path. But this is not
an ideal world. Anti-abuse messages are

evidently not working. And it is still down
to the individual teacher or school nurse
to identify, and often to manage, cases of
substance abuse.
Prevention is better than cure. If
possible, stepping in to offer support when
a teenager is first exposed to the stresses
or peer pressures that lead to exploring
alcohol or drugs may head off problems
that will be much harder to manage later,
when unhealthy habits have become
established. But, it can be hard to detect
the early stages of substance abuse, and
hard, too, to know how best to handle your
suspicions. Various websites and helplines
offer advice on both these matters.
YoungMinds has a useful website and a
helpline that can offer general advice and
point you to more specialised resources
in light of the specifics of a problem.
Useful sources of information and advice
for issues with drugs include Talk to Frank
and Addaction, and for alcohol problems:
Drinksense and Alcoholics Anonymous
(see Further information). General advice
from such sources suggests 4 key points:
��Be constantly vigilant for the signs of
substance abuse—A student who comes
to school high or hungover may seem
physically ill, may be slurred, have
bloodshot eyes, or eye pupils that are too
large or too small for the ambient light
(check another nearby individual). But
in the early stages of abuse, teenagers
may keep their experiments away from

school, so that the signs of abuse are
more ambiguous. Clumsiness or poor
concentration may be the first sign of
a problem. Substance abuse can also
progressively affect energy levels, either
producing increased lethargy and
apathy or the opposite: hyperactivity
and agitation. There may also be mood
swings, extreme moods, loss of control of
various kinds (angry outbursts, irrational
anxiety, even paranoia).
��Take your suspicions seriously from the
‘If possible, stepping in to offer support
when a teenager is first exposed to the
stresses or peer pressures that lead to
exploring alcohol or drugs may head off
problems that will be much harder to
manage later ...’
�
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‘... 25% of our 15–16-year-olds have tried cannabis and 9%
have tried other drugs,
usually amphetamines or ecstacy—both figures significantly
above the European averages.’
302� British Journal of School
Nursing��July/August�2015��Vol�10�No�6
Mental Health
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start—A teenager who is palpably ill may
need urgent medical attention. But any
real suspicion of substance abuse should
be referred to your school abuse team
without delay. It is far better to err on
the side of caution, suspecting substance
abuse where there is none (which can
be quickly cleared up) than to let such
abuse slip through and grow—especially
as the signs of substance abuse may also
point to other forms of mental health or
a personal issue.
��Explore what is driving this individual’s
experiments with drugs or drink—An
individual who uses these substances to
manage stress or medicate misery is in
a very different situation from one who
is abusing to keep up with a peer group,
for example—and needs a very different
kind of intervention. Talking the reasons
for using alcohol or drugs through with
the teenager, as non-judgmentally as
possible, may provide vital insights for
supporting that individual in finding
healthier strategies.
��Discuss the realities of substance abuse,
which may be less salient for the young
than one might suppose—A key finding
of the recent European School Survey
Project on Alcohol and Other Drugs
(ESPAD) research (Hibell et al 2012)
is that British teenagers are more likely
than peers in many other European
nations to discount the negative

‘... British teenagers are more likely than
peers in many other European nations to
discount the negative consequences of
drinking, focusing only on the personal and
social benefits ...’
consequences of drinking, focusing only
on the personal and social benefits—
and this, despite the fact that they also
report having experienced more negative
consequences of alcohol than most of
their European peers. The same may well
be true for their attitude to illegal drugs.
Such perceptual biases may play a role in
fuelling the high rates of substance abuse
in the UK. BJSN
Copeland J, Rooke S, Swift W (2013) Changes
in cannabis use among young people: Impact
on mental health. Curr Opin Psychiatry 26(4):
325–9
Haynes J, Farrell M, Singleton N, Meltzer H,
Araya R, Lewis G, Wiles N (2005) Alcohol
consumption as a risk factor for anxiety and
depression. Br J Psychiatry 187: 544–51
Hibell B, Guttormsson U, Ahlstrom S, Balakireva
O, Bjarnason T, Kokkevi A, Kraus L (2012) The
ESPAD report 2011: Substance abuse in students
in 36 European countries. The Swedish Council
for Information on Alcohol and other Drugs
(CAN), The European Monitoring Centre
for Drugs and Drug Addiction (EMCDDA),
Council of Europe, Co-operation Group to
Combat Drug Abuse and Illicit Trafficking in

Drugs (Pompidou Group)
Johns A (2001) Psychiatric effects of cannabis. Br J
Psychiatry 178 116-122
Patton G, Coffey C, Carlin J, Lynskey M, Hall
W (2002) Cannabis use and mental health in
young people: A cohort study. BMJ 325(7374):
1195–8
Pope H, Gruber A, Yurgelun-Todd D (1995) The
residual neuropsychological effects of cannabis:
The current status of research. Drug Alcohol
Alcoholics�Anonymous
Mutual�aid�fellowship�for�people�who�
have�a�drinking�problem.
www.alcoholics-anonymous.org.uk/
Addaction
Addaction�is�a�UK-based�drug�and�
alcohol�treatment�charity.
http://addaction.org.uk
Drinksense
Local�alcohol�and�drugs�charity�for�
young�people.
www.drinksense.org
Talk�to�Frank
Talk�to�Frank�is�a�long�running�anti-
drugs�campaign.�The�website�offers�
advice�to�young�people.
www.talktofrank.com/
YoungMinds

YoungMinds�specialises�in�supporting�
children�and�teenagers�with�mental�
health�problems,�their�family�and�
professionals�working�with�them�
(helpline�0808�8025544).
www.youngminds.org.uk
Further information
Depend 38(1): 25–34
Roustit C, Chaix B, Chauvin P (2007) Family
breakup and adolesent’s psychosocial
maladjustment: Public health implications of
family disruptions. Pediatrics 120(4): 984–91
Sher L (2004) Depression and alcoholism.
Quarterly Journal of Medicine 97: 237–40
Squeglia L, Jacobus B, Tapert S (2009) The
influence of substance abuse on adolescent
brain development. Clin EEG Neurosci 40(1):
31–8
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Session 6 – Sustainability
Sustainability
Learning objectives:
• What is business sustainability?
• What are some of the international guidelines for
business sustainability, and how could these be effectively
implemented?
• What is the relationship between sustainability and
corporate governance?
• How can organisations change to become more
sustainable?
• What are some of the current trends in business
sustainability?
What is sustainability?
• Sustainability is the use of resources to enable society to
satisfy current needs, without compromising the ability of
future generations to meet these needs.
• Sustainable development meets the needs of the present
without hurting future generations.
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© John Wiley and Sons Australia
Three pillars of sustainable development
Defining sustainability
• Sustainability results from activities that:
– extend the productive life of organisations and
maintain high levels of corporate performance
– maintain decent levels of welfare for present and
future generations
– enhance society’s ability to maintain itself to solve its
major problems
– enhance the planet’s ability to maintain and renew
the biosphere and protect all living species
Zero emissions
• Zero emissions occur when carbon or polluting emissions
are reduced and/or offset so that there is no net addition
of emissions that are harmful to the environment or
climate, usually by the emitting source.
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Why sustainability?
• Business growth and urban growth have gone hand in
hand.
• Industries, buildings and transportation systems depend
on fossil fuels.
• The future lies with renewable energy.
• A renewable energy target is a percentage of total energy
production that is generated by renewable sources.
Energy and the natural environment
• The quadruple bottom line is a measure of company
performance covering results in terms of economic, social
and environmental and cultural factors.
• Social justice is concerned with creating a more just and
equitable world.
International sustainability guidelines for
business
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The UN Global Compact
• The UN Global Compact provides ‘universal’ guidance to

businesses in developing sustainable practices, and sets
some standards in relation to businesses that aim to
operate ethically.
• First ratified at the World Economics Forum in Davos,
Switzerland, on 31st January 1999.
• It is the world’s largest corporate sustainability initiative.
• Steps to promote environmental responsibility include:
– redefining company vision, policies and strategies
– developing sustainability targets and indicators
– working with suppliers to improve environmental
performance
– adopting voluntary charters, codes of conduct or
practice internally
– ensuring transparency and unbiased dialogue with
stakeholders.
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The Millennium Development Goals (MDG)
• The Millennium Development Goals are a UN‐sponsored
set of eight time‐bound goals that aim to reduce global
extreme poverty.
– To build economic and social sustainability amongst
the poorest people in the world.
– Provide a focus for businesses as they work in
partnership with governments and not‐for‐profit
organisations in building global sustainability .
The Millennium Development Goals (MDG)
• Adopted by 189 UN member states to, by 2015:
– eradicate extreme poverty and hunger
– achieve universal primary education
– promote gender equality and empower women
– reduce child mortality
– improve maternal health
– combat HIV/AIDS, malaria and other diseases
– ensure environmental sustainability
– develop a global partnership for development.
Sustainability and organisations
• One approach to the problem of building consensus in
organisations is the concept of shared value.
– The policies and operating practices that enhance the
competitiveness of a company while simultaneously
advancing the economic and social conditions in the
communities in which it operates.

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Closed‐loop model of a sustainable business
organisation
Corporate governance
• A major consideration in sustainability is how a company
governs itself. The scope of governance includes:
– methods of decision‐making
– the ways in which stakeholders are included in the
process
– their interests are represented
– the transparent, ethical principles that are applied to
all decision‐making.
Organisational change: developing the
sustainable firm
• Ethical consumerism is the practice of purchasing
products and services produced in a way that minimises
social and/or environmental damage, while avoiding
products and services deemed to have a negative impact
on society or the environment.
• Global Reporting Initiative promotes environmental,
economic and social responsibility.

• The bottom of the pyramid – the poor are not victims
rather, they are resilient and creative entrepreneurs.
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Incremental change
• Dunphy, Griffiths and Benn distinguish four phases of
transition:
1. From non‐responsiveness to compliance.
2. From compliance to sustainable efficiency.
3. From efficiency to strategic productivity.
4. From strategic productivity to the sustaining
corporation.
Current trends in business sustainability
• Alvin Toffler introduced the concept of waves of change in
his book The Third Wave
– The First Wave was the agricultural revolution.
– The Second Wave was the Industrial Revolution.
– The Third Wave marks growing concern for balance
and sustainability and is epitomised by a world view
stressing the connectedness of individuals, cooperation

and value creation.
Rio+20 Corporate Sustainability Forum
• The Rio+20 Corporate Sustainability Forum was a UN‐
sponsored forum comprising business, governments,
academics and community activists that met in Rio de
Janiero in 2012 to develop sustainability initiatives.
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Summary
• What is business sustainability?
• What are some of the international guidelines for
business sustainability, and how could these be effectively
implemented?
• What is the relationship between sustainability and
corporate governance?
• How can organisations change to become more
sustainable?
• What are some of the current trends in business
sustainability?
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Session 5 – Ethical behaviour
and social responsibility
Ethical behaviour and social responsibility
• What is ethical behaviour?
• How do ethical dilemmas complicate the
workplace?
• How can high ethical standards be maintained?
• What is organisational social responsibility?
• How do organisations and government work
together in society?
What is ethical behaviour?
• Ethics: set of standards as to what is good or
bad, or right or wrong in a person’s conduct.
• Ethical behaviour is accepted as ‘right’ or ‘good’
or ‘proper’ in the context of a governing moral
code.
• If an act is legal, some will proceed with it
confidently, while others might believe that the
ethical test goes beyond legality. This is a matter
of personal values.

• Values are broad beliefs about what is or is not
appropriate behaviour.
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Alternative views of ethical behaviour
• There are many different interpretations of what
constitutes ethical behaviour:
– The utilitarian view considers ethical
behaviour as that which delivers the greatest
good to the greatest number of people.
– The individualism view considers ethical
behaviour as that which advances long‐term
self‐interests.
– The moral‐rights view considers ethical
behaviour as that which respects and protects
the fundamental rights of people.
Alternative views of ethical behaviour
• The justice view considers ethical behaviour as
that which treats people impartially and fairly
according to guiding rules and standards.
– Procedural justice is concerned that policies
and rules are fairly administered.
– Distributive justice is concerned that people

are treated the same regardless of individual
characteristics.
– Interactional justice is the degree to which
others are treated with dignity and respect.
Four view of ethical behaviour
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Cultural issues in ethical behaviour
• Cultural relativism
– There is no one right way to behave; ethical
behaviour is determined by its cultural
context.
• Universalism
– Alternative positions, in which ethical
standards apply across all cultures.
– Critics call this a form of ethical imperialism,
an attempt to impose one’s ethical standards
on other cultures.
Ethical dilemmas
• An ethical dilemma arises when action must be

taken but there is no clear ‘ethically right’ option.
• Cause stress until they are resolved.
• The burden is on the individual to make good
choices.
Ethical dilemmas
• Sources of ethical dilemmas include:
– Discrimination
– Sexual harassment
– Conflicts of interest
– Customer confidence
– Organisational resources
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Rationalisations for unethical behaviour
Four common rationalisations that are used to
justify misconduct:
1. Convince yourself that the behaviour is not
really illegal.
2. Convince yourself that the behaviour is really in

everyone’s best interests.
3. Convince yourself that nobody will ever find out
what you’ve done.
4. Convince yourself that the organisation will
‘protect’ you.
• When in doubt about taking an action, don’t do
it
Factors influencing ethical behaviour
Ethics in the workplace
• Factors influencing ethical behaviour:
– The person – family influences, religious
values, personal standards and personal
needs.
– The organisation – formal policy statements
and written rules establish an ethical climate
– The environment – government laws and
regulations, and social norms and values.
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Ethics training

• Ethics training seeks to help people understand
the ethical aspects of decision‐making, and
incorporate high ethical standards into their daily
behaviour.
• Many ethical dilemmas arise as a result of the
time pressures of decisions. Ethics training is
designed to help people deal with ethical issues
under pressure.
Checklist for making ethical decisions
• Step 1. Recognise the ethical dilemma.
• Step 2. Get the facts.
• Step 3. Identify your options.
• Step 4. Test each option: Is it legal? Is it right? Is
it beneficial?
• Step 5. Decide which option to follow.
• Step 6. Double‐check decision by asking follow‐
up questions.
• Step 7. Take action.
Whistleblower protection
• Whistleblowers
– People who expose the misdeeds of others in
organisations in order to preserve ethical
standards and protect against wasteful,

harmful or illegal acts.
• Whistleblowers face the risks of impaired career
progress and other forms of organisational
retaliation, up to and including dismissal.
• Federal and state laws in Australia/NZ offer
whistleblowers some defence against ‘retaliatory
discharge’.
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Ethical role models
• Top managers in large and small businesses have
the power to shape their organisation’s policies
and set its moral tone.
• All managers must act as ethical role models and
set an ethical tone in their areas of responsibility.
• Part of the manager’s ethical responsibility is to
be realistic in setting performance goals for
others.
Codes of ethics
• Codes of ethics
– Written guidelines that state values and
ethical standards intended to guide the
behaviour of employees.

• Codes of conduct may cover:
– Discrimination
– Forced labour
– Working conditions
– Freedom of association.
Social responsibility
• Organisational stakeholders
– Directly affected by the behaviour of the
organisation and hold a stake in its
performance.
– May include government, competitors,
shareholders, customers, employees, civil
society, suppliers, pressure groups and
regulators.
• Corporate social responsibility
– The obligation of an organisation to act in
ways that serve its own interests and the
interests of its stakeholders.
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Stakeholder issues and practices

• Leadership beliefs that guide socially responsible
practices:
– people do their best in healthy work
environments
– organisations perform best when located in
healthy communities
– organisations gain by treating the natural
environment with respect
– organisations must be managed and led for
long‐term success
– reputation must be protected for support.
Perspectives on social responsibility
• The classical view holds that management’s only
responsibility in running a business is to
maximise profits.
• The socioeconomic view holds that management
of any organisation must be concerned for the
broader social welfare and not just for corporate
profits.
Evaluating social performance
• A social audit is a systematic assessment of an
organisation’s accomplishments in areas of social
responsibility.
• Is the organisation’s:

– economic responsibility met? Is it profitable?
– legal responsibility met? Does it obey the law?
– ethical responsibility met? Is it doing the
‘right’ things?
– discretionary responsibility met? Does it
contribute to the community?
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Social responsibility strategies
How governments influence organisations
• Governments often pass laws and establish
regulating agencies to control and direct the
behaviour of organisations.
• Managers must stay informed about new and
pending laws as well as existing ones.
• Laws and regulations are usually in the form of
minimum standards which must be met in terms
of occupational health and safety (OHS), fair
labour practices, environmental protection and
the like.
How organisations influence governments

• Just as government takes action to influence
organisations, representatives of organisations take
action to influence government.
• Through personal contacts and networks, executives
get to know important people in government. These
contacts can be used for persuasion.
• Lobbying expresses opinions and preferences to
government officials.
• Executives can unfortunately resort to use of bribes
or illegal financial campaign contributions in the
attempt to gain influence over public officials.
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Why managers make the difference
• Trends demand that managerial decisions reflect
ethical as well as high‐performance standards.
• Decisions must always be made and problems
solved with ethical considerations standing side
by side with high‐performance objectives.
• It is the manager whose decisions affect ‘quality‐
of‐life’ outcomes in the critical boundaries
between people and organisations and between
organisations and their environments.

Session 5 – Ethical behaviour and social
responsibility
Summary:
• What is ethical behaviour?
• How do ethical dilemmas complicate the
workplace?
• How can high ethical standards be maintained?
• What is organisational social responsibility?
• How do organisations and government work
together in society?
30/07/2015
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Session 1 – The
contemporary workplace
The contemporary workplace
• What are the challenges in the contemporary workplace?
• What are organisations like in the contemporary

workplace?
• Who are managers and what do they do?
• What is the management process?
• How do you learn the essential managerial skills and
competencies?
Working in today’s economy
• A new workplace.
• Today’s economy is a networked economy.
• The new economy is a global economy. National
economies are becoming increasingly interdependent.
• Organisations are expected to continuously excel on
performance criteria.
• For individuals, there are no guarantees of long‐term
employment.
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Intellectual capital

• Employees represent the firm’s intellectual capital. The
challenge is to combine the talents of many people,
sometimes thousands, to achieve unique and significant
results.
• Intellectual capital
– The collective brain power or shared knowledge of a
workforce.
• Knowledge worker
– Someone whose knowledge is an important asset to
employers.
Globalisation
• Globalisation:
– The worldwide interdependence of:
• resource flows
• product markets
• business competition.
Technology
• Computers allow organisations of all types and sizes,
locally and internationally, to speed transactions and
improve decision‐making.
• In ‘virtual space’ people in remote locations can hold

meetings, access common databases, share
information/files, make plans and solve problems
together, without having to meet face to face.
• Computer literacy must be mastered and continuously
developed as a foundation for career success.
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Diversity
• Workforce diversity
– Differences among workers in gender, race, age, ethnic
culture, able‐bodiedness, religious affiliation and
sexual orientation.
• The legal context of HRM is very strict in prohibiting the
use of demographic characteristics to make decisions
about things like hiring and promotion.
• By valuing diversity, organisations can tap a rich talent
pool and help people work to their full potential.
Diversity
• Diversity bias is still a limiting factor in many work
settings.

• Prejudice
– The display of negative, irrational attitudes towards
members of diverse populations.
• Discrimination
– Occurs when someone is denied a job or a job
assignment for reasons not job‐relevant.
• The glass ceiling effect refers to an invisible barrier
limiting the advancement of women and minority groups.
Ethics
• Ethical and social responsibility issues involve all aspects
of organisations, the behaviour of their members and
their impact on society.
• Expectations now include:
– Sustainable development, environmental protection
– Product safety and fair practices
– Protection of human rights
– In the workplace: equal employment opportunities,
equity of compensation, privacy, job security, health
and safety, and freedom from sexual harassment.
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Careers
• Today’s career implications include:
– Core workers: full‐time, pursuing a traditional career
path
– Contract workers: perform specific tasks as needed
– Casual and part time workers: hired as needed.
• The term free agency is increasingly used to describe
career management – you must be prepared to change
jobs over time, and your skills must be portable and of
current value in the market.
Organisations in today’s workplace
• Organisation
– A collection of people working together with a division
of labour to achieve a common purpose.
– An organisation should return value to society and
satisfy customers’ needs to justify its continued
existence.
• Open systems
– Transform resource inputs from the environment into
product or service outputs.
Organisations as open systems

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Organisational performance
• Value is created when resources are used in the right way,
at the right time, at minimum cost to create high‐quality
goods/services.
• Performance measures include:
– Productivity – the quantity and quality of work
performance, with resource use considered.
– Performance effectiveness – an output measure of
task or goal accomplishment.
– Performance efficiency – a measure of resource cost
associated with goal accomplishment.
Productivity and the dimensions of
organisational performance
Changing nature of organisations
• Important organisational transitions include:
– pre‐eminence of technology
– demise of command and control
– focus on speed

– embrace networking
– belief in empowerment
– emphasis on teamwork
– new workforce expectations
– concern for work‐life balance.
• Total quality management (TQM) is managing with
commitment to continuous improvement, product quality
& customer satisfaction.
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Managers in today’s workplace
• Managers
– The people in organisations who directly support and
help activate the work efforts and performance
accomplishments of others.
• Top managers
– Guide the performance of the organisation as a whole,
or one of its major parts.
– Common job titles include chief executive officer, chief
operating officer, managing director and director.

Levels of managers
• Managers work in different capacities within
organisations.
– Middle managers oversee the work of large
departments or divisions.
– Project managers coordinate complex projects with
task deadlines and people with many areas of
expertise.
– Team leaders or supervisors report to middle
managers and directly supervise non‐managerial
workers.
Types of managers
• Line managers directly contribute to the production of
basic goods or services.
• Staff managers use special technical expertise to advise
and support line workers.
• Functional managers are responsible for one area of
activity such as finance, marketing or sales.
• General managers are responsible for complex
organisational units that include many areas.
• Administrators work in public or not‐for‐profit
organisations.

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Managerial performance
• Accountability
– The requirement to show performance results to a
supervisor.
• Quality of work life (QWL)
– The overall quality of human experiences in the
workplace.
The organisation as an
‘upside‐down pyramid’
The management process
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The management process
• Management: The process of planning, organising,

leading & controlling the use of resources to accomplish
performance goals.
• Planning: The process of setting objectives and
determining how to accomplish them.
• Controlling: The process of measuring performance and
taking action to ensure desired results.
• Organising: The process of assigning tasks, allocating
resources and arranging activities to implement plans.
• Leading: The process of arousing enthusiasm and
directing efforts towards organisational goals.
Mintzberg’s ten managerial roles
Managerial agendas and networks
• Agenda setting
– Action priorities that include goals and plans that span
long and short time frames.
– Good managers implement their agendas by working
with people inside and outside the organisation, which
is made possible by networking.
• Networking
– The process of building and maintaining positive
relationships with people whose help may be needed
to implement work agendas.

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Managerial learning
• Lifelong learning
– Continuous learning from daily experiences and
opportunities.
– Especially in today’s dynamic environment, a
commitment to lifelong learning helps us build skills
that are up‐to‐date and valuable in the market.
• Skill
– The ability to translate knowledge into action that
results in desired performance.
Essential managerial skills
Essential managerial skills
• Technical skill
– The ability to use a special proficiency or expertise in
your work.
• Human skill
– Ability to work well with other people.
• Emotional intelligence

– Ability to manage ourselves and our relationships.
• Conceptual skill
– Ability to think analytically and solve complex
problems.
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Skill and outcome assessment
• Managerial competency
– A skill‐based capability for high performance in a
management job.
• Competencies for managerial success include:
– Communication
– Teamwork
– Self‐management
– Leadership
– Critical thinking
– Professionalism
Session 1 – The contemporary workplace
Summary:
• What are the challenges in the contemporary workplace?

• What are organisations like in the contemporary
workplace?
• Who are managers and what do they do?
• What is the management process?
• How do you learn essential managerial skills and
competencies?
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Session 4 – International
dimensions of management
International dimensions of management
• What are the international management challenges of
globalisation?
• What are the forms and opportunities of international
business?
• What are multinational corporations and what do they
do?
• What is culture and how does it relate to global diversity?
• How do management practices and learning transfer
across cultures?

International management and globalisation
• In the global economy, resources, markets and
competition are worldwide in scope.
• Globalisation
– The worldwide interdependence of resource flows,
product markets and business competition.
• The global economy offers great opportunities for
worldwide sourcing, production and sales capabilities.
• Multinational businesses are increasingly adopting
transnational or ‘global’ identities.
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International management and globalisation
• International management
– Involves managing operations in more than one
country.
• Global managers are culturally aware and well informed
on international affairs.
• Organisations have to ensure that their people are ready,
willing and able to manage in the global environment.
• Having the right people in the right place at the right time

is essential to a company’s successful international
growth.
Asia and the Pacific Rim
• Asia has attained superpower status in the world
economy. China’s economy in particular is closely tied
with the world at large.
• Notwithstanding the global financial crisis (a
consequence of subprime mortgage defaults in the
United States in 2008, culminating in a worldwide
recession), Asian and Pacific Rim economies are soon
expected to be larger than those of the European Union
(EU).
• The Asia‐Pacific Economic Cooperation (APEC) has
become the region’s leading forum.
Asia and the Pacific Rim
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Significance of major APEC nations to
Australia and New Zealands’s trade
Europe

• The European Union (EU)
– A political and economic alliance of European
countries, and an institutional framework for the
construction of a united Europe.
• EU members are linked through favourable trade and
customs laws.
• The euro is the common European currency.
• Despite uncertainties post‐GFC, expected regional
benefits of an expanding EU include higher productivity,
lower inflation and steady growth.
The Americas
• NAFTA is the North American Free Trade Agreement
linking Canada, the United States and Mexico in a regional
economic alliance.
• The United States is among Australia’s and New Zealand’s
largest trading partners and sources of foreign direct
investment.
• In 2005, Australia entered into a bilateral free trade
agreement with the United States, known as the
Australia–United States Free Trade Agreement (AUSFTA).
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Africa
• Foreign businesses is giving increased attention to stable

countries in Africa. The Congo, Nigeria and Angola are
especially rich in natural resources.
• The Southern Africa Development Community (SADC)
links 14 countries of southern Africa in trade and
economic development efforts.
• South Africa is experiencing economic recovery and
attracting outside investors. The country still only ranks as
Australia’s 20th largest trading partner in the world.
International business challenges
• International businesses conduct commercial transactions
across national boundaries. They are the foundations of
world trade.
• The reasons for international business include the search
for:
– profits
– customers
– suppliers
– capital
– labour.
Competitive global business environment
• As economies move to free markets, they face problems in
rising prices, unemployment, competition and privatisation.
• Privatisation
– The selling of state‐owned enterprises into private
ownership.

• In the World Trade Organization (WTO), member nations
agree to negotiate and resolve disputes about tariffs and trade
restrictions.
• Protectionism is a call for tariffs and favourable treatments to
protect domestic firms from foreign competition.
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Forms of international business
Market entry strategies
• In global sourcing, materials or services are purchased
around the world for local use.
• In exporting, local products are sold abroad.
• Importing is the process of acquiring products abroad and
selling them in domestic markets.
• A licensing agreement occurs when a firm pays a fee for
the rights to make or sell another company’s products.
• Franchising provides the complete ‘package’ of support
needed to open a particular business.
Direct investment strategies
• Joint ventures establish operations in a foreign country

through joint ownership with local partners.
– The foreign partner gains new markets and the
assistance of a knowledgeable local partner.
– The local partner gains new technology as well as
opportunities for its employees to learn new skills by
working in joint operations.
• A wholly owned subsidiary is a local operation
completely owned by a foreign firm.
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Multinational corporations
• Multinational corporation (MNC)
– A business with extensive operations in more than one
foreign country. Examples include Microsoft, Rio Tinto
and McDonald’s.
• Transnational corporations
– MNCs that operate worldwide on a borderless basis.
BHP Billiton and PricewaterhouseCoopers are good
examples.
• Virtual borderless companies
– MNCs that make use of the internet to conduct
business worldwide on a borderless basis

Pros and cons of multinational corporations
Multinational corporations
• Multinational corporations may encounter difficulties in
their home country:
– An identity with local and national interests means loss
of local jobs is controversial
– Governments engage in corporate decisions with
regard to the firm’s domestic social responsibilities
– Shifting capital investment abroad is a source of local
complaints.
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Ethical issues for multinational operations
• Ethical issues for multinationals:
– Corruption involves illegal practices to further one’s
business interests.
– Sweatshops employ workers at very low wages, for
long hours, and in poor working conditions.
– Child labour is the full‐time employment of children for
work otherwise done by adults.
• Sustainable development meets the needs of the present
without hurting future generations.

– ISO 14000 offers a set of certification standards for
responsible environmental policies.
Culture and global diversity
• Culture
– The shared set of beliefs, values and patterns of
behaviour common to a group of people.
• Culture shock
– The confusion and discomfort a person experiences
when in an unfamiliar culture.
• Ethnocentrism
– The tendency to consider one’s culture superior to
others.
Culture and global diversity
• Stages in adjusting to a new culture:
– Confusion
– Small victories
– The honeymoon
– Irritation and anger
– Reality.

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Popular dimensions of culture
• Language is a medium of culture, providing the
understanding needed to conduct business and develop
relationships.
• Low‐context cultures emphasise communication via
spoken or written words.
• High‐context cultures rely on non‐verbal and situational
cues as well as spoken or written words in
communication.
• Interpersonal space is one of the important ‘silent
languages’ of culture. Misunderstandings are possible if
one businessperson moves back as another moves
forward, for example.
• Time‐orientation is a ‘silent language’. The way people
approach and deal with time varies widely.
– In monochronic cultures, people tend to do one thing
at a time.
– In polychronic cultures, time is used to accomplish
many different things at once.
• Religion is also important as a cultural variable, with

associated personal and institutional implications.
• Role of agreements. Cultures vary in their use of
contracts and agreements.
– In Australia and New Zealand (low‐context cultures) a
contract is viewed as a final and binding statement of
agreements.
– In other parts of the world with high‐context cultures,
such as China, the written contract may be viewed as
more of a starting point.
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Hofstede’s dimensions of national culture
Understanding cultural diversity
• Trompenaars’ five ways in which people differ culturally:
1. Universalism vs particularism
2. Individualism vs collectivism
3. Neutral vs affective
4. Specific vs diffuse
5. Achievement vs prescription

Management across cultures
• Comparative management studies how management
differs between countries/cultures.
• Organisations with foreign investments must factor risk
into their planning.
– Currency risk: currencies vary over time and not always
easy to predict
– Political risk: Possible loss of investment/control over
foreign asset because of political changes in host
country. Political‐risk analysis forecasts how political
events may affect investments.
• Global success often depends on expatriates, who live
and work in a foreign country.
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Alternative multinational structures for
global operations
Are management theories universal?
• It is argued that management theories should not be
applied universally as many theories are ethnocentric and
fail to take into account cultural differences.

– e.g. A keiretsu is a group of Japanese manufacturers,
suppliers and finance firms with common interests.
• Global organisational learning is a timely and relevant
theme.
Session 4 – International dimensions of
management
Summary:
• What are the international management challenges of
globalisation?
• What are the forms and opportunities of international
business?
• What are multinational corporations and what do they
do?
• What is culture and how does it relate to global diversity?
• How do management practices and learning transfer
across cultures?
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Session3 – Environment
and diversity
Environment and diversity

• What is the external environment of organisations?
• What is the internal environment and organisational
culture?
• What is a customer‐driven organisation?
• What is a quality‐driven organisation?
• How is diversity managed in a multicultural organisation?
Environment and competitive advantage
• Strategic capabilities: Those that are difficult to imitate,
are of value to the customer, and are better than those
possessed by the majority of competitors.
• Dynamic capabilities: Physical (e.g. state‐of‐the‐art
equipment or advantageous location), organisational (e.g.
outstanding sales force) and human (e.g. expertise in a
specialised field).
• A competitive advantage allows an organisation to deal
with market and environmental forces better than its
competitors.
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The general environment
The specific environment
Environmental uncertainty
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Internal environment and organisational
culture
• Organisational culture
– The system of shared beliefs and values that develops
within an organisation and guides the behaviour of its
members.
• The internal culture has the potential to shape attitudes,
reinforce common beliefs, direct behaviour and establish
performance expectations and the motivation to fulfil
them.
Levels of organisational culture
Internal environment and culture

• Observable culture
– The elements of daily organisational life through which
new members learn the organisation’s culture and all
members share and reinforce its special aspects over
time.
• Examples of observable culture include:
– Stories
– Heroes
– Rites and rituals
– Symbols.
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Leadership and organisational culture
• A symbolic leader uses symbols to establish and maintain
a desired organisational culture. They talk the ‘language’
of the organisation, highlight the observable culture, and
tell key stories repeatedly.
• Group culture depends on values that should meet the
following criteria:
– Relevance
– Pervasiveness
– Strength.

Customer‐driven organisations
Customer relationship management
• Customer relationship management (CRM)
– When the business strategically tries to build lasting
relationships with, and add value for, customers.
• Supply chain management
– Involves strategic management of all operations
relating an organisation to the suppliers of its
resources, including purchasing, manufacturing,
transportation and distribution.
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Total quality management
• ISO certification indicates conformance with a rigorous
set of international quality standards.
• Total quality management (TQM) is managing with
commitment to continuous improvement, product quality
and customer satisfaction.
• The ‘four absolutes’ of TQM are:
– Conformance to standards
– Defect prevention
– Defect‐free work
– Quality saves money.

Quality and continuous improvement
• With regard to TQM, continuous improvement involves
always searching for new ways to improve operations
quality and performance.
• The key principles of TQM include:
– Continuous improvement of quality
– Reduced waste
– Less variation and defect prevention
– Supplier partnership
– Team process
– Customer focus.
Quality and continuous improvement
• Quality circle
– A group of employees who periodically meet to discuss
ways of improving work quality.
• Benefits of a quality circle include:
– Achievement of creative potential
– Worker empowerment
– Cost savings from improved quality
– Greater customer satisfaction
– Improved morale and commitment.

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Quality, technology and design
• Lean production uses new technologies to streamline
systems.
• Flexible manufacturing allows processes to be changed
quickly and efficiently.
• Agile manufacturing and mass customisation allow
individualised products to be made quickly and with
production efficiencies.
Diversity and multicultural organisations
• The term diversity describes differences in race, gender,
age, ethnicity, physical ability, culture and sexual
orientation, among other individual differences.
• Inclusivity
– The degree to which the organisation is open to
anyone who can do the job, regardless of their diversity
attributes. The ‘best’ organisational cultures in this
sense are inclusive, because they value the talents,
ideas and creative potential of all members.
Diversity and multicultural organisations
• Multiculturalism: A multicultural organisation is based on
pluralism and operates with respect for diversity.
• Characteristics of a truly multicultural organisation:

– Pluralism: Members of both minority cultures and
majority cultures are influential.
– Structural integration: Minority‐culture members are
well represented at all levels and functions.
– Informal network integration.
– Absence of prejudice and discrimination.
– Minimum intergroup conflict.
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Organisational subcultures
• Subcultures
– Cultures common to groups of people with similar
values and beliefs based on shared work
responsibilities and personal characteristics.
• Subcultures can be:
– Occupational (e.g. lawyers, accountants)
– Functional (e.g. ‘marketing people’, ‘finance people’)
– Ethnic or national
– Generational.

Challenges faced by minority groups
and women
Challenges faced by minority groups
and women
• Minority‐group workers can be the targets of:
– A lack of sensitivity
– Sexual harassment
– Cultural jokes
– Discrimination.
• In Australia, various national and state laws cover equal
employment opportunity and anti‐discrimination in the
workplace.
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Diversity trends
• Diversity trends include the following:
– People from a non‐English‐speaking background are an
increasing percentage of the workforce.
– More women are working.
– People with disabilities are gaining more work.

– Workers are increasingly from non‐traditional families
(e.g. single parents).
– Average age of workers is increasing.
Managing diversity
• Leadership approaches to diversity:
– Affirmative action commits the organisation to hiring
and advancing minority groups and women.
– Valuing diversity commits the organisation to
education and training programs to help people
understand and respect differences.
– Managing diversity is the most comprehensive,
approach, committing the organisation to changing the
culture, in order to build an inclusive work
environment that allows everyone to reach their full
potential.
Multicultural organisations
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Diversity mature?
Questions to ask include:
• Do you accept responsibility for improving your

performance?
• Do you accept responsibility for improving the performance
of your organisation?
• Do you understand important diversity concepts?
• Do you understand that diversity is a complex and
accompanied by tensions?
• Are you able to cope with tensions when dealing with
diversity?
• Are you willing to challenge the way things are?
Session3 – Environment and diversity
Summary:
• What is the external environment of organisations?
• What is the internal environment and organisational
culture?
• What is a customer‐driven organisation?
• What is a quality‐driven organisation?
• How is diversity managed in a multicultural organisation?
Assessment Item 1
Due date: Week 6 –Thursday Midnight

Length: 2000 words
Value: 30 %
Task
Diversity in the workplace is clearly the subject of significant
attention.
Managers and employers are being urged to recognise and value
diversity,
and many are pursuing active programs to improve the
environment for
diversity in the workplace. Yet ‘glass ceilings’ remain obstacles
to career and
personal accomplishment for too many females and other
minority groups.
Why has diversity in the workplace been given so much
attention lately?
What are the workforce diversity challenges and opportunities
confronting
new managers in the 21st century?
Preparation Read the assigned readings for Weeks 1 – 6.
Presentation Assignments are to be typed, with one and a half
line spacing, and be in 12-

point font.
Assessment criteria Presentation:
Neatness, layout, correct spelling and grammar, page
numbering, consistency
of formatting and font size, and readability.
Within +/- 10% of word limit of 2000 words.
Integrated Discussion of Topic
Answer clearly demonstrates a good understanding of the topic
and presents
ideas/views in a balanced manner with a well-integrated and
complex style.
Research and Referencing
The use of at least 6 ‘peer reviewed’ journal articles or
appropriate reference
articles/texts considered of high academic standard.
Correct referencing in-text and in reference list
Penalties Late Submissions
Late assignments will lose 5% of the available marks each day
(or part thereof).

After 10 days, assignments will not be accepted.
Plagiarism
You are to identify the sources of any ideas and words in your
assignment that
are not yours. Unattributed materials will not be included in the
consideration of
your assignment and serious cases will be handled in
accordance with the
Student Plagiarism Management Process.
14 P S Y C H I AT R I C T I M E S
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exception of the latter 2 rates of extreme binge drinking,
these estimates range between 6% and 9% higher in col-
lege students. While in high school, the college-bound
students were less likely to consume alcohol; thus, these
rates indicate a substantial increase in alcohol consump-
tion in the transition between high school and college.
In contrast, the annual prevalence of illicit drug use was
lower among college students compared with their non-
college peers: at 39% and 44%, respectively. In the college
population, the highest annual prevalence was for mari-
juana use (34%), followed by medically unsupervised
amphetamines (10%), medically unsupervised sedatives/
tranquilizers (6.6%), and ecstasy/3,4-methylenedioxy-
methamphetamine (5%). Prescription opioid narcotics,
cocaine, and hallucinogen misuse was slightly under 5%,
while use of inhalants, gamma hydroxybutyrate, ket-
amine, and heroin was much rarer. It is worth noting that,
like alcohol use, past-year amphetamine salts misuse was
higher among college students compared with their non-
college peers. Annual prevalence of marijuana use was
5% greater in college men than in women, and amphet-
amine misuse was 2.5% greater in men.
While these rates may seem trivial, the consequences
are clear. Excessive college drinking has a profound
effect on the individual and the community, with yearly
estimates of 1825 deaths; 599,000 injuries; 696,000 as-
saults; and 97,000 sexual assaults or date rapes.2 More
than 80% of all apprehensions by campus police in-
volve alcohol. And a quarter of students report academ-
ic problems related to alcohol consumption.3 It is abun-

dantly clear that college substance abuse poses a significant
community health risk. Furthermore, the increased risk to the
individual may be long-lasting and have lifelong consequences.
by Derek Blevins, MD and Surbhi Khanna, MBBS
T
he transition from high school to college often
sparks excitement and fear in the new high
school graduate. There are many things to con-
sider as he or she plans for this transition, and
these considerations are influenced by the ex-
periences of parents and older siblings and friends; ad-
vice from teachers and guidance counselors; and—last
but not least—popular media, including movies, televi-
sion, and music.
These sources play a major role in shaping the idea
of what college might be like. Some nights will be spent
in the library writing term papers, while others may be
spent socializing at fraternity parties playing beer pong
and drinking a mysterious “jungle juice.” Along with
the sense of newfound freedom from the “hall pass,”
high school truancy laws, and the umbrella of parental
oversight comes increased access to alcohol, illicit sub-
stances, and pharmaceutical drugs.
As clinicians, we may find it difficult to address this
developmental period. We understand how important it
is for youth to develop an individualized sense of self outside
the
context of previous constraints, but we also want to limit risk to
young persons and to the community, which makes it difficult to
determine when and how to intervene.

Prevalence
Alcohol use among college students far exceeds that of any
other psychoac-
tive substance. The most recent data from the Monitoring the
Future Na-
tional Survey estimate that 63% of college students in 2014
consumed alco-
hol within the past 30 days and 35% had occasions of heavy
drinking (5 or
more drinks in a row) in the past 2 weeks.1 In addition, 43%
reported being
drunk in the past 30 days; 13% reported having 10 or more
drinks in a row
in the past 2 weeks, and 5% reported having 15 or more in a
row. With the
YOUNG ADULT PSYCHIATRY: PART 2
Clinical Implications of Substance
Abuse in Young Adults
18 Transition Issues for Patients With Eating Disorders
Jennifer Derenne, MD
20 Cyberbullying, Who Hurts, and Why
Michelle C. Ramos, PhD and Diana C. Bennett, MS
25 Growing Up With ADHD: Clinical Care Issues
Thomas E. Brown, PhD
Special Report Chairperson Jerald Kay, MD
ALSO IN THIS SPECIAL REPORTSPECIAL
REPORTSPECIAL REPORTSPECIAL REPORTSPECIAL

K
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Neurobiology of substance use and development
At the biological level, various regions of the brain continue to
develop and
mature at different intervals throughout young adulthood. These
active pro-
cesses make the individual more likely to engage in novelty-
seeking behav-
iors while simultaneously making the brain more susceptible to
neurotoxic
processes that can result from substance use. For substance
abusers, increased
neuroplasticity during development comes with a cost.
Imaging studies have confirmed various neural structural and
physiologi-
cal changes associated with adolescent and young adult alcohol
use.4,5 These
changes include reduced hippocampal volumes and accelerated
gray matter
reduction in the frontal and temporal cortices with attenuated
white matter
growth in the corpus callosum and pons. These effects translate
into problems
with executive function, learning and memory, impulse control,
and affective
regulation. In addition, neurobiological changes alter cognition
and increase
the risk of substance use disorders and other neuropsychiatric
processes.

Impact on psychopathology
Drug use among college students puts them at increased risk for
adverse
health, behavioral, and social consequences. Among adults aged
18 or older
with serious mental illness in 2014, the percentage of those who
had past-year
substance use disorder was highest among 18- to 25-year-olds
(35%), fol-
lowed by 26- to 49-year-olds (25%).6 Evidence suggests that
heavy drinking
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PSYCHIATRY: PART 2
during adolescence and young adult-
hood is associated with poor neuro-
cognitive functioning and is particu-
l a r l y a s s o c i a t e d w i t h p o o r
visuospatial skills and attention.7
Students who regularly used mar-
ijuana and those who increased their
use mid-college utilized health care
services more often and had higher
levels of depressive and anxiety-re-
lated symptoms up to 7 years after
college.8 Substance use may also be
an independent risk factor for sui-
cide, and it is important to recognize
this during risk assessments, espe-
cially in adolescents and young
adults. In college students, the co-
occurrence of substance use behav-
iors and mental health problems (eg,
major depression, panic disorder,
generalized anxiety disorder) was as-
sociated with higher odds of ciga-
rette smoking. Among the 67% with
co-occurring frequent binge drinking
and mental health problems, only
38% received mental health services
in the past year.9
The most recent data from the Na-
tional College Health Assessment
survey reported that 35% of under-
graduates felt so depressed it was dif-

ficult to function in the past year,
58% felt overwhelming anxiety, and
a staggering 10% seriously contem-
plated suicide.10 This contrasts with
low reports of college students who
received treatment for depression
(13%), anxiety (15.8%), and sub-
stance abuse (1%). Given the estab-
lished bidirectional relationship be-
t w e e n s u b s t a n c e a bu s e a n d
depression and anxiety, as well as the
clear increased risk of suicide with
substance abuse, this information is
alarming for families, college cam-
puses, and mental health providers
alike.
Among the 20.2 million adults
aged 18 or older in 2014 who had a
past substance use disorder, 2.3 mil-
lion (11.3%) also had a serious mental
illness.6 It is clear that substance abuse
during the early college years is sig-
nificant and that the potential conse-
quences are not only imminent but
may be lasting. However, this also
presents an opportunity to make a
change early because a large number
of youths transitioning to adulthood
on college campuses can be reached
during this vulnerable period.
Primary prevention on
college campuses
Colleges and universities are espe-
cially critical for early intervention,

given that they are the gateway to
adulthood for nearly half of the US
population and that the college years
are the period during which young
adults initiate or increase drug use.1
P S Y C H I AT R I C T I M E S
(Please see Substance Abuse in Young Adults, page 16)
In terms of comorbidities, ap-
proximately 1% of adults in the gen-
eral population met criteria for both
mental illness and substance use dis-
order in the past year.6 Delivering
interventions in settings where stu-
dents who have problems with alco-
hol are most likely to be seen, such as
in health or counseling centers, may
be most effective. Research shows
that several carefully conducted
community initiatives aimed at re-
ducing alcohol problems among
college-age youths have been effec-
tive, leading to reductions in under-
age drinking, alcohol-related as-
saults, emergency department visits,
and alcohol-related crashes.11
One strategy to increase participa-
tion in these interventions is to make
screening routine in university health
centers and to use new technology to
reach a larger percentage of stu-
dents.12 A review of computerized

and web-based brief interventions
for college students suggested that
personalized feedback may be the
key component in this strategy’s suc-
cess, both in motivating students and
in helping them learn the skills they
need to successfully change their
behavior.13
Anonymous mandatory surveys
during new and returning student ori-
entation could dually serve to in-
crease college administrators’
awareness of the prevalence of sub-
stance use and allow the student to
reflect on his or her substance use
patterns. However, using universal
screenings as a means of mandating
treatment referrals may result in un-
der-reporting and thus limit their
utility to both administrators and stu-
dents. New college students, in par-
ticular, are only beginning to appre-
ciate that honest information does
not always result in restriction or
punishment. This allows an opportu-
nity to establish a relationship that is
more likely to result in a partnership
with college administrators and po-
tentially with clinicians in the future.
Another strategy to improve pre-
vention and increase participation of

students is to develop a system of
referral and financial penalties for
students who are disciplined for sub-
stance-related infractions, such as a
mandated intervention at campus
student health. These types of prac-
tices may prevent the escalation of
alcohol or drug use in students who
are just beginning to experiment with
substances.
Screening considerations
The most critical skill for clinicians
is to recognize problem drinking or
substance use behaviors. Keep in
mind that most college students have
only recently been released from pa-
rental oversight; thus, the most effec-
tive approach is likely to be non-con-
frontational and nonjudgmental and
to lack paternalism. The AUDIT (Al-
cohol Use Disorders Identification
Test) is a commonly used 10-item
alcohol screening tool.14 It has been
shown to be effective in the college
population, with a sensitivity of 91%
when compared with a more com-
prehensive diagnostic interview.
Findings indicate that the AUDIT-C,
which consists of the first 3 items
from the AUDIT, is effective at de-
tecting at-risk drinking in the college
population (Figure 1).15
Screening college students for
substance use other than alcohol

may be more complicated for a
number of reasons. Simply asking
about drug use may result in a nega-
tive screening because the college
student may consider only sub-
stances such as cocaine, heroin, or
methamphetamine in this category
(the prevalence of abuse of these
substances in the college population
is low). Asking specifically about
marijuana use and the use of their
friends’ prescription medications,
especially stimulants, is likely to re-
sult in more clinically useful infor-
mation. The Drug Abuse Screening
Test (DAST) is a 28-item instru-
ment that has been validated as a
clinical screening tool for past-year
substance use.16 The brief 10-item
version, DAST-10, has been shown
to be effective in college-age stu-
dents (Figure 2).17
An additional complication of
substance use screening is the ever-
growing list of new illicit drugs and
AUDIT-C Questionnaire
1. How often do you have a drink containing alcohol?
0 = Never
1 = Monthly or less often

2 = 2 to 4 times monthly
3 = 2 to 3 times weekly
4 = ≥ 4 times weekly
2. How many standard drinks containing alcohol do you have
on a typical day?
0 = 1 or 2
1 = 3 or 4
2 = 5 or 6
3 = 7 to 9
4 = ≥ 10
3. How often do you have 6 or more drinks on one occasion?
0 = Never
1 = Less than monthly
2 = Monthly
3 = Weekly
4 = Daily or almost daily
AUDIT, Alcohol Use Disorders Identification Test.
Copyright © 1990 World Health Organization.
Figure 1. AUDIT-C is a 3-item screening test that can be used

in college students
using a cut-off score of 7 in men and 5 in women; in the general
population, scores
of 4 or more in men and 3 or more in women are considered
positive.14
It is clear that substance abuse during the early college
years is significant and that the potential consequences
are not only imminent but may be lasting.
16 J A N UA RY 2 0 1 6P S Y C H I AT R I C T I M E S
w w w. p s y c h i a t r i c t i m e s . c o m
S
P
E
C
IA
LR
E
P
O
R
T
cally showing a reduction in early-

onset (before age 25) alcoholism.18
Agonist therapies, including
methadone and buprenorphine, re-
main the mainstay of opioid depen-
dence treatment. In the college stu-
dent population, treatment with
buprenorphine is likely a more ac-
ceptable alternative to methadone
maintenance, which requires daily
visits to a methadone clinic. Anoth-
er option for opioid dependence is
antagonist therapy with oral or
monthly injections of naltrexone.
Unfortunately, current evidence
for cannabis dependence, the most
widely abused substance in this
population, is limited to a handful of
open-label studies; more research
on pharmacotherapy is needed.
Nonpharmacological interven-
tions. A study involving students
mandated to substance abuse treat-
ment showed a reduction in high-
risk drinking with either a brief mo-
tivational intervention (MI) or an
alcohol education session, but stu-
YOUNG ADULT PSYCHIATRY: PART 2
dents who received a brief MI re-
ported fewer alcohol-related prob-
lems. 19 A follow-up study of
high-risk college students who re-
ceived a single brief MI continued

to show a significant reduction in
negative alcohol-related conse-
quences at 4 years.20 These positive
results for a brief MI have also been
shown to generalize to drug use in a
college student health clinic.21
No published study has exam-
ined the utility of pharmacotherapy
with a brief intervention for alcohol
dependence specifically in youth
transitioning to adulthood. A brief
MI, such as the BASICS (Brief Al-
cohol Screening and Intervention
for College Students) program, con-
tinues to be the most validated ther-
apeutic option in this population. A
recent review focused on different
modalities for adolescent substance
use, including 12-step–based thera-
py, cognitive behavioral therapy
(CBT), motivation-based therapy,
family-based intervention, and
mixed or other approaches.22 A con-
sistent pattern emerged that showed
overall positive effects for all treat-
ment modalities; however, family-
based intervention, CBT, and moti-
vational enhancement therapy had
the best outcomes.
Although pharmacotherapy may
play some role for college students
with substance abuse problems, ef-
fective psychotherapies remain the
mainstay of treatment. Furthermore,

as is true for all age groups, the im-
portance of treating comorbid mood
and anxiety disorders cannot be
overemphasized.
Conclusion
College substance use is clearly a
prevalent and controversial issue.
Many who engage in binge drinking,
experiment with illicit drugs, and/or
misuse pharmaceuticals will go
through this rite of passage relative-
ly unscathed. However, others will
not. Identifying and treating prob-
lematic substance use behaviors in
college students may prevent injury,
sexual assault, academic difficulties,
and legal complications during col-
lege, and may reduce the risk of fu-
ture substance dependency or men-
tal health complications.
Dr Blevins and Dr Khanna are third-year
psychiatry residents in the department of
psychiatry and neurobehavioral sciences at
the University of Virginia Medical School in
Charlottesville, VA. The authors report no
conflicts of interest concerning the subject
matter of this article.
References
1. Johnston LD, O’Malley PM, Bachman JG, et al.
Substance Abuse in
Young Adults

Continued from page 15
DAST-10 No Yes
1. Have you used drugs other than those
required for medical reasons?
0 1
2. Do you abuse more than one drug at a
time?
0 1
3. Are you always able to stop using drugs
when you want to? (If never used drugs,
answer Yes)
0 1
4. Have you had blackouts or flashbacks as a
result of drug use?
0 1
5. Do you ever feel bad or guilty about your
drug use? (If never used drugs, answer No)
0 1
6. Does your spouse (or parents) ever complain
about your involvement with drugs?
0 1
7. Have you neglected your family because of

your use of drugs?
0 1
8. Have you engaged in illegal activities in
order to obtain drugs?
0 1
9. Have you ever experienced withdrawal
symptoms (felt sick) when you stopped taking
drugs?
0 1
10. Have you had medical problems as a result
of your drug use (eg, memory loss, hepatitis,
convulsions, bleeding)?
0 1
DAST, Drug Abuse Screening Test.
Copyright © 1982 Addiction Research Foundation.
Figure 2. DAST-10 is a modified version of the DAST
developed by Harvey A. Skinner:
scores of 0 (no problems reported) suggest no action; 1-2 (low
level problems) sug-
gest monitoring and reassessment; 3-5 (moderate level
problems) suggest further
investigation; and 6-8 (substantial level problems) or 9-10
(severe level problems)
suggest intensive assessment.17
variations of old ones, which limits

the use of a list of commonly abused
drugs with yes or no checkboxes. Re-
gardless of the tool that is used,
maintaining a nonjudgmental stance,
asking the right questions, and re-
minding college students that their
parents and college deans cannot ac-
cess their medical records are likely
to result in a more clinically mean-
ingful substance use history.
Treatment options
Pharmacotherapy. There have been
no FDA approvals for medications
for alcohol dependence in over 10
years, which leaves disulfiram, nal-
trexone, and acamprosate as the
only FDA-approved options. Other
medications including gabapentin,
topiramate, and ondansetron have
been shown to improve drinking
outcomes, with the latter specifi-
Monitoring the Future National Survey Results on
Drug Use, 1975-2014: Volume II, College Students
and Adults Ages 19-55. Ann Arbor, MI: Institute for
Social Research, The University of Michigan; 2015.
2. Hingson RW, Wenxing Z, Weitzman ER. Magnitude
of alcohol-related mortality and morbidity among
U.S. college students ages 18-24, 1998-2005. J
Stud Alcohol Drugs. 2009;16:12-20.
3. Presley CA, Meilman PW, Lyerla R, Cashin JR.
Alcohol and Drugs on American College Campuses.
Use, Consequences, and Perceptions of the Cam-
pus Environment. Volume I: 1989-1991; 1996.
http://eric.ed.gov/?id=ED358766. Accessed De-

cember 1, 2015.
4. De Bellis MD, Clark DB, Beers SR, et al. Hippo-
campal volume in adolescent-onset alcohol use
disorders. Am J Psychiatry. 2000;157:737-744.
5. Squeglia LM, Tapert SF, Sullivan EV, et al. Brain
development in heavy-drinking adolescents. Am J
Psychiatry. 2015;172:531-542.
6. Center for Behavioral Health Statistics and Qual-
ity. Behavioral health trends in the United States:
results from the 2014 National Health Survey on
Drug Use and Health; 2015. http://www.samhsa.
gov/data/sites/default/files/NSDUH-FRR1-2014/
NSDUH-FRR1-2014.pdf. Accessed December 1,
2015.
7. Tapert SF, Caldwell L, Burke C. Alcohol and the
adolescent brain: human studies. Alcohol Res
Health. 2004;28:205-212.
8. Caldeira KM, O’Grady KE, Vincent KB, et al. Mari-
juana use trajectories during the post-college tran-
sition: health outcomes in young adulthood. Drug
Alcohol Depend. 2012;125:267-275.
9. Cranford JA, Eisenberg D, Serras AM. Substance
use behaviors, mental health problems, and use of
mental health services in a probability sample of
college students. Addict Behav. 2009;34:134-145.
10. American College Health Association. ACHA—
National Health Assessment II: Undergraduate Stu-
dents Reference Group Data Report, Spring 2015.
Hanover, MD: American College Health Association;
2015.
11. Hingson R, Heeren T, Winter M, Wechsler H.
Magnitude of alcohol-related mortality and morbid-
ity among US college students ages 18-24: chang-
es from 1998 to 2001. Annu Rev Public Health.
2005;26:259-279.
12. National Institute on Alcohol Abuse and Alcohol-

ism. What colleges need to know now: an update on
college drinking research; 2007. http://www.col-
legedrinkingprevention.gov/1college_bulletin-
508_361C4E.pdf. Accessed December 1, 2015.
13. Walters ST, Neighbors C. Feedback interven-
tions for college alcohol misuse: what, why and for
whom? Addict Behav. 2005;30:1168-1182.
14. Kokotailo PK, Gangnon R, Brown D, et al. Valid-
ity of the alcohol use disorders identification test in
college students. Alcohol Clin Exp Res. 2004;28:
914-920.
15. DeMartini KS, Carey KB. Optimizing the use of
the AUDIT for alcohol screening in college students.
Psychol Assess. 2012;24:954-963.
16. Skinner HA. The Drug Abuse Screening Test. Ad-
dict Behav. 1982;7:363-371.
17. McCabe SE, Boyd CJ, Cranford JA, et al. A mod-
ified version of the Drug Abuse Screening Test
among undergraduate students. J Subst Abuse
Treat. 2006;31:297-303.
18. Johnson BA. Medication treatment of different
types of alcoholism. Am J Psychiatry. 2010;167:
630-639.
19. Borsari B, Carey KB. Descriptive and injunctive
norms in college drinking: a meta-analytic integra-
tion. J Stud Alcohol. 2003;64:331-341.
20. Baer JS, Kivlahan DR, Blume AW, et al. Brief
intervention for heavy-drinking college students:
4-year follow-up and natural history. Am J Public
Health. 2001;91:1310-1316.
21. Amaro HA, Reed E, Rowe E, et al. Brief screen-
ing and intervention for alcohol and drug use in a
college student health clinic: feasibility, implemen-
tation, and outcomes. J Am Coll Health. 2010;58:
357-364.
22. Tanner-Smith EE, Wilson SJ, Lipsey MW. A com-

parative effectiveness of outpatient treatment for
adolescent substance abuse: a meta-analysis.
J Subst Abuse Treat. 2013;44:145-158. ❒
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Online Journal of Rural Nursing and Health Care, 12(2) 41
Rural Adolescent Substance Abuse: Prevention Implications
from the Evidence
Jason Allen Gregg, APRN, FNP-C, DNP1
1Assistant Professor of Clinical, FNP Program Coordinator,
College of Nursing, University of
Cincinnati, [email protected]
Abstract
Purpose: To identify appropriate adolescent substance abuse

prevention programming for rural
populations through the application of three concepts:
effectiveness (best clinical evidence),
efficiency (benefit to rural populations), and equality (access).
Methods: A review of the literature guided by these concepts
was conducted to identify criteria
essential to the tailored development of rural adolescent
substance abuse prevention
programming. An advanced search of the Substance Abuse and
Mental Health Services
Administration’s (SAMHSA) National Registry of Evidence-
based Programs and Practices
(NREPP) was then conducted using criteria tailored to rural
populations.
Findings: Results from the literature search support the
inclusion of two components directed at
improving quality of outcomes through a customized approach
to rural adolescent substance
abuse prevention programming: inclusion of parents in
prevention education efforts and use of
the Internet as an appropriate method of program delivery.
These components were satisfied by
one program listed on SAMHSA’s NREPP: Parenting Wisely.
Conclusions: While Parenting Wisely is an ideal program for
rural adolescent substance abuse
prevention strategy, it may not be suitable for all communities.
Parallel to recommendations
from the SAMHSA and Institute of Medicine, other evidence-
based prevention programs need to
be expanded to include a web-based delivery option. Strategies
for moving forward would
include the use of advanced-practice nurses at the forefront of
discussion for rural professionals,
researchers, educators, and policymakers.
Keywords: Access to care, Technology, Substance abuse

prevention, Rural
Rural Adolescent Substance Abuse: Prevention Implications
from the Evidence
Adolescent substance abuse is a considerable problem in the
United States. Although
alcohol can best be described as an older problem with
increasing incidence, illegal drug usage is
a fairly new phenomenon in rural America (Schoeneberger,
Leukefeld, Hiller, & Godlaski,
2006). With increased access to cell phones, Internet usage and
migration of peoples to rural
areas, what was formerly considered an urban issue is becoming
an increasingly apparent
problem in rural America (Dew, Elifson, & Dozier, 2007).
Lambert, Gale, and Hartley (2008)
note rural youth have a greater incidence of alcohol and
methamphetamine usage when
compared to urban youth. The authors also demonstrated a
negative correlation between
population and use of these substances in that alcohol and
methamphetamine usage increases as
population decreases.
The Substance Abuse and Mental Health Services
Administration (SAMHSA)
demonstrated these rural trends with its 2008 national survey
results on drug use (SAMHSA,
2009). In 2008, alcohol binge drinking rate for young persons

ages twelve to seventeen was
greatest in nonmetropolitan areas at 9.8%. Small metropolitan
areas had a rate of 9.0%, while
large metropolitan areas had a rate of 8.4%. Illicit drug use in
completely rural counties rose
from 4.1% in 2007 to 6.1% in 2008. While it seems rural youth
substance abuse rates now
parallel their metropolitan counterparts, there still remains a
disparity in resources available to
combat the problem (Rural Assistance Center, 2010).
Regardless of geographical context, youth substance abuse
results in the following
problems: disrupted peer and family relationships (Collins,
Johnson, & Becker, 2007), school
problems such as misbehavior and academic failure (Henry,
Smith, & Caldwell, 2006), and
higher risk behavior (Lambert et al., 2008). Spending on
substance abuse treatment is projected
to increase to thirty-five billion dollars by 2014 (Levit, Kassed,
Coffey, Mark, McKusick, King,
Vandivort, Buck, Ryan, & Stranges, 2008). This spending
increase coupled with the added social
costs of overextended law enforcement, educational, and
counseling-related services can deplete
the already limited resources of a rural community. Therefore, it
is imperative to identify
effective strategies for youth substance abuse prevention and
that those strategies be tailored
specifically to the needs and abilities of rural communities. In
order to reduce resource strains
while maximizing the quality of outcomes, strategy
development for the rural community can be
guided by the vision of a pioneer in healthcare quality,
Archibald “Archie” Cochrane.

Methods
A review of the literature guided by the concepts of
effectiveness (best clinical evidence),
efficiency (population benefit), and equality (access) as defined
by Archie Cochrane (1972) was
carried out in order to identify criteria essential to the
development of rural adolescent substance
abuse prevention programming. Methodology which
incorporates the processes of a systematic
review and meta-analysis affords clinicians the ability to
summarize information from research
literature in order to apply best evidence-based strategies to
clinical practice (Haase, 2011). This
review process incorporated a three-tiered approach. First, the
CINAHL, Medline, PubMed, and
Cochrane Library databases were utilized to conduct a text
search of the research literature using
several keywords: rural, adolescent, substance abuse, and
prevention. Subsequently, search
results were analyzed through the application of an A to D letter
grade scale (Titler, 2002). Grade
criteria are as follows: Grade A (evidence from well-designed
meta-analysis or other systematic
reviews); Grade B (evidence from well-designed controlled
trials, both randomized and
nonrandomized, with results that consistently support a specific
action, intervention, or
treatment); Grade C (evidence from observational studies or
controlled trials with inconsistent
results); and Grade D (evidence from expert opinion or multiple
case reports). Based on the
concepts of effectiveness and efficiency (Cochrane, 1972),
articles were reduced to those graded
as either A or B.

According to Cochrane (1972), equality can only be met by
satisfying the concepts of
effectiveness and efficiency. As a result of this preliminary
literature search, a secondary
examination of the literature was conducted via methods similar
to the initial search but using the
following keywords: parents, prevention, and technology. Based
on the concept of equality
(Cochrane, 1972), results were reduced to information relevant
to the prevention of mental health
issues including parenting skills education utilizing methods
designed to increase access with
hard to engage groups such as those in rural populations.
In the third tier of this review process, an advanced search of
the SAMHSA National
Registry of Evidence-based Programs and Practices (NREPP)
was conducted (SAMHSA, 2010)
using the following search criteria: areas of interest (substance
abuse prevention); geographical
location (rural and/or frontier); ages (6-12 [childhood], 13-17
[adolescent]); and setting (home,
workplace, other community settings). This search method was
designed to identify substance
abuse prevention programs which would satisfy the concepts of
effectiveness and efficiency
(Cochrane, 1972). Program results were then tailored to rural
populations by narrowing
interventions to those that included delivery methods suggested
by the secondary literature
review which would satisfy the concept equality (Cochrane,

1972) by increasing access.
Results
In the first tier of the literature review process, search terms
yielded over two hundred
articles. Through application of Titler’s (2002) letter grade
criteria, search results were reduced
to less than a dozen research articles. None of these A or B
Grade articles addressed the use of
technology-based methods for substance abuse prevention
program delivery. However, the
secondary literature review did produce some evidence through
data supporting use of the
Internet as a delivery method for prevention programming in
mental health including education
designed to improve parenting skills. In a Grade B randomized
study, Calam, Sanders, Miller,
Sadhnani, and Carmont (2008) demonstrated improvement in
parenting skills and child behavior.
In addition, Internet-based training methods demonstrated
principles inherent to the concept of
equality (Cochrane, 1972): provide mental health services
access to families who might not
otherwise receive them (Feil, Baggett, Davis, Sheeber, Landry,
Carta, & Buzhardt, 2008), meet
cultural demands today for Internet-based delivery methods
(Feil et al., 2008), and improve cost-
effectiveness by permitting parents access convenience of
services whenever needed (Calam et
al., 2008). An advanced search of the SAMHSA NREPP
(SAMHSA, 2010) yielded one program
that encompassed the concepts of effectiveness, efficiency, and
equality resulting in a prevention
approach tailored to the needs of a rural community. In order to
put the results into full

perspective, it is important to address specific findings
individually through each of the three
concepts and tailored approach results.
Effectiveness
Cochrane describes effectiveness as the best clinical evidence
(Cochrane, 1972). In other
words, clinical applications of evidence should be derived from
high quality research designs
such as randomized controlled trials, systematic reviews, and/or
meta-analyses. Most of the
substance abuse prevention programming interventions in the
research literature for both rural
and urban populations are targeted towards one of three key
aspects: parenting skills, peer
socialization skills, or school-based interventions. A systematic
review demonstrated significant
findings for these same populations: positive outcomes were
most evident in the areas of
parenting skills and peer socialization skills; programs directed
at parenting skills and improving
family processes demonstrated great success in substance abuse
reduction outcomes; and the
most beneficial approaches were those that focused on parental
involvement (Petrie, Bunn, &
Byrne, 2007).
The Cochrane Library, named after Archie Cochrane (Cochrane,
1972), currently has two
systematic reviews in its database of Cochrane Reviews
demonstrating similar results with
parental findings. The first systematic review examined school-
based programming focused on
illicit drug use prevention in both rural and urban settings
(Faggiano, Vigna-Taglianti, Versino,

Zambon, Borraccino, & Lemma, 2005). Findings indicated
social skills programs were most
popular and effective in reducing substance use. The second
systematic review examined non
school-based programs designed to prevent drug use in young
people (Gates, McCambridge,
Smith, & Foxcraft, 2006). This review examined the prevention
programming types of
motivational interviewing or brief intervention, education or
skills training, family interventions,
and multi-component community interventions. Findings were
mostly inconclusive due to lack
of homogeneity in research designs, but the authors did
conclude there was enough evidence to
suggest that family-based interventions including contact with
parents to be beneficial in
preventing substance use.
The aforementioned research findings supporting benefit with
parental inclusion in
prevention efforts parallel adolescent reports in SAMHSA’s
2008 National Survey on Drug Use
and Health (SAMHSA, 2009). A majority of adolescents ages
twelve to seventeen reported a
belief that their parents would strongly disapprove of substance
usage: 90.8% in regard to
marijuana or hashish; 89.7% in regard to alcohol usage; and
92.4% in regard to cigarette usage.
Adolescents who believed their parents would strongly
disapprove of substance usage were less
likely to use substances than those who sensed a lesser degree

of parental disapproval
(SAMHSA, 2009). Research has demonstrated that changing
parental opinions is necessary in
altering adolescent beliefs (Abbey, Pilgrim, Hendrickson, &
Buresh, 2000). Adolescents view
parents as believable in terms of drug knowledge, and substance
abuse prevalence decreases as
perceived family penalties for such usage increases (Kelly,
Comello, & Hunn, 2002).
Survey results also demonstrated level of parental involvement
including support,
oversight, and control of adolescent activities affected
substance usage. Use of substances
including illicit drugs, alcohol, and cigarettes was less for
adolescents ages 12-17 who reported
regular parental monitoring of behaviors than those whose
behaviors were rarely monitored by
parents (SAMHSA, 2009). As depicted in Table 1, substance
usage rates for adolescents whose
parents seldom or never monitored behaviors were
approximately twice that of adolescents
whose parents were always or sometimes involved (SAMHSA,
2009).
Table 1
Efficiency
Cochrane describes efficiency as involving benefit to a
predefined population (Cochrane,
1972). In other words, interventions found to be effective
through research should provide a
benefit to the community. Substance abuse prevention
programming that includes parental

involvement has demonstrated benefits other than just youth
substance abuse prevention. A
systematic review found such interventions improved both
parenting skills and family processes
resulting in greater family cohesiveness and less family fighting
(Petrie et al., 2007). Other
benefits include saved dollars from reduced usage of resources
provided by both society and the
government (SAMHSA, 2007).
An example of a family-based program demonstrating an
increase in cost benefit is the
Strengthening Families Program. This prevention program for
parents and youth ages ten to
fourteen cost $851 per child participant to implement but
yielded an estimated $9656 social cost
benefit (Aos, Lieg, Mayfield, Miller, & Pennucci, 2004). While
this program demonstrated a
benefit greater than eleven times the investment, not all
programs provide similar results;
however, even the smallest measure of mental and behavior
problem prevention will result in
significant cost-benefit and savings for rural communities
(SAMHSA, 2007). A key to
improving rural community benefit is by focusing on equality,
specifically access to the
prevention intervention.
Equality
According to Cochrane, equality can be met by satisfying the
preliminary steps of

effectiveness and efficiency. He hoped this third concept would
provide a humanitarian bridge in
the gap of care between the rich and poor (Cochrane, 1989). In
order to bridge this gap, access to
substance abuse efforts need to be increased in rural
populations. Failure to provide access to
evidence-based substance abuse prevention programming in
rural populations will result in
continued financial strains with agencies at the local, state, and
national levels (SAMHSA,
2007).
Geographical disparities often provide an obstacle to substance
abuse prevention efforts
with rural populations. In comparison to their metropolitan
counterparts, rural areas typically
lack assets needed to implement evidence-based substance
abuse prevention programming:
adequate funding, trained professionals to implement the
programs, sufficient infrastructure, and
appropriate facilities for instruction provision. In addition,
population numbers in rural areas are
less and more widely dispersed in comparison to their urban
counterparts. These disparities often
reduce cost effectiveness due to lessened access (SAMHSA,
2007). As a result, the uniqueness
of rural populations facilitates the need for tailored
implementation strategies designed to
increase access.
Basic principles to increasing family involvement are dependent
upon making programs
more accessible and acceptable (SAMHSA, 2007). Program
effectiveness and population
acceptance can be increased when programs are tailored to

cultural and community norms of
rural populations. Program tailoring would include strategies
designed to integrate the
intervention into the normal daily schedule of participants,
utilizing community assets, and
adaptation to financial limitations (SAMHSA, 2007). In order to
successfully tailor substance
abuse prevention efforts in rural communities, one solution
method for program implementation
would be a nontraditional, web-based programming approach.
Interestingly, the same technology that has increased rural
access to substances of abuse
can be used to target parents with prevention efforts. The
significant increases in Internet usage
and demand has led to alternative delivery method
considerations for mental health services
(Calam et al., 2008). Parallel with traditional direct-contact
approaches, nontraditional web-
based prevention methods have demonstrated ability to improve
both child behavior and
parenting skills (Feil et al., 2008). In addition, these web-based
programs also have the ability to
increase cost-effectiveness by allowing parents access to needed
services at the time and location
most convenient to them (Feil et al., 2008).
According to the United States Department of Agriculture
(USDA) Economic Research
Service (2009), current estimates describe the rate of Internet
use for individuals in rural areas to
be 71%. In 2007, 63.3% of rural residents accessed the Internet
at home or elsewhere, whereas
51.9% maintained home Internet service. Broadband, considered
the gold standard in Internet
connection and speed, has seen rapid growth in rural areas since

300 British Journal of School NursingJulyAugust2015Vo.docx

300 British Journal of School NursingJulyAugust2015Vo.docx

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300 British Journal of School NursingJulyAugust2015Vo.docx