This document provides an overview of adolescent substance abuse, including epidemiology, etiology, neurobiology, assessment, diagnosis, and treatment. Some key points: - Substance abuse is common among adolescents, with 11.4% meeting criteria for a substance use disorder. Marijuana is the most commonly used illicit drug. - Risk factors for adolescent substance abuse include genetics, prenatal substance exposure, childhood abuse/neglect, parenting influences, deviant peer groups, and externalizing disorders. - Adolescents are vulnerable to substance abuse due to an imbalance between developing cognitive control systems and mature reward systems in the brain. Substance use can negatively impact brain development. - Assessment of adolescent substance

1. SPEAKER: AMIT CHOUGULE

2. OVERVIEW
1. Background and implications for studying adolescent and children substance
abuse
2. Epidemiology of substance abuse in children and adolescents
3. Etiology
4. Neurobiology of Adolescent Substance Use and Addictive Behaviors
5. Assessment of Adolescent Substance Use and Problems
6. Diagnosis and Clinical Features
7. Differential Diagnosis and Comorbidity
8. Treatment of adolescent substance abuse
9. Prevention strategies of adolescent substance abuse

3. SUBSTANCE ABUSE
 A maladaptive pattern of substance use leading to clinically significant
impairment or distress
 Manifested by one or more of the following, occurring within a 12-month
period:
1. Recurrent substance use resulting in a failure to fulfill major role
obligations at work, school, or home
2. Recurrent substance use in situations in which it is physically hazardous
3. Recurrent substance-related legal problems
4. Continued substance use despite persistent or recurrent social or
interpersonal problems

4. BACKGROUND AND IMPLICATIONS
 Adolescent and children substance abuse can bring immediate and late
onset devastating consequences
 The acute effects of intoxication can be devastating:
1. Alcohol-related motor vehicle accidents remain leading causes of
mortality among youth
2. Sharing needles, I.V drug use lead to transmission of blood borne
viruses
3. High risk behaviour like sexual risk taking, sexual victimization and
unintentional injury is high

5.  Age of initiation into substance abuse is progressively falling
 Early initiation of alcohol and drug use is associated with
1. Poor prognosis
2. Life long pattern of irresponsible behaviour
 Family and the community have to bear the social costs like:
1. Increased morbidity and mortality
2. Increased criminality
3. Decreased productivity and absenteeism

6.  Physical adverse effects of substance abuse are:
 Rare in children and adolescents
 Develop only after chronic use over several decades
 Understanding of substance abuse problems during adolescence is critical
to study any approach aimed at lessening these physical adverse effects
 Adolescent substance use has been relatively neglected in clinical
practice and in research studies practice
(Abrantes, Strong, Ramsey et al., 2005)
 The societal costs of this neglect of adolescent substance use are high

7. EPIDEMIOLOGY
1. Lifetime prevalence of Substance use disorders in children and
adolescents is 11.4%
2. More than half of adolescents report alcohol use
3. One fourth report exposure to illicit drugs
4. Prevalence rates of alcohol and drug dependence (1.3% and 1.8%
respectively) are one-fourth the magnitude of abuse (5.2% and 7.1%,
respectively)
[Results from the National Comorbidity Survey Replication- Adolescent Supplement (NCS-A)]

8. The most important ongoing descriptive study of drug use in youth is the
Monitoring the Future (MTF) survey
1. Sponsored by National institute drug abuse (NIDA) since 1975
2. Provides information on annual trends in adolescent substance use
3. Anonymous paper and pencil questionnaire is used
4. Nationally representative cross-sectional school-based samples of 8th,
10th and 12th graders is studied
(Johnston et al. 2011)

9.  The most recent MTF study was conducted in 2010
 Key findings of MTF study include:
1. Increase in the overall rate of illicit drug use for all grades
2. Older students in the study showed increase in the use of marijuana
and alcohol
3. 19.6% of students have tried an illicit drug by eighth grade
4. 34.1% by 10th grade
5. 47.4% by 12th grade
6. Marijuana remains by far the most commonly used illicit drug

10. 7. Number of individuals who report misuse of prescription drugs has
been increasing in recent years
8. Marked increase in the misuse of prescription opioid medications, such
as oxycodone and hydrocodone
9. Overall illicit drug use:
 Reached a peak in the late 1970s
 Declined during the 1980s
 Rose again in the 1990s
 Has remained relatively stable during the past several years
10. Illicit drug use remains very common and typically begins during
adolescence

11. EPIDEMIOLOGY IN INDIAN CONTEXT
 Extent and pattern of substance abuse among children and adolescent
in India is different from the West
 Substance abuse among girls is uncommon
 Common drugs abused in Indian adolescents are:
1. Alcohol
2. Tobacco
3. Minor tranquillizer
4. Analgesics
5. Cannabis

12.  A general population survey reported substance use in 0.2-0.3% of children
less than 15 years of age
 Only a few cases of opioid dependence were reported
 A higher prevalence of substance abuse was reported among school
students:
1. Alcohol (4-13%) most common
2. Tobacco (3-6%)
3. Minor tranquillizers (1-4%)

13. HEROIN USE IN INDIA
 Initiation to heroin use was before the age of 16 years in 8% of heroin
abusers in the north-eastern part of the country
 A similar age of initiation of heroin abuse has been reported from other
parts of India as well
 A country profile documented by the Ministry of Welfare, Government of
India reported mean age of initiation to heroin as 14 years

14. SUBSTANCE USE AMONGST CHILDREN IN INDIA
 A high prevalence of tobacco, alcohol and opioid use has been
reported amongst street children
 Inhalants, sedatives, cough syrups and smokeless tobacco is also
common
 Most street children are multiple drug users
 Alcohol use (75%) is most common followed by charas (50%) and
heroin (5-10%)
 Drug use in 91% of street children was reported from Madurai

15.  The Global Youth Tobacco Survey in 2006 showed that in India
1. 3.8% of students smoke
2. 11.9% used smokeless tobacco
 A study of 300 street child laborers in slums of Surat in 1993 showed that
135 (45%) used substances

16. ETIOLOGY
 The etiology of adolescent substance abuse lies in factors that predispose
an individual to:
 Experiment with substances
 Progress to regular use
 Develop abuse or dependence
 A range of risk factors are associated with the development of adolescent
Substance abuse

17. FOUR DIMENSIONS OF RISK FACTORS
Predictors of
early onset
Predictors of
heaviness of
use
Predictors of
dependence
vulnerability
Predictors of
desistance i.e.,
Protective
factors

18. GENETIC AND ENVIRONMENTAL INFLUENCES
 Adoption study literature shows that substance dependence in adoptees
is:
1. Significantly correlated with alcoholism in biological fathers
2. Uncorrelated or only weakly correlated with alcoholism in adoptive
parents
3. A positive family history of substance use disorder is a strong predictor
for substance use and dependence

19.  Genetic influences on the development of adolescent substance abuse
may act through:
1. A direct effect on psychophysiological reactions to substances or their
metabolism
2. Indirectly through genetic effects on personality traits such as behavioral
disinhibition which leads to substance experimentation

20. PRENATAL SUBSTANCE EXPOSURE
 Prenatal exposure to alcohol, cannabis, cocaine is associated with:
 Cognitive and behavioral self-regulation difficulties in children
(Knopik, Sparrow, Madden et al., 2005)
 Increased risk of adolescent substance use and abuse
(Biederman, Monuteaux, Mick et al., 2006)

21. CHILD MALTREATMENT AND ABUSE
 Childhood neglect, physical abuse (PA), sexual abuse (CSA) are predictive
of:
1. Early onset tobacco, alcohol, marijuana and other illicit drug use
2. Alcohol or other drug problems during adolescence
3. Women are more susceptible
(Widom, Ireland, & Glynn, 1995)

22. Marital Conflict, Parental Divorce and Repartnering
 Parental divorce, subsequent repartnering and marital conflicts are
associated with increased rates of :
1. Initiation of offspring alcohol, tobacco, marijuana and other illicit drug
use
2. Heavier use of these substances
3. Greater risk of problem use
(Fergusson, Horwood, & Lynskey, 1994; Hoffman & Johnson, 1998)

23. PARENTING INFLUENCES
Parenting behaviors predictive of early initiation and substance abuse
during adolescence :
 Inconsistent, ineffective discipline, poor supervision and monitoring
 Parent –child conflict
 Low levels of parent support and parent– child attachment
 Permissive or tolerant attitudes about substance use
(Ary, Tildesley, Hops et al., 1993; Brook, Whiteman, Gordon et al.)

24. PEER INFLUENCES
 Deviant peer affiliation is one of the best predictors of early onset
substance abuse during the adolescent years
 Mechanisms underlying this association remain unknown
 Among competing explanations is the possibility that:
1. Deviant peers have a direct influence through peer pressure and
socialization
2. Deviant peers provide both modeling and reinforcement for substance
use
3. Substance using adolescents seek out peers who also use substances, a
form of social homophily
(Fergusson, Swain-Campbell, & Horwood, 2002)

25. EXTERNALIZING DISORDERS
 Externalizing disorders are major risk factors predicting the initiation of
substance use and the development of abuse and dependence
 Risk factors associated with the development of externalizing disorders
also predispose to the development of substance use disorders
 These disorders are :
1. Conduct disorder
2. Oppositional defiant disorder (ODD)
3. Attention deficit hyperactivity disorder (ADHD)
[Review by Crowley and Riggs, 1995]

26. STAGE THEORY
 Stage theory proposes that:
1. There is a temporal ordering of substance experimentation
2. Lower order substances which are more commonly used precede the use
of higher order substances
 A licit/legal substance such as alcohol or cigarettes is used first
 It is followed by marijuana which is usually the first illicit substance
 This stage is followed by use of other illicit substances like opioids, cocaine,
stimulants etc.

27. GATEWAY HYPOTHESIS
This theory proposes that:
 Use of marijuana facilitates the entry into other illicit substance use
 This effect can be explained by:
1. Heavy cannabis users have preexisting traits that predispose them to the
use of a variety of different substances
2. Marijuana use is a marker for a tendency to use multiple drugs
3. Marijuana use results in socialization into an illicit drug subculture which
creates favorable attitudes toward the use of other illicit drugs

28. NEUROBIOLOGY OF ADOLESCENT
SUBSTANCE USE AND ADDICTIVE
BEHAVIORS

29. Why adolescents are prone to
experimenting with drugs and
alcohol?

30. Adolescent Brain Development and Addiction
Vulnerability
 Adolescent brain is vulnerable
 During adolescence dynamic shifts occur in:
1. Brain morphology
2. Fiber architecture
3. Biochemical changes like alterations in dopaminergic and GABAergic
neurotransmitter systems
4. Neuroendocrine factors

31.  Neurodevelopmental morphology studies indicate that:
1. Gray matter volume and cortical thickness follow an inverted parabolic
curve across the lifespan
2. Peak occurs in early adolescence (ages 12–14 years)
3. Decline occurs as adult life progresses

32. Regional brain morphology shows temporal variance:
 It follows a caudal-to-rostral pattern
 Areas of brain to mature at earlier stage are:
1. Occipital region
2. sensorimotor cortices
3. Striatum
 Area of brain to mature last are :
1. PFC
2. Association cortices

33.  Neurodevelopmental models postulates that :
 In adolescent substance abusers there is developmental imbalance
between:
 Top down cognitive control systems
 Bottom up incentive-reward systems

34. TOP DOWN SYSTEM
 Components of a “top-down” executive system are
1. Pre-frontal cortex (PFC)
2. Anterior cingulate cortex (ACC)
 Cognitive control is the ability to resist temptation in favor of long-term
goal-oriented behavior
 Cognitive control is regulated by top down system
 Top down system improves in a linear fashion from childhood through
adulthood

35. BOTTOM-UP SYSTEM
 A “bottom-up” subcortical system includes:
1. Striatum
2. Midbrain dopaminergic system
 Important in reinforcement learning
 Matures at an earlier stage of development than a “top-down” system

36. THE CIRCUIT IMBALANCE
During adolescence there is imbalance between:
 Immature “top-down” cognitive control processes
and
 Mature and hyperactive “bottom-up” incentive-reward processes
 This allow bottom up system (incentive-reward) system to supersede
cognitive control
 This leads to increased susceptibility to the (incentive-reward) properties
of psychoactive substances

37. TRIADIC MODEL OF ADOLESCENT ADDICTION
It involves the interface of 3 neurobiologic systems:
1. Control /regulatory system involving the medial and ventral PFCs
2. Reward system involving the ventral striatum and midbrain
dopaminergic system
3. Threat/harm-avoidance system involving the amygdala
Increased engagement in substance use during adolescence takes place due
to:
1. An inefficient control/regulatory system
2. A strong reward system
3. A weak harm-avoidance system

38.  During adolescence
1. Maturational imbalances are the greatest
2. Adolescents are not able to regulate motivational or emotional states in
the same way as adults
 This explains the early onset and elevated rates of addictive disorders
during adolescent period

39. EFFECT OF ADDICTIVE PROCESSES ON BRAIN
STRUCTURE AND FUNCTION
1. Animal models suggest that the brain is more vulnerable to the effects of
psychoactive substances during adolescence
2. Among adolescents substance abuse for as few as 1 to 2 years leads to
structural and functional deficits in brain
 Adolescent substance abuse leads to alterations in:
1. white matter
2. PFC
3. Corpus callosum
4. Cerebellum

40.  Hippocampal volumes are smaller among adolescents with heavy alcohol
use patterns compared to nonsubstance using adolescents
 PFC volume seems to vary among adolescents with AUD compared to
nondrinking controls
 Findings vary by gender:
1. Female adolescents with AUDs had significantly smaller PFC volumes
compared to female nondrinkers
2. Male adolescents with AUDs had significantly larger PFC volumes
compared to male nondrinkers

41. Neurocognitive deficits are found in adolescents across the domains of:
1. Attention
2. Visuospatial processing
3. Speeded information processing
4. Memory
5. Executive functioning

42. ASSESSMENT OF ADOLESCENT SUBSTANCE USE
 Research suggests that face-to-face interview assessment leads to
underreporting of substance use by adolescents
 Strategy which should be used in assessment:
1. Use a self-administered questionnaire during an interview
2. Obtain drug use history information
3. Then use a computer self-administered interview to obtain this same
information
4. Supplement it by toxicology screens

43. ADOLESCENT SUBSTANCE ABUSE SCREENING
INSTRUMENTS
1. Adolescent Drinking Index (ADI)
2. Drug Use Screening Inventory –Revised (DUSI-R)
3. Problem Oriented Screening Instrument for Teenagers (POSIT)
4. Rutgers Alcohol Problem Index (RAPI)
5. Substance Abuse Subtle Screening Inventory Adolescent Version(SASSI-A)
6. Teen Addiction Severity Index (T-ASI)
7. CRAFFT – a brief screening tool for adolescent substance abuse

44. DIAGNOSIS AND CLINICAL FEATURES
 The diagnosis of substance abuse is made primarily through:
1. Clinical interview with the adolescent
2. Obtaining collateral information from parents and teachers
 Adolescents and children are:
1. Likely to be in a precontemplative stage of change
2. Minimize the extent of their substance involvement
 Establishing rapport with the adolescent is critical in order to increase the
chance of self-disclosure of drug use

45. INTERVIEWING TECHNIQUES
 Parents or caretakers should ideally be present at the initial interview for
assessment of adolescents
 This allows the establishment of:
1. Rules of confidentiality
2. Threats of harm to self or others

46. DEALING WITH CONFIDENTIALITY
 During assessment adolescent's confidentiality should be honored unless:
1. Specific permission and release is obtained or
2. Patient is clinically judged to be a danger to self or others
 Adolescents are usually willing to self-disclose if the rules of confidentiality
are clearly established
 Exceptions to confidentiality should be specified at the beginning of
treatment

47. The interview with the parents or caretakers should be used to obtain a
history of:
1. Presenting complaint
2. Early development history
3. Assess family dynamics
Private interview with the adolescent is important in facilitating:
 Strong treatment alliance
 Eliciting information about substance abuse and behavior problems
 Eliciting vital information that patient may not be comfortable disclosing in
presence of parents

48.  History of clinical concern is:
1. Extent or severity of substance involvement
2. Specific substances that the patient is abusing or dependent on
3. Length of time that the pattern has persisted
 For each substance clinicians should inquire about:
1. Age of onset of first use or experimentation
2. Age of progression to regular use
3. Peak use
4. Current use
5. Last use

49.  Other important information includes:
1. Triggers for craving and use
2. Context of use (e.g with particular peers, or at or before school)
3. Perceived motivation for using
4. Positive and negative consequences of use
5. Current motivation
6. Goals for treatment

50. DIFFERENTIAL DIAGNOSIS
 The primary differential diagnosis is establishing whether :
1. Substance abuse or Substance dependence exists for each substance
2. Extent of relevant comorbid psychiatric and medical conditions

51. COMORBIDITY IN SUBSTANCE USE DISORDERS
 Past 6 month prevalence for comorbid psychiatric disorders with an
adolescent substance use disorder is:
1. 76% for any comorbid disorder
2. 68% for any disruptive behavior disorder
3. 32% for any mood disorder
4. 20% for any anxiety disorder
 Comorbidity is the rule rather than the exception among adolescents with
substance use disorders
(Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) study)

52. TREATMENT OF ADOLESCENT
SUBSTANCE ABUSE

53. PROBLEMS WITH ADOLESCENT SUBSTANCE ABUSE
TREATMENT STRATEGIES
 The efficacy of pharmacotherapies for adolescent drug use disorders has
not been established
 No clear evidence exits for:
1. Specific components of therapy that are critical for successful outcome
2. Therapy particularly efficacious with particular type of substance abuse

54.  Randomized clinical trials focused on adolescent substance abusers are:
1. Rare
2. Typically single site
3. Cannot be generalized to patient populations across diverse clinical
settings
4. Underpowered

55.  Adolescents with substance abuse:
1. Do not self-refer for treatment
2. Often pressured into treatment by family, school, or court
3. Are defiant
4. Minimize their drug use
 Ethical challenges of clinical research with minors include:
1. Requirement to obtain parental consent for participation
2. Potential for confidentiality breach in obtaining parental consent

56. TREATMENT STRATEGIES
 Treatment for adolescent with substance involves recognizing that these
are chronic relapsing conditions
 Patients may need multiple episodes of treatment over time
 Treatment typically involves:
1. Initial attempts to create abstinence or markedly reduce drug use
2. Addressing the biopsychosocial aspects of substance use
3. Maintenance or relapse prevention•phase

57. PHARMACOTHERAPY
TOBACCO
 An early open-label trial using nicotine patch with adolescent smokers
desiring to quit reported no benefit (5% abstinence rate at 6 months)
(Hurt, Croghan, Beede et al., 2000)
 Single underpowered clinical trial failed to find a significant improvement
in abstinence rates at 6 months using the nicotine patch
(Grimshaw & Stanton, 2006)
 Efficacy for pharmacological treatment of adolescent smokers remains to
be established

58. ALCOHOL
 There have been no multisite randomized clinical trials of
pharmacotherapies for alcoholism in adolescents
 Most recent findings from large US multisite trials with adults suggest that
behavioral interventions should remain the treatment of choice for
adolescents with alcohol problems

59. OPIOIDS
 Relatively little research has been conducted on the effectiveness of
treatment of opioid abuse in children and adolescents
 Findings from the limited adolescent-focused research suggest that
methadone is likely to be effective in reducing long-term use of heroin and
other illicit opioids in those adolescents who have developed severe
dependence
(Kellogg, Melia, Khuri et al., 2006)

60.  There is little research evaluating pharmacological treatments for
adolescent substance abuse
 Available evidence is based almost entirely on adult, rather than
adolescent samples
 Evaluations of the efficacy of pharmacotherapies have produced
equivocal results regarding their efficacy in adolescents
(DeLima, Soares, Reisser et al.,2002)

61. SPECIFIC THERAPEUTIC APPROACHES
Motivational Interviewing:
1. Motivational interviewing techniques have been demonstrated to
promote:
 Treatment engagement
 Strong treatment alliance
 Patient generated treatment goals
2. Motivational interviewing principles can be effectively used in
conjunction with another empirically supported treatment modalities
such as individual and/or family-based treatment

62. COGNITIVE-BEHAVIORAL THERAPY
 Cognitive-behavioral therapy (CBT) is effective in treating adolescent
substance use disorders
 In CBT following characteristics need to be identified:
1. Reinforcers of substance use
2. Skills deficits
3. Specific cognitive distortions associated with substance use
 CBT should be provided to:
1. Enhance coping strategies to deal effectively with drug cravings and
negative affects
2. Strengthen problem solving and communication skills
3. Identify and avoid high-risk situations

63.  An important feature of CBT is its emphasis on developing new behaviors
that are:
 Enjoyable
 Incompatible with drug use
Riggs et al. (2005) demonstrated that
 When treatment was free or incentivized, many adolescents voluntarily
entered treatment when referred by counselors, teachers, friends, or
family
 Thus, individual CBT is a viable therapeutic option for youth with SUDs

64. CONTINGENCY MANAGEMENT
 This approach encourages healthy changes in behavior by rewarding
adolescents for objective evidence of abstinence such as negative
urinalyses
 It regards substance use as operant behaviors that are reinforced by the
effects of the drugs involved
 Following the operant conditioning model, the adolescent’s drug use will
subside when tangible incentives are offered for abstinence

65. TWELVE-STEP PROGRAMS
 These programs incorporate a self-help approach centered within the
context of reciprocal support
 They are organized around the basic tenets of Alcoholics Anonymous (AA)
 In this approach individuals support each other’s sobriety through
encouragement of mental and spiritual health via a lifelong spiritual
journey through 12 steps

66. MULTISYSTEMIC THERAPIES
Multisystemic therapies:
 Treat adolescents within the context of their environment
 Try to modify multiple environmental factors contributing to SUDs
 Multisystemic therapy is an approach that addresses
1. Social and family influences of drug use
2. Associated antisocial behaviors
 Therapists make frequent home visits and are available on a full time basis
to families
 Henngeler et al. (1996) demonstrated that over 98% of youth receiving
MST remained in treatment, compared to very few youth in a control group

67. EVIDENCE-BASED PREVENTION
PROGRAMS FOR ADOLESCENT AND
CHILDREN SUBSTANCE USE DISORDERS

68. School Based Prevention
 School-based efforts are efficient as they offer access to large numbers of
students
 Contemporary approaches to school-based prevention of substance use
are:
1. Social resistance skills training
2. Normative education
3. Competence enhancement skills training

69. Social Resistance Skills
 These interventions are designed with the goal of:
1. Increasing adolescent’s awareness of various social influences that
support substance use
2. Teaching them specific skills for effectively resisting both peer and media
pressures to smoke, drink, or use drugs

70. Normative Education
 Normative education approaches include content and activities to correct
inaccurate perceptions regarding the high prevalence of substance use
 Many adolescents overestimate the prevalence of smoking, drinking, and
the use of certain drugs, which can make substance use seem to be
normative behavior
 Educating youth about actual rates of use, which are almost always lower
than the perceived rates of use, can reduce perceptions regarding the
social acceptability of drug use

71. COMPETENCE ENHANCEMENT PROGRAMS
 Competence-enhancement programs recognize that youth with poor
personal and social skills are more susceptible to substance abuse
 Competence enhancement approaches teach following life skills:
1. General problem-solving and decision-making skills
2. General cognitive skills for resisting interpersonal or media influences
3. Skills for increasing self control and self-esteem
4. Adaptive coping strategies for relieving stress and anxiety

72. LIFE SKILLS TRAINING
 The Life Skills Training (LST) program seeks to influence major social and
psychological factors that promote substance use
 Separate curricula have been developed for:
1. Elementary school students (grades three to six)
2. Middle or junior high students (grades six to eight, or grades seven to
nine)
3. High school students (grades nine or ten)
 The program content is delivered using cognitive-behavioral skills training
techniques

73. LST COMPONENTS
 The LST program consists of three major components that address critical
domains found to promote substance use
 Each component focuses on a different set of skills
1. Drug Resistance Skills enable young people to:
 Recognize and challenge common misconceptions about substance use
 Deal with peer and media pressure to engage in substance use

74. 2. Personal Self-Management Skills help students to:
 Examine their self-image and its effects on behavior
 Identify everyday decisions and how they may be influenced by others
 Consider the consequences of alternative solutions before making
decisions
3. General Social Skills give students the necessary skills to:
 Overcome shyness
 Communicate effectively and avoid misunderstandings
 Use both verbal and nonverbal assertiveness skills to make or refuse
requests

75. PROJECT TOWARDS NO DRUG ABUSE
 Project Towards No Drug Abuse (TND) is designed to help high risk students
(14 to 19 years old) resist substance use and abuse
 It is based on an underlying framework that young people at risk for
substance abuse will not use substances if they:
 Are aware of misconceptions and myths about drug use
 Have adequate coping skills and self-control
 Know about negative consequences of substance use
 Are aware of cessation strategies for all forms of substance use
 Have good decision-making skills

76. BRIEF ALCOHOL SCREENING AND INTERVENTION FOR COLLEGE
STUDENTS (BASICS)
(BASICS) is a program for college students who drink alcohol heavily and are
at risk for alcohol-related problems like:
 Poor class attendance
 Missed assignments
 Accidents
 Sexual assault
 Violent behavior
 It is not designed for students who are alcohol dependent
 The goal of BASICS is to motivate students to reduce their alcohol use in
order to decrease the negative consequences of drinking

77. Family Based Prevention Programs
 Family based substance abuse prevention programs for adolescents are:
1. Family Matters
2. Creating Lasting Family Connections
3. Brief Strategic Family Therapy

78. FAMILY MATTERS
 Family Matters is a universal prevention program
 It is designed to prevent tobacco and alcohol use in children 12 to 14 years
old
 The program is implemented at home by parents with the help of four
instructional booklets

79. CREATING LASTING FAMILY CONNECTIONS
(CLFC)
 (CLFC) is a selective intervention
 It is designed to prevent substance abuse and violence among
adolescents and families in high-risk environments
 CLFC is designed to:
 Enhance family bonding and communication skills among parents and
youth
 Promote healthy beliefs and attitudes that are inconsistent with drug
use and violence

80. BRIEF STRATEGIC FAMILY THERAPY
 BSFT is an indicated family-based prevention program
 It aims to decrease individual and family risk factors through skills building
and by improving and strengthening family relationships
 BSFT targets children and adolescents (6 to 17 years of age) who engage in:
1. Rebellious , truant, or delinquent behaviors
2. Substance use
3. Peers exhibiting these behaviors

81. MODEL COMMUNITY BASED PREVENTION PROGRAM
 Community Trials Intervention to Reduce High-Risk Drinking (RHRD) is a
universal intervention
 RHRD aims to alter community-wide alcohol use patterns such as:
1. Drinking and driving
2. Underage drinking
3. Binge drinking and related problems

82.  The RHRD program uses five prevention components:
1) Reducing alcohol access by helping communities use zoning and
municipal regulations to control the density of bars, liquor stores, etc.
2) Responsible beverage service by training alcohol beverage servers and
assisting retailers develop policies and procedures to reduce drunkenness
3) Reduce drinking and driving through increased law enforcement
4) Reduce underage alcohol access by training alcohol retailers to avoid
selling to minors and increased enforcement of laws regarding alcohol
sales to minors
5) Provide communities with tools to form the coalitions needed to
implement and support the interventions

83. HARM REDUCTION INITIATIVES
 These interventions aim at limiting or reducing the harm caused by
substance use even if substance use itself continues
 These include:
1. Campaigns that aim to reduce alcohol related harm by reducing driving
under the influence
2. Needle and syringe exchange programs that help in reducing
transmission of blood borne viruses without reducing drug use per se
 There is no evidence indicating that such programs increase either the
prevalence of drug use or the frequency of drug use among users

84. CONCLUSION
 Understanding of substance abuse problems during adolescence is critical
 Prevalence rates of alcohol, tobacco, and other drug use increase rapidly
from early to late adolescence and typically peak during young adulthood
 Deviant peer affiliation is one of the best predictors of early onset
substance abuse during the adolescent years
 Currently the research on adolescent SUD treatment is dominated by
psychosocial-based modalities
 Family systems based treatments and motivational enhancement
therapy/BI approaches have received the most empiric support compared
with other modalities

85. REFERENCES
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2. Lewis's Child and Adolescent Psychiatry: A Comprehensive Textbook, 4th
Edition
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86. 5. Evidence for Optimism: Behavior Therapies and Motivational Interviewing in
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87. THANK YOU