Prevention Research
Rob O’Neill
U of U Special Ed class
November 18, 2010
Definition of Prevention
• How would YOU
define
PREVENTION ?
Definition of Prevention
A proactive process that empowers
individuals and systems to foster a climate
in which:
• Alcohol use is acceptable only for adults when
risk of adverse consequences are minimal
• Prescriptions, over-the-counter drugs, and other
abusable substances are used only for their
intended purposes and as intended
• Illegal drugs and tobacco are not used at all
(CSAP’s
Prevention Primer, 1994; SW CAPT online glossary)
Prevention Research
Why study prevention research?
• “Evidence-based” prevention is the
standard of accountability in the field
• Prevention theory assists in identifying
what contributes to substance abuse and
how it can be prevented
• Results depend on the quality of the
research that guides prevention
What is “Evidence-based”
Prevention?
• Based upon research meeting commonly
agreed-upon criteria of rigor
• Guided by credible and substantiated
research evaluation
• Principles, strategies and programs that
are theory-driven, well implemented,
and shown to have an effect on specific
behaviors, or on specific risk factors
that have been linked to them
(SAMHSA’s
Prevention Platform online glossary and CSAP’s Southwest CAPT Community
Mobilization for Prevention online course glossary)
Why All the Concern Over
Evidence-based Prevention?
• To use the most effective programs and
strategies
• To improve existing programs
• To use limited resources wisely
• To ensure public accountability
• To meet requirements of federal and state
agencies and private funders
What Should a Good Theory
Do?
• Identify the factors that predict substance
abuse
• Explain the mechanisms through which
they operate
• Identify the internal and external variables
that influence these mechanisms,
including cultural factors
• Predict points to interrupt the course
leading to substance abuse
• Specify the interventions to prevent onset
of substance abuse
Activity
Risk & Protective Factors
Theory
• Similar to public health model of disease
prevention: focus on decreasing risk and
increasing protection
• Risk factors predict substance abuse and
protective factors can buffer risk factors
• To prevent substance abuse, reduce risk
factors and increase protective factors
throughout an individual’s life
Risk & Protective Factors
Theory
Risk and protective factors:
• Can be influenced by individual,
family, school, and environmental
change strategies
• Have a cumulative effect
• Occur in communities, families,
schools, and individuals and are
subject to change
Risk & Protective Factors
Theory
• Different adolescent health and behavior
problems share common risk factors
–
–
–
–
–
–
Substance Abuse
Delinquency
Teen Pregnancy
School Drop-out
Violence
Depression & Anxiety
Criteria for Inclusion
as a Risk Factor
• Multiple studies
• Longitudinal
• Predictive
Community Risk Factors
• Availability of alcohol/other drugs
• Community laws and norms
favorable toward drug use
• Transitions and mobility
• Low neighborhood attachment and
community disorganization
• Extreme economic deprivation
Risk
Factors
Domain
C
O
M
M
U
N
I
T
Y
Adolescent
Problem Behaviors
Substance
Abuse
Depression
& Anxiety
Delinquency
Availability of
alcohol/other
drugs

Community laws
and norms
favorable to
drug use

Transitions and
mobility

Low
neighborhood
attachment and
community
disorganization


Extreme
economic
deprivation


Teen
Preg
School
Dropout
Violence










Family Risk Factors
• Family history of substance abuse
• Family management problems
• Family conflict
• Parental attitudes and
involvement in drug use
Risk
Factors
Domain
F
A
M
I
L
Y
Adolescent
Problem Behaviors
Substance
Abuse
Depression
& Anxiety
Delinquency
Teen
Preg





Family
history of
the problem
behavior


Family
management
problems



Family conflict



Favorable
parental
attitudes and
involvement
in problem
behaviors



School
Dropout

Violence




School Risk Factors
• Academic failure beginning in
elementary school
• Lack of commitment to school
Risk
Factors
Domain
S
C
H
O
O
L
Adolescent
Problem Behaviors
Substance
Abuse
Depression
& Anxiety
Delinquency
Teen
Preg
School
Dropout
Violence
Academic
failure
beginning in
late
elementary
school





Lack of
commitment
to school





Individual/Peer
Risk Factors
• Early and persistent antisocial behavior *
• Rebelliousness
• Friends who use drugs
• Favorable attitudes toward drugs
• Early initiation of drug use
• Gang involvement
• Constitutional factors *
* Child Development
Journal ©2006
CHILDREN WHO
• had less control over their behavior and
impulses between 3 and 5 years of age
• gained behavioral control more slowly
WERE MORE LIKELY TO
• drink alcohol at age 14
• develop an alcohol problem
• try illicit drugs
Source: Dr. Maria M. Wong, Idaho State University
Society for Research in Child Development
* MRDD Research Reviews
2006; 12:41-47
• TITLE:
A review of substance use research
among those with mental retardation
• AUTHOR:
Neil B. McGillicuddy
• ABSTRACT:
This article reviews research
conducted on the cigarette, alcohol, and illicit drug use
of adolescents and adults with mental retardation
(MR). Overall, results of these studies suggest that,
although substance use is slightly lower among those
with MR than among nondisabled comparison groups,
it is nonetheless a problem for many individuals.
Further, the examination of education, prevention, and
treatment programs for this population has been
overlooked. The article concludes with a discussion of
several topics that need to be addressed in future
studies, including best practices.
© 2006 Wiley-Liss, Inc.
* ERIC Identifier: ED4694411
2002-08-00
Title:
Substance Abuse Prevention and
Intervention for Students with
Disabilities: A Call to Educators
Author:
McCombs, Kathryn - Moore, Dennis
Source:
ERIC Clearinghouse on Disabilities and Gifted
Education Arlington VA
• Youth with disabilities experience a
substantially higher substance abuse risk than
their nondisabled peers.
• In addition to the same risk factors as their
counterparts in regular education, they also
face many disability-specific factors, such as
prescribed medications, chronic medical
problems, social isolation, co-existing
behavioral problems, and disenfranchisement.
* ERIC Identifier: ED4694411
2002-08-00
• While educating youth with disabilities in inclusive settings
exposes them to positive learning opportunities in the
classroom, they also have more exposure to peer pressure
for substance use, and at earlier ages.
• On the other hand, children in contained special education
classrooms often have less socialization practice or skills,
and may use substances in order to feel accepted by their
peers.
• Compared with their counterparts in regular education, a
significantly greater proportion of students who have been
in special education classes live in single-parent and
nontraditional households, have a family member with an
alcohol or other drug problem, have witnessed or
experienced physical abuse, and report a history of sexual
abuse and poor emotional health (Borowsky & Resnick,
1998).
* ERIC Identifier: ED4694411
2002-08-00
Research indicates that people with MR/DD, 11% of the
special education population nationwide in 2000-2001, use
alcohol and other drugs at rates less than or similar to the
general population (Westermeyer, Kemp & Nugent, 1996).
Because judgment and other social skills tend to require more
concentration for MR/DD students, the same amount of
alcohol can impact cognitive and motor skills more
severely.
Other significant risks faced by youth with MR/DD include
communication barriers, increased family stress, enabling
behaviors of family and friends, use of therapeutic
medications which may themselves be addictive, and
secondary complications from combining therapeutic
medications with illicit drugs or alcohol. Nonetheless,
controlled research dealing with the origin and prevention
of drug abuse among people with MR is essentially
nonexistent, but badly needed (Christian, & Poling, 1997).
* ERIC Identifier: ED4694411
2002-08-00
Special education students with emotional
disturbance (ED), who in 2001 comprised 8% of
the special education population nationwide,
frequently have one or more additional
disabilities.
Speculated to be the highest risk group of all
students in school, these students are put at an
inordinate risk for violence and substance abuse
by stressful family situations and unsuccessful
school experiences.
The increased risks appear to be related to the
inability to develop healthy peer and family
relationships, social isolation, oppositionaldefiant behavior, use of therapeutic
psychotropic medications, and social and
communication barriers.
* ERIC Identifier: ED4694411
2002-08-00
About half the students diagnosed with attentiondeficit/hyperactivity disorder (ADHD) receive special
education services as a result of other learning disabilities
(Substance Abuse and Mental Health Services
Administration, 1998).
People with this condition often experience a variety of
coexisting problems including anxiety and depression, low
self-esteem, obsessive-compulsive behaviors and chemical
addictions (Hallowell & Ratey, 1995).
With or without hyperactivity, attention deficit disorder does
not disappear after the onset of puberty, and it can lead to
social and scholastic failure. It often results in increased
risk of substance abuse, as well as trauma, conduct and
affective disorders during adolescence and marital
disharmony, family dysfunction, divorce and incarceration
in adulthood.
Additionally, prescribed medications may be a risk factor for
some forms of subsequent alcohol and other drug abuse.
* ERIC Identifier: ED4694411
2002-08-00
Low incidence disabilities: <5% of students in special ed.
Increased risk for alcohol and other drug abuse problems
among people who are blind or visually impaired has been
associated with isolation, excess free time, and
underemployment (Nelipovich & Buss, 1991). Youth with
visual impairments may face fewer consequences from
alcohol and other drug abuse due to the enabling of others,
social isolation, and constraints imposed by the disability.
People with severe hearing loss or deafness do not have ready
access to appropriate alcohol and other drug information.
When problems do exist, treatment professionals lack the
training required to meet their needs (Guthman, 1995).
Alcohol and other drug abuse prevention materials do not
take into account the cultural, language, or communication
differences faced by people who are hearing impaired. There
is also concern that people who are deaf more vigorously
attempt to avoid social stigma associated with an alcohol or
other drug abuse label, thereby making detection of problem
use more difficult.
* ERIC Identifier: ED4694411
2002-08-00
Disabilities with traumatic origin are strongly
associated with substance abuse. Specifically, as
many as 50% of spinal cord injuries (SCI) and
traumatic brain injuries (TBI) occur as a direct
result of alcohol or drug abuse (Corrigan, Rust,
& Lamb-Hart, 1995). Many people with SCI or
TBI continue to be at risk for substance abuse
problems post-injury. Some people with mobility
limitations are required to take several
medications for health management, which
greatly increases the risk for complications
arising from alcohol or other drug misuse. For
example, many brain-injured individuals take
medications to prevent seizures. There are
serious contraindications for use, even in small
quantities, of alcohol or non-prescribed drugs
for people using anti-seizure medication.
Risk
Factors
Domain
I
N
D
I
V
I
D
U
A
L
Adolescent
Problem Behaviors
Substance
Abuse
Depression
& Anxiety
Delinquency
Teen
Preg


School
Dropout
Violence
Early and
persistent
antisocial
behavior

Rebelliousness


Friends who
engage in the
problem
behavior



Favorable
attitudes toward
the problem
behavior



Gang
involvement



Constitutional
factors











Protective Factors
(community, family, school, peer)
• Individual characteristics
•Resilient temperament
•Positive social orientation
• Bonding
•Opportunities
•Skills
•Recognition
• Healthy beliefs and clear standards
The Social Development Strategy
Healthy
Behaviors
Healthy Beliefs
&
Clear Standards
Bonding
•Attachment
• Commitment
Opportunities
Skills
Individual
Characteristics
Recognition
Resiliency Approach *
• Focuses on how children “bounce back” in
the face of adversity
• Is based largely on the work of Emmy
Werner in Hawaii
• Includes several factors which foster
resilience in kids
• Is a “promising” approach
* Child Development
Journal ©2006
CHILDREN WHO
• Were “resilient” in early childhood, e.g.,
– Were more flexible
– More readily adapted to a changing
environment
WERE LESS LIKELY TO
• Start drinking alcohol in early teenage years
• Display signs of sadness, anxiety,
aggressiveness, or delinquent behavior
Source: Dr. Maria M. Wong, Idaho State University
Society for Research in Child Development
Developmental Assets
Framework
• Emphasizes strengths in people
• Is based on the work of Peter Benson
of the Search Institute
• Focuses on youth as resources, not
problems
• Focuses on increasing the number of
assets present in youths’ lives
• Is a “promising” framework
Blended Model
• Social Development Strategy
• Developmental Assets
Delays Gratification
Overcomes Adversity
Exhibits Leadership
Resists Danger
Healthy Behaviors
Succeeds in School
Helps Others
Values Diversity
Maintains Good Health
Neighborhood Boundaries
Equality & Social Justice Healthy Beliefs &
Clear Standards
School Boundaries
Integrity
Community
Caring Neighborhood
Religious Community
Adult Role Models
Safety
Individual/Peer
Positive Peer Influence
Bonding
Family
Family Support
Positive Family
Communication
Honesty
Responsibility
Sense of Purpose
Positive View of
Personal Future
School
Bonding to School
School Engagement
Achievement Motivation
Opportunities
Recognition
Skills
Other Adult Relationships
Service to Others
Creative Activities
Youth Programs
Youth as Resources
Time at Home
Parental Involvement
Reading for Pleasure
Homework
Community Values Youth
Youth Given Useful Roles
Caring School Climate
High Expectations
Personal Power
Cultural Competence
Family Boundaries
Interpersonal Competence
Peaceful Conflict Resolution
Planning & Decision Making
Resistance Skills
Individual Characteristics
Personal Control SelfEsteem
Restraint
SHARP Survey
• Student Health and Risk Prevention
comprises:
– Youth Tobacco Survey
– Youth Risk Behavior Survey
– Prevention Needs Assessment
•
•
•
•
Administered every other year
Active parental permission required
6th, 8th, 10th, and 12th graders statewide
Results at
http://www.dsamh.utah.gov/sharp.htm
2009 Summary
• 40,832 students in 37 school districts
– Grade:
6
8
10
12
13638
10926
9275
6992
– Gender:
M
F
19418
20809
– Ethnicity:
Afr Amer
544
Amer Ind
778
Asian
695
Hispanic
4848
Pac Island
600
White
30339
Multi-racial 2288
33.4%
26.8%
22.7%
17.1%
48.3%
51.7%
1.4%
1.9%
1.7%
12.1% ^
1.5% ^
75.7%
5.7% ^
2009 Summary
• Survey is collaborative effort among:
– Division of Substance Abuse & Mental
Health
– Office of Education
– Department of Health
• Contains 4 types of data:
– Substance use
– Antisocial behavior
– Risk Factors
– Protective Factors
2009 Summary
• Substance use
– Ever used
– 30-day use
– Heavy Use, Need for Treatment
– Antisocial behaviors (Grade 12)
– Drunk or “high” at school ^
– Suspended from school ^
– Sold illegal drugs ^
– Stolen a vehicle ^
– Been arrested ^
– Attacked to harm ^
– Carried a handgun ^
– Took a handgun to school =
2009 Summary
• Substance use
– Sources & Places of Alcohol Use (new!)
• bought it myself from a store
• got it at a party (#1 Grade 12)
• gave someone else money to buy it for me
• got it from someone I know age 21 or older (#2)
• got it from someone I know under age 21 (#3)
• got it from a family member or relative
other than my parents
• got it from home with my parents’ permission
• got it from home without my parents’ permission
• got it in another way
2009 Summary
• Substance use
– Sources & Places of Alcohol Use (new!)
• My or someone else’s home without any parent
permission (#1 Grade 12)
• Home with my parents’ permission
• Someone else’s home with their parents’
permission (#3)
• Open area like park, beach, back road (#2)
• Public events like sports, concert, festival
• Restaurant, bar, nightclub
• In a car
• Some other place
2007 Summary
• Gambling (11)
–
–
–
–
–
–
–
–
–
–
–
Gambled in the past year
Gambled at a casino
Played the Lottery
Bet on sports (#2)
Bet on cards (#1)
Bet on horses
Played Bingo for money
Gambled on the internet
Bet on dice
Bet on games of skill (#3)
Bet on video poker
• Baseline Data
2007 Summary
Comparison between Gamblers and
Non-Gamblers:
• A large percentage of the student
population engages in some type of
gambling
• 40-50% in the last year
• 28% in the last 30 days
• For most types of gambling, the rate
for males is twice that of females.
• A higher percentage of gamblers than
non-gamblers engage in substance
use and anti-social behavior.
2009 Summary
80. How often have you bet money,
possessions, or anything of value
on the results of a card game such
as poker, sporting event, games of
skill such as pool or bowling, bingo,
dice, or other games?
•
•
•
•
•
•
Never
Not in the past year
A few times in the past year
Once a month
Once a week or more
Almost everyday
2009 Summary
6th
grade
8th
10th
12th
grade grade grade
Total
Never
77.0
66.4
64.1
64.2
68.2
Not in the past year
5.4
7.4
8.3
9.3
7.5
A few times in the past year
13.9
19.5
21.2
20.0
18.5
Once a month
1.8
3.9
4.2
4.4
3.5
Once a week or more
1.3
2.0
1.5
1.6
1.6
Almost everyday
0.5
0.8
0.7
0.6
0.6
Please note that 2009 Gambling data is not comparable to data gathered through the
2007 Utah PNA Survey. The questions were asked differently in each administration
and results should not be compared.
2009 Summary
• Risk Factors
• Protective Factors
Highs/lows will vary from area to area.
Check website for data specific to your
school district or planning district.
http://www.dsamh.utah.gov/sharp.htm
Generally speaking. . .
• Utah use rates are about ½ of
national rates
• Most frequently used substances
1.
2.
3.
alcohol
tobacco
marijuana
• Utah rates for most substances are
down from 2005 and/or 2007
–
–
“Needs treatment” responses also down
Exceptions: slight rise in cigarettes, chewing
tobacco, and marijuana
• New! rates of methamphetamine,
prescription drug abuse, steroids
abuse, and gambling. ???
Signs & Symptoms
• Beyond being aware of students’
risk and protective factors, what
might you see?
• Handout
* ERIC Identifier: ED4694411
2002-08-00
Prevention
Substance abuse prevention efforts have improved greatly during
the past decade. Schools are attempting more comprehensive,
research-based strategies; community and family involvement
are being identified as required ingredients for successful
programming. Unfortunately, youth with disabilities have been
largely neglected in this process.
Drug-free school coordinators and substance abuse counselors
rarely have the necessary training to adapt traditional prevention
messages for special education students.
Special education teachers seldom have the necessary training in
substance abuse to conduct prevention activities or to identify
risk factors or signs of abuse.
Consequently, very few, if any, school or social service personnel
are prepared to intervene or educate disabled students relative to
substance abuse.
* ERIC Identifier: ED4694411
2002-08-00
Prevention
The need to advocate for appropriate prevention and treatment
options for students with disabilities is clear. Our children
in special education are no longer "sheltered" from the rest
of the world in contained classes and separate schools.
The need for specific prevention education training and
materials for teachers and other adults is equally clear. By
adapting and modifying activities, all those who care about
and work with young people with disabilities can address the
particular learning style of the child to make prevention
messages more relevant and interventions more effective.
More than half of special education teachers report that they
conduct prevention activities once a year or less; only 15%
conduct such activities at least once a week (Morgan,
Genaux, & Likins, 1994).
YOUR CHALLENGE?
Resource
EARLY CHILDHOOD MENTAL HEALTH
FACT SHEETS
– Minnesota Association for
Children’s Mental Health
– 1-800-528-4511
– www.macmh.org
Resource
UTAH’S SCHOOL BEHAVIORAL
HEALTH SERVICES
IMPLEMENTATION MANUAL
– DSAMH & USOE
– August 1, 2010
– http://www.dsamh.utah.gov/
– Click on link
Resource
END (End Nicotine Dependence)
Smoking Cessation Curriculum for youth
•Sandra Schulthies
•Utah Department of Health
•801-538-6502
•sandys1@utah.gov
• http://www.tobaccofreeutah.org/end.html
Resource
N-O-T (Not on Tobacco)
Smoking Cessation Curriculum for youth
– Anne Asher
– American Lung Association in Utah
– 801-931-6989
– aasher@lungutah.org
– http://www.notontobacco.com/
Local
Substance
Abuse
and
Mental
Health
Service
Areas
Local Prevention Coordinators
AREA
NAME
EMAIL
Bear River
Cathy Curtis
cacurtis@utah.gov
Central
Jolene Blackburn
joleneb@cucc.us
Davis
Debi Todd
debit@dbhutah.org
Four Corners
Rick Donham
rdonham@fourcorners.ws
Heber
Kathy Day
kday@co.wasatch.ut.us
Northeastern
Robin Taylor
robint@nccutah.org
San Juan
Leslie Wojcik
lwojcik@sanjuancc.org
Salt Lake
Jeff Smart
Jlsmart@slco.org
Southwest
Allen Sain
asain@swcbh.com
Summit
Pamela Bello
pamellab@vmh.com
Tooele
Julie Spindler
julies@vmh.com
Utah County
Pat Bird
PATBI.UCADM@state.ut.us
Weber
Paula Price
paulap@weberhs.org
Local Children’s Mental Health
Coordinators
AREA
NAME
EMAIL
Bear River
Tim Frost
timf@brmh.com
Central
Nathan Strait
nathans@cucc.us
Davis
Marty Hood
martyh@dbhutah.org
Four Corners
Kyle Elder
kelder@fourcorners.ws
Heber
Jenny Pinter
jpinter@co.wasatch.ut.us
Northeastern
Robert Hall
roberth@nccutah.org
San Juan
Ryan Heck
rheck@sanjuancc.org
Salt Lake
Ruth Wilson
ruthw@vmh.com
Southwest
Colleen Moore
cmore@swcbh.com
Summit
Peg Tan
margarett@vmh.com
Tooele
Doug Thomas
dougt@vmh.com
Utah County
Catherine Johnson
cjohnson@wasatch.org
Weber
Pat Millar
PatM@weberhs.org
For more information
http://www.dsamh.utah.gov/sharp.htm
Noreen Heid
801-538-4468
noreenheid@utah.gov
QUESTIONS and
DISCUSSION