What Works in Substance What Works in Substance Abuse PreventionAbuse Prevention

CHAP Fall Meeting 2007CHAP Fall Meeting 2007

Chris Ringwalt, Chris Ringwalt, DrPHDrPHSenior Research ScientistSenior Research Scientist

Pacific Institute for Research and Evaluation1516 E. Franklin St., Suite 200Chapel Hill, N.C. 27514-2812

Phone: (919) 265-2613E-mail: ringwalt@pire.org

Data speakData speakSelected findings from the:Selected findings from the:

National Survey on Drug Use and HealthNational Survey on Drug Use and Healthhttp://www.oas.samhsa.gov/nhsda.htmhttp://www.oas.samhsa.gov/nhsda.htm

Monitoring the FutureMonitoring the Futurehttp://www.monitoringthefuture.org/http://www.monitoringthefuture.org/

Nicotine dependence definedNicotine dependence defined

Smoking drive (compulsion to smoke driven Smoking drive (compulsion to smoke driven by nicotine craving and withdrawal)by nicotine craving and withdrawal)Nicotine toleranceNicotine toleranceContinuous smoking Continuous smoking Behavioral priority (preferring smoking over Behavioral priority (preferring smoking over other reinforcing activities) other reinforcing activities)

Past month cigarette use and Past month cigarette use and nicotine dependencenicotine dependence

Definitions of alcohol useDefinitions of alcohol use

Current use Current use -- At least one drink in the past At least one drink in the past 30 days (includes binge and heavy use). 30 days (includes binge and heavy use). Binge use Binge use -- Five or more drinks on the Five or more drinks on the same occasion at least once in the past 30 same occasion at least once in the past 30 days (includes heavy use). days (includes heavy use). Heavy use Heavy use -- Five or more drinks on the Five or more drinks on the same occasion on at least 5 different days same occasion on at least 5 different days in the past 30 days. in the past 30 days.

Trends in alcohol use and abuseTrends in alcohol use and abuse

Past Month Illicit Drug Use

Trends in Trends in 30 day30 day cigarette usecigarette use

Trends in Trends in 3030--dayday alcohol usealcohol use

Trends in Trends in 22--weekweek binge drinkingbinge drinking

Trends in Trends in annualannual illicit drug useillicit drug use

Number of Deaths in the United States Number of Deaths in the United States in 2000, by Selected Cause of Deathin 2000, by Selected Cause of Death

(N=2,403,351 deaths)(N=2,403,351 deaths)

0

100,000

200,000

300,000

400,000

500,000

SmokingSmoking Poor Diet Poor Diet andand

Physical InactivityPhysical Inactivity

Motor Motor Vehicles Vehicles

AlcoholAlcohol Illicit drugsIllicit drugs

435,000435,000400,000400,000

85,00085,00043,00043,000 29,00029,000 17,00017,000N

umbe

r of D

eath

sN

umbe

r of D

eath

s

FirearmsFirearms

Elements of a definition of Elements of a definition of adolescent substance use preventionadolescent substance use prevention

Delay adolescent initiationDelay adolescent initiation of of allall addictive or addictive or destructive substances (including alcohol and destructive substances (including alcohol and tobacco) as long as possible, regardless of tobacco) as long as possible, regardless of whether they are legal for adultswhether they are legal for adultsAmong youth who have already begun to use Among youth who have already begun to use (but are not addicted), (but are not addicted), stopstop use or use or reducereduce level level of useof useReduce problems associated with useReduce problems associated with use (a.k.a. (a.k.a. harm reduction)harm reduction)

Individual Individual change approaches change approaches defineddefined

Strategies used to Strategies used to deterdeter the use of, or the use of, or reduce the problemsreduce the problems associated with, associated with, substance use and abuse through substance use and abuse through alterations in individuals’: alterations in individuals’: –– values, values, –– knowledge, knowledge, –– attitudes, attitudes, –– beliefs, beliefs, –– social skills, social skills, –– decisiondecision--making, making, –– commitments to remain drug freecommitments to remain drug free

Individual change strategiesIndividual change strategiesCommon objectives:Common objectives:–– Prevent or reduce substance use and abusePrevent or reduce substance use and abuse–– Alter risk factors associated with substance use and Alter risk factors associated with substance use and

abuseabuseCommon risk factorsCommon risk factors–– School failureSchool failure–– SubstanceSubstance--using peersusing peers–– Socially isolated; no friendsSocially isolated; no friends–– Stressful family environmentStressful family environment–– Rebellious against family and other authority figuresRebellious against family and other authority figures–– No goals for the futureNo goals for the future–– Beliefs that peers’ use is widespreadBeliefs that peers’ use is widespread

SchoolSchool--based programsbased programs

What worksWhat worksEffective programs:Effective programs:–– Focus on Focus on malleablemalleable risk factors that are risk factors that are linkedlinked to to

substance usesubstance use–– Values and norms clarificationValues and norms clarification–– DecisionDecision--making and life skillsmaking and life skills–– Use interactive teaching methodsUse interactive teaching methods

Ineffective programs:Ineffective programs:–– Target selfTarget self--esteemesteem–– Increase knowledge (alone)Increase knowledge (alone)–– Use scare tacticsUse scare tactics–– Use didactic methodsUse didactic methods

Case example: Project ALERTCase example: Project ALERT

Drug prevention curriculum for middle Drug prevention curriculum for middle school students (11school students (11--14)14)1 day teacher workshop or on1 day teacher workshop or on--line trainingline training11 weekly “core” lessons in first year11 weekly “core” lessons in first year3 “booster” lessons in second year3 “booster” lessons in second yearParent involvement through homework Parent involvement through homework activitiesactivities

FamilyFamily--based programsbased programs

Case Example: Family MattersCase Example: Family Matters

Targets parents of children aged 12Targets parents of children aged 12--1414Intervention delivered through four booklets Intervention delivered through four booklets mailed to the home mailed to the home –– usually to mothersusually to mothersFollowFollow--up telephone calls by health up telephone calls by health educators to encourage parents to read the educators to encourage parents to read the booklets, do the activities, and to answer booklets, do the activities, and to answer questionsquestions

Booklet contentBooklet contentCommunication skillsCommunication skillsParenting stylesParenting stylesAttachment and time spent togetherAttachment and time spent togetherEducational encouragementEducational encouragementConflict resolutionConflict resolutionAvailability of tobacco and alcohol in the homeAvailability of tobacco and alcohol in the homeFamily rules about child use of tobacco and Family rules about child use of tobacco and alcoholalcoholImportance of monitoring and supervisionImportance of monitoring and supervisionInsights into peer and media influencesInsights into peer and media influences

Environmental strategiesEnvironmental strategies

What are they?What are they?

Strategies used to reduce problems Strategies used to reduce problems associated with substance use through associated with substance use through changes in the physical, social, legal or changes in the physical, social, legal or economic environment economic environment

Environmental strategies:Environmental strategies:alcoholalcohol

Enforcement aimed at retailers helps Enforcement aimed at retailers helps prevent sales to youth.prevent sales to youth.

Vigorous use of compliance checksVigorous use of compliance checksApplication of appropriate sanctions Application of appropriate sanctions to violating merchantsto violating merchantsEducation of merchants regarding Education of merchants regarding techniques and responsibilitiestechniques and responsibilitiesDram shop liability for sales to Dram shop liability for sales to minorsminorsDevelopment of community support Development of community support for enforcementfor enforcement

Limitations on Access

ACCESS

Controls on availability in general reduce Controls on availability in general reduce youth access to alcohol.youth access to alcohol.

Limitations on Access Increase price throughIncrease price through

excise taxesexcise taxesConditional use permits for Conditional use permits for alcohol outletsalcohol outletsControls on outlet locationControls on outlet locationand densityand density

Controls on hours of saleControls on hours of sale

ACCESS

SocialSocial--availability strategies target youth availability strategies target youth access to alcohol beyond retail.access to alcohol beyond retail.

Limitations on Access Enforcement of laws against Enforcement of laws against

buying alcohol for minorsbuying alcohol for minorsSales displays that discourage Sales displays that discourage shopliftingshopliftingSpecial enforcement campaigns Special enforcement campaigns to prevent parties where alcohol to prevent parties where alcohol is servedis servedKeg registration lawsKeg registration laws

ACCESS

NORMS

Expressions of Expressions of Community Community

NormsNorms

EventsEvents--focused strategies seek to focused strategies seek to shape the community norms.shape the community norms.

Prohibition of alcohol Prohibition of alcohol sponsorship of public eventssponsorship of public eventsProhibitions/controls on Prohibitions/controls on alcohol use at community alcohol use at community events or in public areasevents or in public areasCommunity sponsorship of Community sponsorship of alcoholalcohol--free activities for free activities for youthyouth

Prevention of Impaired DrivingPrevention of Impaired Driving

Enforcement of Zero Enforcement of Zero Tolerance lawsTolerance lawsWellWell--publicized traffic publicized traffic safety/sobriety safety/sobriety checkpointscheckpoints

Prevention of Impaired Driving

Banning or controlling beer kegs on campus (registering Banning or controlling beer kegs on campus (registering kegs with campus police/security).kegs with campus police/security).

Banning alcohol sponsorship of athletic events.Banning alcohol sponsorship of athletic events.

Creating alcohol free dorms.Creating alcohol free dorms.

Regulate the use of alcohol by fraternities and sororities Regulate the use of alcohol by fraternities and sororities by creating rules to control attendance at unsupervised by creating rules to control attendance at unsupervised keg parties (Guest lists required from fraternities and keg parties (Guest lists required from fraternities and sororities).sororities).

Provide responsible party host training.Provide responsible party host training.

Potential College Campus StrategiesPotential College Campus Strategies

Thank you for your timeThank you for your time

I am just an eI am just an e--mail away and I mail away and I willwill answer answer your questions.your questions.

ringwalt@pire.orgringwalt@pire.org