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Adolescent Substance Abuse. What We Know … and How to Prevent It!. Michael T. Flaherty, Ph.D. Executive Director/Clinical Psychologist.

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Adolescent Substance Abuse

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Adolescent substance abuse

Adolescent Substance Abuse

What We Know

… and How to Prevent It!

Michael T. Flaherty, Ph.D.

Executive Director/Clinical Psychologist

Institute for Research, Education and Training in Addictions (IRETA), Regional Enterprise Tower, 425 Sixth Avenue, Suite 1710Pittsburgh, PA 15219, (412) 391-4449


Some background and quick premises

Some Background and Quick Premises

  • Addiction to illegal drugs is America’s No. 1, preventable, health problem.

  • Addiction to any drug (alcohol, tobacco, illicit drug) is a chronic illness requiring a continuum of care.

  • The abuse of alcohol and tobacco is a critically important, greatly under-funded, National problem. 50-75% of adolescents in psychiatric care use substance abuse.

Some background and quick premises continued

Some Background and Quick Premises(Continued)

  • Drug use is drug abuse and, however it begins, leads to dependence (psychological) and potentially addiction.

  • The solution of this problem in our society requires a greater partnership of the community with our schools, providers, policy makers, funders, scientists and media.

Adolescent substance abuse1

Adolescent Substance Abuse

  • Despite reports of leveling off (see PPG 1/5/03), substance abuse by adolescents remains high.

  • More than 90% of adults with current substance abuse problems began use before the age of 18 …one-half before the age of 15!

  • In a 2001 national survey, 23% of 8th graders reported being drunk at least once .. with 21.5% reporting current alcohol use.

Adolescent substance abuse continued

Adolescent Substance Abuse(Continued)

  • 54% of all high school graduates in the U.S. have used illicit drugs by the time they graduate.

  • Among 8th graders, illicit drug use is higher in Anglo-Americans than in African-Americans … in fact, suburban America is both at greater risk and a higher target for drugs.

The treatment continuum for adolescents

The Treatment Continuum for Adolescents




The treatment continuum for adolescents continued

The Treatment Continuum for Adolescents(Continued)

  • Outpatient-Standard(1 x wk)-Intensive OP(3 x wk)-Partial Hosp.(3+ x wk)

  • Residential-Detox(1-2 days)-Rehab(1-4 wks)-Stepdown/Halfway(2-6 mos)

The treatment continuum for adolescents continued1

The Treatment Continuum for Adolescents(Continued)

  • Inpatient-Detox(2-3 Days)(Hospital)-Rehab(12-21 Days)

  • Aftercare-Up to 12 months in Continuumat progressively less restrictive care.

    Self-Help-AA, NA, Al-Anon, Al-Ateen(Not Treatment)

Adolescent substance abuse

Scientific studies have now documented that adolescents are at-risk for illicit alcohol/ tobacco/drug use as a result of a unique trajectory of:

  • Biology

  • Environment

  • Development

Adolescent substance abuse

The above factors combine during the critical adolescent years to create a “heightened risk” period – often made obvious by increased externalized behavior and manifest opposition, secrecy and/or aggression.

Ref: Maziade, M., “Should Adverse Temperament Matter to the Clinician?” in Temperament in Childhood, 1989, New York: Wiley

Who is most at risk among adolescents

Who is Most At Risk Among Adolescents?

  • Low Self Esteem

  • Poor Coping Skills

  • Low Behavioral Self Regulation

  • Social Skills Deficits

Ongoing interaction with the environment interacting with individual bio-behavioral aspects.

Ref.: Tarter,, Psychology of Addictive Behaviors, December, 2002

Who is most at risk among adolescents continued

Who is Most at Risk Among Adolescents?(Continued)

If any use* occurs as a result of a composite, unique interaction between environment, development and biology, and we know who is at most risk, can we prevent it?

*Defined as Tobacco, Alcohol or Illicit Drug.

Adolescent substance abuse


A review of the current literature indicates that we can best “intervene” or disrupt the drug use trajectory by:

1 building social competence

1. Building Social Competence

  • Building self-understanding.

  • Owning one’s perspective.

  • Building social problem-solving skills.

  • Having quality child-environment interactions.

  • Teaching addiction/drug impact.

2 developing school bonding and achievement

2. Developing School Bonding* and Achievement

  • Building a commitment to school/self.

  • Build methods that increase bond to school and the opportunity for academic success.

  • Build aspiration for success.

  • Motivate, motivate … motivate.

  • Be long-term.

*Maladjustment in elementary school is a high predictor/risk factor for Substance Abuse. Low school engagement correlates to low self-esteem, low self-expectation and high association to deviant peers … all of which greatly increases likelihood of drub abuse.

3 teaching self regulation

3. Teaching Self-Regulation

  • Teach methods and reasoning for emotional regulation, anger management and impulse control.

  • Teach normative role modeling and problem solving skills.

  • Improve self-control/executive regulation.

  • Be age specific and culturally sensitive.

  • Be interactive.

  • Teach skills.

4 support and build parental adult involvement

4. Support and Build Parental/ Adult Involvement

  • Nothing builds child and adolescent resiliency better than qualitative parental/child or adult/child relationship!

  • The absence of parental involvement highly predicts Substance Abuse use/psychological dysregulation. Parental/child conflict with low involvement highly predicts delinquency and illicit drug use.

Adolescent substance abuse

Overall, addressing the above four interventions in a sustained manner proportionally reduces, in a significant manner, the likelihood of adolescent substance abuse, aggression and social deviancy.

Ref:Tarter, R., “Predictor Variables by Developmental Stages: A Center for Sustained Abuse Prevention Multi-State Study” in Psychology of Addictive Behaviors, Vol. 16, No. 45, 2002.

Four prevention techniques with adolescents

Four Prevention Techniques with Adolescents

  • Building Social Competence

  • Developing School Bonding and Achievement

  • Teaching Self-Regulation

  • Supporting and Building Parental/Adult-Child Involvement

Other sources of help information

Other Sources of Help/Information

  • Allegheny County Treatment System Handout

  • Institute for Research, Education and Training in Addictions (IRETA); 412-391-4449;

  • National Institute on Alcoholism;

  • Making the Grade,

  • Join Together;

  • Center for Substance Abuse Prevention;

  • Community Anti-Drug Coalitions of America;

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