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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

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

Outreach - School/Community/CJ

Assessment - Public/Private/CJ

Treatment - Public/Private/CJ

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)

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
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.


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.
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;