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behaviors and risks to behavioral changes. It addresses a number of issues (drug and alcohol use, decision-making, and financial management) and builds knowledge and skills.

An interesting element to this program is that it uses values traditionally associated and promoted by the military (e.g., personal responsibility, integrity, minimizing risk to other sailors, mission readiness) as a way to encourage sailors to reduce alcohol use and alcohol-related consequences. This element capitalizes on military culture for health promotion and alcohol prevention—something that might be uniquely possible in the military. Based on reports issued by the U.S. Navy, PREVENT appears to be a promising program. For example, graduates reported a 45 percent reduction in heavy drinking days per month and an 82 percent decrease in driving after drinking. Costs associated with alcohol-related incidents and lack of readiness were also decreased (U.S. Navy, 2003). Additional evaluations of military-based programs, including the extent to which they reach underage populations, are warranted.

TREATMENT PROGRAMS

Despite efforts to prevent underage drinking, some youth will drink at a level that requires clinical treatment. Findings from the National Household Survey on Drug Abuse indicate that about 10 percent of 12- to 17-year-olds (about 2.3 million) are heavy users of alcohol. The proportion of users who are clinically dependent is not known, but it is believed to be unacceptably high. Treatment for underage alcohol dependency is scarce. The juvenile justice system is the major route through which most adolescents get into treatment. Although estimates of the cost-effectiveness of early treatment are speculative, research suggests that early treatment has the potential to be cost-effective, especially in comparison with incarceration or treatment for a long-term alcohol abuse problem. For instance, cost-benefit research on drug and alcohol treatment generally (Office of National Drug Control Policy, 2001) suggests that the range of savings is between $2.50 and $9.60 for every dollar spent on treatment. Although these savings were calculated on the basis of adult treatment, and included drugs as well as alcohol, it is reasonable to assume that savings for effective youth alcohol treatment would be at least this high. Unfortunately, only one person in seven who would qualify for treatment was admitted to treatment in 1999 (National Institute on Drug Abuse Community Epidemiology Work Group, 1999). The proportion of youth who are admitted to treatment is undocumented but believed to be even smaller.

Research on treating underage alcohol abusers reveals that nine elements are crucial to success: matching treatment to needs; comprehensive



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