|
||||||||||||||||
|
||||||||||||||||
|
||||||||||||||||
|
| ||||||||||||||||||||||||||||||||
|
||||||||||||||||||||||||||||||||
Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter.
Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.
Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.
OCR for page 45
Concepts of Prevention
To prevent drug abuse, the central question is: What individual and
group factors need to be considered in designing interventions to be effec-
tive? To answer that question, a series of related questions have been
investigated: What elements affect the probability of onset, progression,
severity, and cessation of drug use, abuse, and dependence? By what mechanisms
do these factors work, in what combinations, and with what degrees of
strength or determinacy? What interventions can be used to subject these
probabilistic factors to preventive change?
INTRODUCTION
The research in this field has had to cope with great complexity, involv-
ing multiple causal and conditioning pathways and factors that are influen-
tial in some populations or environments but that appear far less salient in
others. In trying to untangle this complexity, research has followed a num-
ber of paths, some of which were ultimately abandoned as unfruitful. Over
time, the field has increasingly become oriented to a few systematic ap-
proaches that have survived tests of theoretical coherence and empirical
plausibility. Although these approaches are not antagonistic or contradic-
tory, they differ dramatically in emphasis. A more encompassing synthesis
or integration of approaches is not realistically in view. Nevertheless, an
overarching, three-part conceptual framework is helpful in understanding
the current approaches, and it provides a good basis for considering their
differences and commonalities. We refer to three general concepts as pre-
disposing, enabling, and reinforcing elements.
45
OCR for page 46
46
PREVENTING DRUG ABUSE: WHAT DO WE KNOW?
Predisposing elements, the first part of the framework, are comprised of
internalized individual characteristics (also called diatheses) and environ-
mental exposures (conditions). Predisposing elements are in effect prior to
the first encounter or opportunity to try illicit drugs. Predispositional logic
holds that some subsets of individuals, by virtue of factors that they have
acquired or been exposed to, are more vulnerable or more resistant to drug
use, abuse, or dependence than individuals without such factors, or with less
of them, all other things being equal. Potential predisposing elements may be
genetically transmitted vulnerability in the form of certain temperamental or
physiological characteristics; developmental deficits, such as failures in early
socialization or a lack of self-esteem, which imply that interaction within the
family is an important locus of concern; knowledge and beliefs concerning the
hazards of drugs; the individual's own perceptions of a drug's ability to harm;
moral beliefs and attitudes about drug consumption; or the individual's so-
cial circumstances and prospects irrespective of family interaction.
Second are enabling elements. These are decision-making and eco-
nomic or other circumstances relating directly to individual behavior in the
situation of opportunity to consume a drug. The major enablers are of two
kinds: (1) the availability and accessibility of drugs and prevention or
treatment resources in the community and (2) the individual's skills to de-
fine and respond autonomously and effectively to problem situations such
as the ones that drug availability presents.
Knowledge or belief structures, self-perceptions, and skills may be transmitted
interpersonally or through mass media. The distribution of both predispos-
ing and enabling elements tends to be associated with socioeconomic class
and ethnicity. The relationship of predisposing and enabling elements may
be critical to understanding why the rates of onset of drug use may be
similar in different groups but then diverge into sharply different rates of
drug abuse and dependence.
Third are reinforcing elements, which are the environmental (especially
social and economic) contingencies that attach to drug-related behavior.
Reinforcement may result from social recognition by a significant other or
members of an important reference group, in the form of giving or with-
holding approval (praise, prestige, esteem), disapproval (complaint, ridi-
cule, or dislike), or intimacy; or earning money or acquiring property as a
result of drug-related income. Major significant others and groups include
parents (whose influence declines over time), peers (whose influence in-
creases from childhood to adolescence); teachers; and job supervisors and
coworkers (including military peers and superiors). Parents may retain
greater influence than peers in some families. Like enabling elements,
social reinforcers are distributed differently in different socioeconomic classes,
ethnic groups, and residential zones (Green and Kreuter, 1991; Gottlieb and
Green, 1987; Heckler, 1985; Jacob, 1987; Thomas, 1990~.
OCR for page 47
CONCEPTS OF PREVENTION
47
There are four major conceptual approaches to prevention: risk-factor,
developmental, social influence, and community-specific. We briefly de-
fine each of these approaches in the next few pages. We then proceed in the
balance of the chapter to present a more thorough review of the respective
literatures of the first three approaches. Since the community-specific ap-
proach is still largely outside the drug prevention research literature, we
defer discussion of this approach to the appendix.
The Risk Factor Approach
Three major schools of thinking and associated research about preven-
tion emphasize one or more of these concepts of predisposing, enabling,
and reinforcing elements. The first school speaks principally in terms of
risk factors, a concept that is used extensively in the epidemiology of car-
diovascular, cancer, and other chronic diseases (Bry et al., 1982; Newcomb
et al., 1987~. This is the most comprehensive approach in terms of the
range and number of factors considered; it is also the least theoretically
structured and the least empirically focused.
A risk factor is any observable (measurable) characteristic of the indi-
vidual (including duration of exposure to specified environmental condi-
tions) that has been shown to correlate significantly (in population or case-
control studies) with a criterion behavior or outcome in this case, with the
onset of illicit drug use, some threshold level of consumption, or the clini-
cal occurrence of drug abuse or dependence. This specification makes the
risk factor model more empirical than theoretical. The risk factor must
precede or at least occur simultaneously with the drug behavior; that is, a
risk factor must be a potential cause or precursor, not a direct or indirect
effect or symptom, of the criterion behavior. Reciprocal causation between
risk factors and criterion behaviors is not precluded; in fact, as discussed
below, a mutually reinforcing feedback among problem behaviors is the
common pattern. For example, the desire for peer approval may predispose
a teenager to try marijuana with her friends, the reduced inhibition and the
relaxation felt during use reinforces the behavior and predisposes her to
another opportunity to use. Most of the risk factors studied, in terms of the
conceptual framework just reviewed, count as predisposing elements.
Interventions to prevent drug use following the risk factor approach
tend to emphasize educational approaches to modify self-esteem, specific
beliefs and attitudes concerning drug use, and related predisposing factors
(Bry et al., 1982; Newcomb et al., 1987~. Risk factors are statistical or
probabilistic: if an individual "has" the factor, his or her odds (that is,
statistical risk) of having the outcome are higher than if the individual does
not have the factor, all other things being equal. For example, if John
thinks marijuana is harmless, then the odds that he will try it are higher than
OCR for page 48
48
PREVENTING DRUG ABUSE: WHAT DO WE KNOW?
if he thinks marijuana can hurt him. Risk factors are usually additive: that
is, risks add up; the more of them that apply, the more probable it is that the
criterion outcome "at risk" will be observed. Some risk factors are easier to
change than others, and some risk factors may weigh more heavily (higher
zero-order or partial correlations with the criterion) than others. Those that
meet both of these criteria become more strategic targets for intervention.
Some risks may interact or have "synergistic" effects, in which one
factor statistically multiplies rather than simply adds to the effect of other
factors; in other words, a may be a nonsignificant risk factor, b may be a
nonsignificant risk factor, but a and b together may be a formidably sig-
nificant risk factor. Thus, although a may be a significant risk factor, in
the absence of b, its effect on drug use is minimal. An open question is
whether risk factors are generic (i.e., to many drugs) or specific (to each
drug family).
The Developmental Approach
The second school of thought about prevention is based on developmen-
tal theory. This approach particularly emphasizes the character and dynam-
ics of interaction over time within the family during early childhood and
within environments such as the school, especially grades 1-6. It shares
with some risk factor theories a concern with early developmental deficits
or predisposing factors. It differs, however, from risk factor theories in its
heavy concentration on characteristics of the family and school environ-
ment that directly reinforce undesirable patterns of affect, belief, or (most
important) behavior. Conversely, it also concentrates on environmental re-
inforcement of the development of positive motivation, educational poten-
tial, and prosocial behavior. The developmental approach articulates a more
elaborately linked and structured set of factors than risk factor approach. It
has a more diffuse target, however; instead of trying to identify and focus
on individuals who are "high risk" as the object of preemptive intervention,
the developmental approach tends to bracket more inclusive populations
and more dimensions of lifestyle or behavior (more than drug use, that is)
as the loci of long-term environmental and institutional change.
Social Influence Approaches
The third major school of thought about prevention really a family of
related approaches involves research on social influence. It is the most
tightly focused theoretically, and it is population-based. Increasing atten-
tion is being given in social influence research to variations among demo-
graphic and other groups. It recognizes the important role of peers in the
initiation and progression of drug use.
OCR for page 49
CONCEPTS OF PREVENTION
49
The social influence model is based on four core components: (1)
providing information on the negative social and short-term physiological
consequences of smoking; (2) providing information on the social influ-
ences to smoke- namely, peer, parents, and mass media; (3) correcting in-
flated perceptions of smoking prevalence; and (4) training, modeling, re-
hearsal, and reinforcement of methods to resist the social influences to
smoke.
Interventions largely concentrate on 6th through 10th grade students
and are best known for aiming to prevent the onset of use by modifying
enabling factors; in particular, increasing the knowledge of harmful effects
and teaching specific resistance skills for resisting persuasive messages from
peers and mass media. Cigarette smoking is the most thoroughly docu-
mented health-related behavior in social influence theory, and most inter-
ventions to increase resistance skills were originally developed and tested
in the context of preventing the onset of smoking (Evans and Raines, 1982~.
We have documented the relevance of smoking prevention to illicit drug use
prevention in Chapter 1, in the discussion of gateway drugs and the se-
quence of progression of drug involvement.
An important variation on social influence approaches is the cognitive-
behavioral model, which is based on the assumption that substance use
results from the combined influences of social and psychological factors.
Based on work by Schinke and colleagues on pregnancy prevention (Schinke
and Gilchrest, 1977; Schinke, 1982), this approach has been adapted to
smoking and other substances. The theoretical basis of the model is derived
from both developmental and social learning theory. Alcohol and drug use
is viewed as instrumental in meeting the developmental needs of youth
(e.g., transition marker, reducing stress, peer group acceptance, establishing
independence). The strategy for drug prevention emphasizes the develop-
ment of enabling skills, the acquisition of decision-making and problem-
solving skills to equip youth to make informed decisions about alcohol and
drug use. The focus is on the development of cognitive, behavioral, and
interpersonal skills. The approach is based on five core elements, which:
deal with a wide range of problem situations through the use of a
systematic problem-solving strategy,
provide accurate information,
teach coping strategies to relive stress and anxiety,
develop assertiveness skills, and
· develop self-instructional techniques for behavioral self-control.
A final important stream of work is the life skills approach, which
emphasizes the development of general life and coping skills, in addition to
skills and knowledge related more directly to resisting peer influences to
use substances (Botvin et al., 1980; Botvin and Eng, 19801. The program
OCR for page 50
so
PREVENTING DRUG ABUSE: WHAT DO WE KNOW?
focuses on teaching cognitive-behavioral skills that remedy psychological
or behavioral deficits. The Life Skills Model program consists of three
major components. A substance-specific component incorporates most of
the information from the social influences approach. A second component
addresses developing personal skills such as coping strategies, critical thinking,
and decision-making skills and teaches the basic principles of behavior
change. A third component develops social skills designed to improve
interpersonal functioning.
The Community-Specific Approach
A fourth perspective attempts to encompass all of the prior three. We
refer to this as the community-specific prevention approach. Community-
specific prevention is receiving major attention in various fields of public
health, particularly in preventing cigarette smoking and in controlling risk
factors for cardiovascular disease, cancer, AIDS, teenage pregnancy, and
other major health or related social problems.
The conceptual foundations of drug abuse prevention historically have
been imported from behavioral and social science research on cigarette smoking
reduction and public health promotion generally. Large differences in the
scale and nature of severe drug problems experienced in different communi-
ties makes the community-specific approach seem especially applicable to
drug abuse prevention, insofar as it is oriented to investigating population
differences and community variations, and to mobilizing resources accord-
ingly. The community-specific approach is, nevertheless, a barely culti-
vated areas of drug abuse prevention research, within which the published
work is not commensurate in scope with the risk-factor, developmental, and
social-influence literatures. Therefore, we take this subject up in the appen-
dix, which looks more generally to community-based health education to
illuminate this important dimension.
STUDIES OF RISK AND VULNERABILITY
Much research attention has been focused on risk factors variables
that exist before or during the typical age of onset of drug use (the second
decade of life) and predict an elevated probability of developing abuse or
dependence and on their mirror image, protective factors- those that seem
to confer a degree of immunity against drug involvement. By and large,
risk and protective factors are opposed ends of a set of continua, for ex-
ample, impulsivity versus planning, strong versus weak family bonding (Jessor
et al., 1992~. Risk and protective factors thus refer to relative degrees of
vulnerability on a set of continua.
Risk and protective factors may be characteristics of the individual or
OCR for page 51
CONCEPTS OF PREVENTION
51
of the environment. Individuals vary greatly in physical and behavioral
responses to nearly all health-related exposures or opportunities; they also
vary in the environments to which they are exposed. The study of such
variations and how they affect the probability of health problems has been
immensely important in the history of medicine and public health, so it is
no surprise that this approach has been adopted in the drug area (Rennert et
al., 1986).
A salient finding about patterns of drug consumption, discussed in the
previous chapter, is the fact that a much larger number of individuals use
drugs some very briefly, some intermittently over a longer span of years,
some regularly but at a modest level that does not increase over time than
the number who progress to the clinical status of abuse or dependence. The
infrequent and/or low-dose use of drugs is not a matter of indifference,
because such use is illegal and can have serious consequences. Any level of
use generates a degree of risk of progression to abuse or dependence as a
result of internal reinforcement, and use by some is likely to model or
reinforce abuse and dependence by others. But by definition, the conse-
quences of use are much less hazardous for the individual, on average, than
the consequences of abuse and dependence. Although users outnumber
drug dependent and abusing individuals, the smaller number of the latter
incur the majority of the social costs of drug problems. It is therefore
important to give particular attention to the degree to which particular causes
increase the probability of abuse or dependence over and above the inci-
dence of drug use per se.
There are indications that the processes leading to use may be differen-
tiated from those leading to abuse and dependence. In particular, unusually
early onset of drug use (that is, well before the average age of onset in the
population) is a strong correlate of later abuse or dependence, although this
is not an infallible marker (Kandel et al., 1986~. The early onset of ciga-
rette smoking is of special interest, and early alcohol and marijuana onset
are also of concern, because these tend to be gateways to other drugs.
Most studies of drug-related risk factors have been exploratory rather
than substantive, that is, they have employed small samples, followed up
for abbreviated periods, and have inadequate disaggregation and control for
gender, race/ethnicity, and socioeconomic status. There are, however, a few
studies large enough to establish with a certain degree of confidence the
relative importance of key factors, including longitudinal studies conducted
by a number of research teams, including: Judith Brook and colleagues
(Brook et al., 1990~; Brunswick (1988~; Elliott and colleagues (Elliott et al.,
1989~; Jessor and colleagues (Jessor and Jessor, 19771; Kandel and col-
leagues (Kandel et al., 1986~; Kaplan and colleagues (Kaplan, 1985; Kaplan
et al., 1988~; Kellam and colleagues (Kellam et al., 1983~; Newcomb and
gentler (1988, 19891; Pandina and colleagues (Pandina et al., 1984; Labouvie
OCR for page 52
52
PREVENTING DRUG ABUSE: WHAT DO WE KNOW?
et al., in press); Pentz and colleagues (Pentz et al., 1986~; and others. The
following discussions draw heavily on these studies. We first review some
of the literature that has focused on single risk factors; the yield of this
literature is rather low, so we have been highly selective in attempting to
represent it, pointing out major conclusions of studies on the role of genetic
and congenital factors, personality characteristics, and socioeconomic neigh-
borhood characteristics. We then review the results of studies on multiple
risk factors that focus attention on the issue of how these risk factors inter-
relate.
Genetic and Congenital Predispositions
Since psychoactive drugs are chemical agents that work inside the body,
it is natural to think that biological factors, including biologically heritable
factors, play some part in promoting or inhibiting the onset of drug use,
abuse, and dependence. The evidence for this hypothesis, however, was
indirect and slender at the time of the committee's review for all drugs
except alcohol. For alcohol, the heritability of some tendency heavily
modulated by environmental and developmental features appears reason-
ably well established.
The evidence for biological risk factors is of two kinds. First, different
strains of animal species bred for laboratory studies vary in their predilec-
tion or resistance to consuming alcohol and other drugs, and these prefer-
ences can be altered over generations through selective breeding. (These
preferences can also be altered through training; trained behaviors are not,
of course, genetically transmissible, although quickness in learning is.)
Second, there is evidence from behavioral-genetic and related studies
with human populations. Most of this work pertains to alcoholism, al-
though there is evidence from other pharmacogenetic and genetic epidemio-
logical research indicating predispositions to other types of drug abuse and
dependence (Institute of Medicine, 1989; Pickens and Svikis, 1988; Pickens
et al., 1991~. Family and twin studies suggest that there is a genetic predis-
position toward one of two typical patterns of alcoholism. Children with a
biological parent who has developed clinical alcoholism, even if this parent
had no role whatsoever in their childrearing (e.g., children adopted at birth),
are at four- to tenfold greater risk of this outcome compared with matched
children whose biological parents are without a clinical history of alcohol-
ism (Cloninger et al., 1981; Goodwin, 1983~.
One index of risk that has not been well studied is the magnitude of
dissonance among biological, cognitive, and behavioral spheres of function-
ing during the early second decade. It has been observed that girls who
enter puberty early may not yet be equipped with a number of social and
cognitive skills commensurate with biological maturation. They may there
OCR for page 53
CONCEPTS OF PREVENTION
53
fore be at increased risk for a number of adverse outcomes, perhaps for as
long as a decade afterward, including drug and alcohol abuse, antisocial
disorder, school dropout and unplanned pregnancy (Magnussen et al., 1986~.
The age at menarche, as one biological marker of a host of anatomical,
hormonal, and social changes, has been dropping steadily over the past 40
years, and social institutions have adjusted unevenly to these maturational
developments.
Overall, the place of biological heritage and biological mediation in
explaining the onset of drug use, abuse, and dependence remains uncertain.
Further human population research that attends as carefully to environmen-
tal conditioning as to physiological measures is needed to evaluate the rela-
tive role of neurochemical and other biological predisposing factors. A1-
though it is premature to recommend trials of strategies for informing people
of their possible risk based on family history of drug use, further analysis of
the potential risks and benefits of such advice (e.g., the risks of labeling
people and reduced self-esteem versus the benefits of reduced use of drugs)
is justified in anticipation of improved biological markers of risk (Bamberg
et al., 1990; Becker and Janz, 1987; Bensley, 1981; Childs, 1974; Hunt et
al., 1986; Khowry et al., 1985; Zylke, 19873.
Personality Characteristics
Only a small number of the many personality characteristics that have
been investigated in connection with drug use have shown significant re-
sults as risk factors (Lang, 1983~. Among these few characteristics, the
most positive evidence has accumulated in support of a psychological con-
struct called sensation seeking. In contrast, such factors as depression,
suicidal thoughts, and low self-esteem, all of which seem very plausible and
often serve as commonsense assumptions underlying the design of drug
abuse prevention efforts, do not stand up well under empirical investigation.
Zuckerman (1979) described sensation seeking as a fundamental aspect
of personality based in the neurochemistry of monamine oxidase. His four
measures of sensation seeking seeking new experiences, seeking thrills or
adventure, susceptibility to boredom, and disinhibition have been shown
to correlate with a number of illicit activities, including alcohol and drug
use, in adolescent and young adult populations (Bates et al., 1985; Huba et
al., 1981~. In studies using the Rutgers longitudinal sample, sensation seek-
ing and negative affectivity proved to have much larger effects on drug use,
both independently and interactively, than positive affectivity. Newcomb
and McGee (1989), using multivariate methods to probe results with the
UCLA sample, found that sensation seeking had unexpectedly complex ef-
fects, differing for males and females, with the most pronounced relation to
high levels of alcohol use.
OCR for page 54
54
PREVENTING DRUG ABUSE: WHAT DO WE KNOW?
Many clinicians believe that specific emotional disorders, particularly
depression and related distress, trigger or severely aggravate drug use,
abuse, or dependence. The evidence in this direction is inconsistent. Kaplan
(1985), Huba et al., (1986), Aneshensel and Huba (1983), and Labouvie
(1986) all found that drug use is often preceded by emotional distress or
depression. But the relieving effects of drug use on these states is short-
lived. Newcomb and gentler (1988) found that alcohol use over time in a
general population sample of adolescents was correlated with a reduction
in depression, but no such correlation emerged linking other drug use to
depression or other emotional distress. Elliott and Huizinga (1984) found
that emotional problems and social isolation (feelings of loneliness) were
moderately correlated with the level of use of alcohol, marijuana, and
other illicit drugs in a general youth population sample. Dembo and col-
leagues (1991) found a similar result among detainees in a juvenile deten-
tion center.
The most extreme level of depression is suicidal thinking and attempts.
Suicide is the second leading cause of death among adolescents. However,
drug use seems to be more a risk factor for suicide attempts than the other
way around. Newcomb and gentler (1988) reported that adolescent use of
"hard" drugs (beyond alcohol and marijuana) was associated with subse-
quently increased suicidal thinking in young adulthood.
The belief is widely held and intuitively appealing that a strong sense
of self-esteem is a protective factor and lack of it a risk factor for adoles-
cent drug use. There is no doubt that most cases of adolescent drug abuse
or dependence that come to clinical attention are individuals who are short
on self-esteem. The specific notion is that individuals with low self-esteem
seek drugs in order to raise it (Kaplan, 19861. Numerous preventive inter-
ventions have applied this theory by seeking to build up their participants'
self-esteem, teaching them how to raise it, or expanding the opportunities
for enhancing self-esteem in ways other than by taking drugs.
Despite its attractions, the evidence for the self-esteem theory is mostly
not supportive. In large studies such as White et al. (1986) and Kaplan et
al. (1984), very weak correlations were observed between self-esteem and
drug use, and these variables paled into insignificance under further statisti-
cal manipulation. Even if self-esteem did seem to be an important risk
factor for drug taking, the idea that it might be altered by any of the pro-
gram measures ordinarily undertaken is problematic, denying or ignoring as
it does commonly assumed determinants of self-esteem such as physical
attractiveness (Simcha-Fagen et al., 19861.
In summary, the search for specific personality risk factors for illicit
drug taking has been mostly disappointing. Studies on sensation seeking,
an active trait, have proven more promising than those focusing on more
inward-turning characteristics such as depression and self-devaluation.
OCR for page 55
CONCEPTS OF PREVENTION
55
Socioeconomic Factors at the Neighborhood Level
The epidemiologic evidence indicates that onset of illicit drug use oc-
curs mainly through peer group contact and that rates of onset (as distinct
from continued use) are at rather similar levels within economic and ethnic
groups. We suspect that the illicit drug use and trafficking that occur in
economically disadvantaged communities, which are disproportionately black,
Puerto Rican, and Mexican-American, occur for many of the same reasons
as in other segments of the population, but that these reasons are more
intense. In the most depressed portions of these communities, there is an
additional dimension associated with greater numbers of drug abusing and
dependent individuals and high levels of violence: namely, for many poor,
young minority men and women, illicit drug markets are key sources of
employment and are perceived as a route to economic mobility. In order to
be successful in selling drugs, it is necessary for these young people to
encourage drug use aggressively among the most vulnerable members of the
community and to be prepared to enforce and protect their transactions in
an increasingly gun-ridden and anarchic environment.
As Brunswick (1988) notes in her longitudinal study of several hundred
youths from central Harlem: "An often overlooked cornerstone of hard
drug use among young black males is that it is not only and perhaps not
primarily a consumption and/or recreational behavior. It also serves eco-
nomic functions of occupation and career for this group" (see also Johnson
et al., 1985; Preble and Casey, 1966; Williams and Kornblum, 1986~. In a
population subgroup in which employment opportunities are severely con-
strained, and at a life stage at which economic independence is expected
and required, the drug economy is one of the relatively few high-wage
options that seem wide open (Reuter et al., 1990~.
It is not known with certainty what distinguishes those who sell drugs
in economically disadvantaged communities from the majority of their peers
in these areas who, with similarly limited opportunities, shun drug involve-
ment, or from those in the middle who use but do not sell drugs. The
perception and fact of being socially distant from mainstream opportunities,
at the same time needing money in order to survive, are important. But, in
every ethnic group in subcommunities dominated by drug use and sales,
families are the most important social unit particularly so given the pau-
city of institutional infrastructure in most economically impoverished areas.
Although drug users in poor minority subcommunities are predominantly
from single-parent, female-headed households, the same is true of those
adolescents who do not use drugs (Fitzpatrick, 1990~. Whether or not there
is an intact nuclear family, the most important family inhibitions against
drug use (either through predisposition or through reinforcement) may be
the active involvement of multiple adults in the immediate or extended
OCR for page 65
CONCEPTS OF PREVENTION
65
least prevention of smoking onset as a dependent variable (Cornell and
Turner, 1 985; Connell et al., 1 9851.
Many programs are theory based, specifying which risk factors or me-
diating variables they are trying to change and measuring whether these are
in fact changed by program exposure. Studies of social influence interven-
tion studies have measured changes in information, in specifically instructed
interactive skills, and in native expectations regarding alcohol, tobacco,
and drug use. MacKinnon et al. (1991) analyzed the first year of the Kan-
sas City STAR program and found that a large share of the observed desir-
able effects were best explained by changes in normative expectations among
program-exposed youth.
The fundamental work of Evans and colleagues (Evans, 1976; Evans et
al. 1978, 1981) relied heavily on McGuire's (1964) "social inoculation" and
"resistance to persuasive communication" theories for background. They
drew most heavily, however, on Bandura's (1977, 1982, 1986) theories of
social learning and his prescriptions for enhancing perceived self-efficacy:
(1) specifying very explicit and proximal goals of training in this case,
resistance skills; (2J promoting accomplishments of performance through
participation and practice, (3) providing models of successful behavior in
this case, peer models; and (4) providing task-specific feedback to reinforce
and validate successful performance.
The most fully developed, research-based, social-influence programs
are cast from a single mold. Virtually all are based on a core of junior high
or middle school classroom lessons given by regular teachers, trained "peer
leaders," or specialized health educators. The curriculum runs through a
sequence of modules attending to predisposing, enabling, and reinforcing
factors, with central attention to the development of resistance behaviors
against the initial opportunity to use drugs (tobacco, alcohol, or marijuana)
in a peer group context. Ellickson et al. (1988:vi-vii) give a cogent sketch
of a typical lesson plan, the 7th and 8th grade ALERT program:
The first two lessons are intended to develop motivation to resist by sharp-
ening students' perception of the seriousness of drug use and by revealing
their personal susceptibility to the harmful effects of such use [predisposi-
tional factors]. The next three lessons focus on resistance skills helping
students to identify pressures to use drugs, counter prodrug messages and
learn how to say "no" to both internal and external pressures Enabling
factors]. The final three sessions reinforce the earlier content and clarify
the benefits of resistance. During the eighth grade, students receive a
three-session booster curriculum designed to reinforce resistance skills learned
the previous year "reinforcing factors].
The curriculum provides multiple opportunities for student participation-
role playing, question and answer techniques, small group activities, indi-
vidual and group practice in saying "no," and written exercises.
OCR for page 66
66
PREVENTING DRUG ABUSE: WHAT DO WE KNOW?
There is some diversity among social influence researchers in how nar-
rowly or broadly the programs are defined. Pentz et al. (1989) have pro-
posed embedding the school-based curriculum within more comprehensive
school and community efforts, for example, efforts to invigorate school
antidrug policies and to mobilize community-wide awareness and support.
Most of the research, however, has been focused on the curriculum compo-
nent. There are differences here as well concerning the degree to which
there is an emphasis on building general social competence or skills (such
as assertiveness) in addition to ones targeted specifically at resisting peer-
stimulated drug onset. This division between targeting proximal variables
that will affect drug behavior but not (according to design) much else versus
generic training that may have effects in many directions is characteristic of
the larger school health education field, which has moved increasingly from
categorical toward comprehensive programming (Green and Iverson, 1982;
Kolbe and Iverson, 1983~.
Research Needs
A particular problem with social influence models is the implicit as-
sumption that school-based influence encompasses all young people. The
needs for recognition of many youths, especially economically disadvan-
taged children in inner cities, are not well enough served by the schools to
lead them to look to schools or even to their peers within the school frame-
work for practical or moral instruction. These youths largely define them-
selves by their street peer loyalties, not by school district lines. Peer influ-
ences, as defined in research literature, are too often generalized as though
all adolescents were culturally homogeneous; there is not enough research
that recognizes the specific features of ethnic and street culture (Becker et
al., 1989~.
The foundations of social influence theory were in relatively small-
scale social psychological studies, and more of these are needed now to
extend our understanding of influence processes. More fundamental re-
search is needed on small groups with a variety of youth-cultural affilia-
tions. The careful studies in the l950s and 1960s of institutionalized
street gangs, including attempts to change them, are a model worth recon
. .
SIC .erlIlg.
SUMMARY
Three principal approaches in drug abuse prevention research emerge
from the recent past: the study of risk factors, the study of developmental
sequences, and the study of social influence. It is helpful in seeing how
these approaches relate to each other to note their differential emphasis on
OCR for page 67
CONCEPTS OF PREVENTION
67
predisposing, enabling, and reinforcing elements or variables in the respec-
tive theories and methods of inquiry.
The risk factors under study include biological, personality, and socio-
economic variables. In general, under longitudinal study, risk factors seem
to operate as individually small but cumulative causes of criterion behav-
iors. These studies generally suggest prevention strategies based on identi-
fication of the high-risk youths, those for whom many such factors apply.
Studies of risk factors are hobbled by measurement deficiencies with re-
spect to environmental variables in particular, and methodological invest-
ments and improvements in this respect are needed.
The developmental approach involves a more structured, sequential model
of poor early parenting, school maladjustment, academic deficiency, and
gravitation toward school-oppositional groups, which are seedbeds of illicit
drug use and other disorderly and problem behaviors. This approach incor-
porates the general sense that there is a weakening of family bonds through-
out the population and that primary schools, which may be more amenable
to intervention particularly experimental intervention than family units,
should be a key locus of study.
The study of social influences, largely in junior high school popula-
tions, has also been based on a highly structured theory derived from the
concept of self-efficacy and its roots in social learning. While these theo-
retical foundations have been extensively researched and appear robust in
many ways, there has not been enough study of the differentiated social and
normative world of early adolescence. This applies particularly to the emergence
and significance of norms strongly antagonistic to schools and to the per-
ception by adolescents of prodrug or antidrug norms in their peers. These
are critical reinforcing environments that may make or break intervention
strategies, so it is critical to build a more systematic understanding of them.
REFERENCES
Ames, C.
in The enhancement of student motivation, In M.L. Maehr and D.A. Kleiber, eds.,
press Advances in Motivation and Achievement, Vol. 5. Greenwich, Conn.: JAI Press.
Aneshensel, C.S., and G.J. Huba
1983 Depression, alcohol use, and smoking over one year: a four-wave longitudinal
causal model. Journal of Abnormal Psychology 92:134-150.
Bamberg, R., R.T. Acton, J.M. Roseman, R.C.P. Go, B.O. Barger, C.J. Vanichanan, and R.B.
Copeland
1990 The effect of genetic risk information and health risk assessment on compliance
with preventive behaviors. Health Education 21(2):26-32.
Bandura, A.
1977 Social Learning Theory. Englewood Cliffs, N.J.: Prentice-Hall.
Bandura, A.
1982 Self-efficacy mechanisms in human agency. American Psychologist 37:122-147.
OCR for page 68
68
PREVENTING DRUG ABUSE: WHAT DO WE KNOW?
Bandura, A.
1986 Social Foundations of Thought and Action: A Social Cognitive Theory. Englewood
Cliffs, N.J.: Prentice-Hall.
Bates, M.E., E.W. Labouvie, and H.R. White
1985 The effect of sensation seeking needs on alcohol and marijuana use in adoles-
cence. Bulletin of HTE Society of Psychologists in Addictive Behaviors 5:29-36.
Becker, M.H., and N.K. Janz
1987 On the effectiveness and utility of health hazard/health risk appraisal in clinical
and non-clinical settings. Health Services Research 22:537-551.
Becker, S.L., J.A. Burke, R.A. Arbogast, M.J. Naughton, I. Bachman, and E. Spohn
1989 Community programs to enhance in-school anti-tobacco efforts. Preventive Medi-
cine 18:221-228.
Bensley, L.B.
1981 Health risk appraisals in teaching health education in colleges and universities.
Health Education 12:31-33
Blount, W.R., and R. Dembo
1984 The effect of perceived neighborhood setting on self-reported tobacco, alcohol,
and marijuana use among inner-city minority junior high school youth. The Inter-
national Journal of the Addictions 19(2): 175- 198.
Botvin, G.J., and A. Eng
1980 A comprehensive school-based smoking prevention program. Journal of School
Health 50:209-213.
Botvin, G.J., A. Eng, and C.L. Williams
1980 Preventing the onset of cigarette smoking through life skills training. Preventive
Medicine 9: 135- 143.
Brook, J.S., D.W. Brook, A.S. Gordon, M. Whiteman, and P. Cohen
1990 The psychosocial etiology of adolescent drug use: a family interactional approach.
Genetic, Social, and General Psychology Monographs 116:111-267.
Brunswick, A.F.
1988 Drug use and effective distress: a longitudinal study of black youth. Advances in
Adolescent Mental Health 3:101-125.
Bry, B.H., P. McKeon, and R.J. Pandina
1982 Extent of drug use as a function of number of risk factors. Journal of Abnormal
Psychology 91 :273-279.
Carnegie Council on Adolescent Development
1989 Turning Points: Preparing American Youth for the 21st Century. New York:
Carnegie Corporation.
Childs, B.
1974 A place for genetics in health education and vice versa. American Journal of
Human Genetics 26:120-135.
Cloninger, C., M. Bohman, and S. Sigvardsson
1981 Inheritance of alcohol abuse: cross fostering analyses of adopted men. Archives
of General Psychiatry 38:861-868.
Connell, D.B., and R.R. Turner
1985 The impact of instructional experience and the effects of cumulative instruction.
Journal of School Health 55:324-331.
Connell, D.B., R.R. Turner, and E.F. Mason
1985 Summary of findings of the school health education evaluation: health promotion
effectiveness, implementation and costs. Journal of School Health S5:316-321.
Deci, E.L., and R.M. Ryan
1985 Intrinsic Motivation and Self-Determination in Human Behavior. New York: Ple-
num.
OCR for page 69
CONCEPTS OF PREVENTION
69
Dembo, R., L. Williams, J. Schmeidler, E.D. Wish, A. Getreu, and E. Berry
1991 Juvenile crime and drug abuse: a prospective study of high risk youth. Journal of
Addictive Diseases 11:5-31.
Durlak, J.A.
1985 Primary prevention of school maladjustment. Journal of Consulting and Clinical
Psychology 53:623-620.
Ellickson, P.L., and R.M. Bell
1990 Drug prevention in junior high: a multi-site longitudinal test. Science 247:1299-
1305.
Ellickson, P.O., R.M. Bell, M.A. Thomas, A.E. Robyn, and G.L. Zellman
1988 Designing and Implementing Project ALERT: A Smoking and Drug Prevention
Experiment. Santa Monica, Calif.: The RAND Corporation.
Elliott, D.S., and D. Huizinga
1984 The Relationship Between Delinquent Behavior and ADM Problem Behaviors.
Paper prepared for the ADAMHA/OJJDP State of the Art Research Conference on
Juvenile Offenders with Serious Drug/Alcohol and Mental Health Problems, Bethesda,
Md.
Elliott, D.S., and B.J. Morse
1987 Drug Use, Delinquency, and Sexual Activity. Unpublished paper.
Elliott, D.S., D. Huizinga, and S.S. Aceton
1985 Explaining Delinquency and Drug Use. Beverly Hills, Calif.: Sage Publications.
Elliott, D.S., D. Huizinga, and S. Menard
1989 Multiple Problem Youth: Delinquency, Substance Use, and Mental Health Prob
lems. New York: Springer-Verlag.
Evans, R.I.
1976 Smoking in children: developing a social psychological strategy of deterrence.
Preventive Medicine 5:122-127.
Evans, R.I., and B.E. Raines
1982 Control and prevention of smoking in adolescents: a psychological perspective.
In T.J. Coates, A.D. Peterson, and C. Perry, eds., Promoting Adolescent Health: A
Dialog on Research and Practice. New York: Academic Press.
Evans, R.I., R.M. Rozelle, M. Mittelmark, W.B. Hansen, A. Bane, and J. Havis
1978 Deterring the onset of smoking in children: knowledge of immediate psychologi-
cal effects and coping with peer pressure, media pressure, and parent modeling.
Journal of Appl~ed Social Psychology 8:126-135.
Evans, R.I., R.M. Rozelle, S.E. Maxwell, B.E. Raines, C.A. Dill, T.J. Guthrie, A.H. Henderson,
and P.C. Hill
1981 Social modeling films to deter smoking in adolescents: results of a three-year
field investigation. Journal of Applied Psychology 66:399-414.
Farquhar, J.W., S.P. Fortmann, J.A. Flora, C.B. Taylor, W.L. Haskell, P.T. Williams, N. Maccoby,
and P.D. Wood
Effects of community-wide education on cardiovascular disease risk factors the
Stanford 5-city Project. Journal of the American Medical Association 264:359-
365.
1990
Fitzpatrick, J.
1990 Drugs and Puerto Ricans in New York City. Pp. 103-126 in R. Glick and J.
Moore, eds., Drugs in Hispanic Communities. New Brunswick, N.J.: Rutgers
University.
Flay, B.R.
1987 Social psychological approaches to smoking prevention: review and recommenda
tions. Pp. 121-180 in Advances in Health [Education and Promotion, Vol. 2.
Greenwich, Conn.: JAI Press Inc.
OCR for page 70
70
PREVENTING DRUG ABUSE: WHAT DO WE KNOW?
Flay, B.R., K.K. Ryan, J.A. Best, K.S. Brown, M.W. Kersell, J.R. d'Avernas, and M.P. Zanna
1985 Are social psychological smoking prevention programs effective? The Waterloo
study. Journal of Behavioral Medicine 8:37-59.
Goodlad, J.I.
1984 A Place Called School. New York: McGraw-Hill.
Goodstadt, M.S.
1986 School-based drug education in North America: what is wrong? What can be
done? Journal of School Health 56:278-281.
Goodwin, D.
1983 Alcoholism. Pp. 195-213 in R. Tarter, ea., The Child at Psychiatric Risk. New
York: Oxford University Press.
Gottlieb, N.H., and L.W. Green
1987 Ethnicity and lifestyle health risk: some possible mechanisms. American Journal
of Health Promotion 2:37-45.
Green, L.W.
1990 The revival of community and the public obligation of academic health centers.
Pp. 148-164 in R. Bulger, R.E. Bulger, and S. Reiser, eds., The Role of the Aca-
demic Health Center in Humani ing Medicine. Ames, Iowa: University of Iowa
Press.
Green, L.W., and D.C. Iverson
1982 School health education. Annual Review of Public Health 3:321-338.
Green, L.W., and M.W. Kreuter
1991 Health Promotion Planning: An Educational and Environmental Approach. Palo
Alto, Calif.: Mayfield.
Hawkins, J.D., D.M. Lishner, and R.F. Catalano
1987 Schooling and delinquency. In E.H. Johnson, ea., Handbook on Crime and Delin-
quency Prevention. Westport, Conn.: Greenwood Press.
Heckler, M.
1985 Report of the Secretary's Task Force on Black and Minority Health. Washington,
D.C.: U.S. Department of Health and Human Services.
Huba, G.J., J.A. Wingard, and P.M. gentler
1980 Applications of a theory of drug use to prevention programs. Journal of Drug
Education 10:25-38.
Huba, G.J., J.A. Wingard, and P.M. gentler
1981 A comparison of two latent causal variable models for adolescent drug use. Jour-
nal of Personality and Social Psychology 40:180-193.
Huba, G.J., M.D. Newcomb, and P.M. gentler
1986 Adverse drug experience and drug use behaviors: a one-year longitudinal study of
adolescents. Journal of Ped iatric Psychology 11 :203-219.
Hunt, S.C., R.R. Williams, and K.K. Barlow
1986 A comparison of positive family history definitions for defining risk of future
disease. Journal of Chronic Diseases 39:809-821.
Institute of Medicine
1989 Prevention and Treatment of Alcohol Problems: Research Opportun~ties. Com
mittee to Identify Research Opportunities in the Prevention and Treatment of Al
cohol-Related Problems. Washington, D.C.: National Academy Press.
Jacob, J.
1987 Black America, 1986: an overview. In The St:ate of Black America. New York:
National Urban League.
Jessor, R., and S.L. Jessor
1977 Problem Behavior and Bsychosocial Development: A Longitudinal Study of Youth.
New York: Academic Press.
OCR for page 71
CONCEPTS OF PREVENTION
71
Jessor, R., J.E. Donovan, and F.M. Costa
1992 Beyond Adolescence: Problem Behavior and Young Adult Development. New
York: Academic Press.
Johnson, B.D., P.J. Goldstein, E. Preble, J. Schmeidler, D.S. Lipton, B. Spunt, and T. Miller
1985 Taking Care of Business: The Economics of Crime by Heroin Abusers. Lexing-
ton, Mass.: Lexington Books.
Johnson, C.A., W.B. Hansen, L.M. Collins, and J.W. Graham
1986 High-school smoking prevention: results of a three-year longitudinal study. Jour-
nal of Behavioral Medicine 9(5):439-452.
Jones, M.C.
1968 Personality correlates and antecedents of drinking patterns in adult males. Journal
of Consulting and Clinical Psychology 32:2-12.
Jones, M.C.
1971 Personality antecedents and correlates of drinking patterns in women. Journal of
Consulting and Clinical Psychology 36:61-69.
Kandel, D.B., O. Simcha-Fagan, and M. Davies
1986 Risk factors for delinquency and illicit drug use from adolescence to young adult-
hood. Journal of Drug Issues 16:67-90.
Kaplan, H.B.
1985
Testing a general theory of drug abuse and other deviant adaptations. Journal of
Drug Issues 15:477-492.
Kaplan, H.B.
1986 Social Psychology Self-Referrent Behavior. New York: Plenum.
Kaplan, H.B., S.S. Martin, and C. Robbins
1984 Pathways to adolescent drug use: self-derogation, peer influence, weakening of
social controls, and early substance use. Journal of Health and Social Behavior
25:270-289.
Kaplan, H.B., R.J. Johnson, and C.A. Bailey
1988 Explaining adolescent drug use: an elaboration strategy for structural equation
modeling. Psychiatry 51:142- 163.
Katz, L.G.
1989 Engaging Children's Minds: The Project Approach. Norwood, N.J.: Ablex.
Kellam, S.G., C.H. Brown, B.R. Rubin, and M.E. Ensminger
1983 Paths leading to teenage psychiatric symptoms and substance abuse: developmen-
tal epidemiological studies in Woodlawn. In. S.B. Guze, F.J. Earls, and J.E.
Barrett, eds., Childhood Psychopathology and Development. Vienna, Va.: Center
for Advanced Health Studies.
Khowry, M.J., C.A. Newill, and G.A. Chase
1985 Epidemiological evaluation of screening for risk factors: application to genetic
screening. American Journal of Public Health 75:1204-1208.
Klitzner, M., M. Blasinsky, K. Marshall, and U. Paquet
1985 Determinants of Youth Attitudes and Skills Towards Which DrinkinglDriving Pre-
vention Programs Should be Directed, Vol. 1. Report No. DOT HS 806-903.
Springfield, Va.: National Technical Information Service.
Knitzer, J., Z. Steinberg, and B. Fleish
1990 At the Schoolhouse Door: An Examination of Programs and Policies for Children
with Behavioral and Emotional Problems. New York: Bank Street College of
Education.
Kolbe, L.J., and D.C. Iverson
1983 Integrating school and community efforts to promote health: strategies, policies
and methods. Hygie: International Journal of Health Education 3:40-47.
OCR for page 72
72
PREVENTING DRUG ABUSE: WHAT DO WE KNOW?
Kumpfer, K.L.
1989 Effective Parenting Strategies for High Risk Youth and Families: Literature Re-
view. Social Research Institute, Graduate School of Social Work, University of
Utah.
Labouvie, E.W.
1986 Alcohol and marijuana use in relation to adolescent stress. International Journal
of the Addictions 21:333-345.
Labouvie, E.W., R.J. Pandina, and V. Johnson
in press Developmental trajectories of substance use in adolescence: differences and pre
dictors. International Journal of Behavioral Development.
Lang, A.R.
1983 Addictive personality: a viable construct? Pp. 157-236 in P.K. Levison, D.R.
Gerstein, and D.R. Maloff, eds., Commonalit~es in Substance Abuse and Habitual
Behavior. Lexington, Mass.: D.C. Health and Company.
Lorion, R.P., D. Bussell, and R. Goldberg
1989 Identification and Assessment of Youths at High Risk of Substance Abuse. Rockville,
Md.: Office of Substance Abuse Prevention.
MacKinnon, D.P., C.A. Johnson, M.A. Pentz, J.H. Dwyer, W.B. Hanson, B.R. Flay, and E.Y.I.
Ward
1991
Mediating mechanisms in a school-based drug prevention program: first-year
effects of the Midwestern Prevention Project. Health Psychology 10(3):164-172.
Magnussen, D., H. Statin, and V. Allen
1986 Differential maturation among girls and its relation to social adjustment: a longi-
tudinal perspective. In P. Baltes, D. Featherman, and R. Lerner, eds., Life Span
Development and Behavior. Hillsdale, N.J.: Erlbaum.
McAlister, A.L., C. Perry, J. Killen, L.A. Slinkard, and N. Maccoby
1980 Pilot study of smoking, alcohol, and drug abuse prevention. American Journal of
Public Health 70-719-721.
McCord, W., and J. McCord
1962 A longitudinal study of the personality of alcoholics. In D.J. Pittman and C.R.
Snyder, eds., Society, Culture, and Drinking Patterns. New York: Wiley.
McGuire, W.J.
1964 Inducing resistance to persuasion. In L. Berkowitz, ea., Advances ~n Experimental
Social Psychology, Vol. 1. New York: Academic Press.
McMillan, D.W., and D.M. Chavis
1986 Sense of community: a definition and theory. Journal of Community Psychology
14:6-23.
Monnelly, E.P., E.M. Hartl, and R. Elderkin
1983 Constitutional factors predictive of alcoholism in a follow-up of delinquent boys.
Journal of Studies on Alcohol 44:530-537.
Moskowitz, J.M.
1987a The Primary Prevention of Alcohol Problems: A Critical Review of the Research
Literature. Berkeley, Calif.: Prevention Research Center.
Moskowitz, J.M.
1987b School Drug and Alcohol Policy: A Preliminary Model Relating Implementat~on
to School Problems. Berkeley, Calif.: Prevention Research Center.
National Commission on the Role of the School and the Community in Improving Adolescent
Health
1990 Code Blue: Uniting for Healthier Youth. Alexandria, Va.: National Association
of State Boards of Education, and Chicago, Ill.: American Medical Association.
Newcomb, M.D., and P.M. gentler
1988 Consequences of Adolescent Drug Use. Beverly Hills, Calif.: Sage Publications.
OCR for page 73
CONCEPTS OF PREVENTION
73
Newcomb, M.D., and P.M. gentler
1989 Substance use and abuse among children and teenagers. American Psychologist
44:242-248.
Newcomb, M.D., and L. McGee
1989 Alcohol use and other delinquent behaviors: a one-year longitudinal analysis
controlling for sensation-seeking. Criminal Justice Behavior 16:345-369.
Newcomb, M.D., E. Maddahian, and P.M. gentler
1986 Risk factors for drug use among adolescents: concurrent and longitudinal analy-
sis. American Journal of Public Health 76(5):525-531.
Newcomb, M.D., E. Maddahian, R. Skager, and P.M. gentler
1987 Substance abuse and psychosocial risk factors among teenagers: associations with
sex, age, ethnicity, and type of school. American Journal of Drug and Alcohol
Abuse 13(4):413-433.
Nicholls, J.G.
1989 The Competitive Ethos and Democratic Education. Cambridge, Mass.: Harvard
University Press.
Getting, E.R., and F. Beauvais
1987 Common elements in youth drug abuse: peer clusters and other psychosocial
factors. Journal of Drug Issues (Spring): 133-151.
Pandina, R.J., E.W. Labouvie, and H.R. White
1984 Potential contributions of the life span developmental approach to the study of
adolescent alcohol and drug use. Journal of Drug Issues 14:253-270.
Pentz, M.A., C. Cormack, B. Flay, W.B. Hansen, and C.A. Johnson
1986 Balancing program and research integrity in community drug abuse prevention:
project STAR approach. Journal of School Health 56:389-393.
Pentz, M.A., J.H. Dwyer, D.P. MacKinnon, B.R. Flay, W.B. Hansen, E.Y.I. Wang, and C.A.
Johnson
1989 A multi-community trial for primary prevention of adolescent drug abuse: effects
on drug use prevalence. Journal of the American Medical Association 261:3259-
3266.
Pickens, R., and D. Svikis, eds.
1988 Biological Vulnerability to Drug Abuse. NIDA Research Monograph 89. Rockville,
Md.: National Institute on Drug Abuse.
Pickens, R.W., D.S. Svikis, M. McGue, D.T. Lykken, L.L. Heston, and P.J. Clayton
1991 Heterogeneity in the inheritance of alcoholism. A study of male and female twins.
Archives of General Psychiatry 48(1):19-28.
Preble E., and J.J. Casey
1966 Taking care of business: the heroin user's life on the street. International Journal
of the Addictions 4: 1 -24.
Puska, P., A. McAlister, J. Pekkola, and K. Koskela
1981 Television in health promotion: evaluation of a national programme in Finland.
International Journal of Health Education 24:2-14.
Puska, P., A. Nissinen, J. Tuomilehto, J.T. Salonen, K. Koskela, A. McAlister, T.E. Kottke, N.
Maccoby, and J.W. Farquhar
1985 The community-based strategy to prevent coronary heart disease: conclusions
from the ten years of the North Karelia Project. Annual Review of Public Health
6: 147-193.
Rennert, M.P., M.J. Telch, J.W. Farquhar, and J.D. Killen
1986 Disease and risk factor clustering in the United States: the implications for public
health policy. In lnteg'-ation of Risk Factor Interventions: Two Reports to the
Office of Disease Prevention and Health Promotion. Washington, D.C.: U.S.
Department of Health and Human Services.
OCR for page 74
74
PREVENTING DRUG ABUSE: WHAT DO WE KNOW?
Resnick, L.B., ed.
1989 Knowing, Learning, and Instruction: Essays in Honor of Robert Glaser. Hillsdale,
N.J.: Lawrence Erlbaum.
Reuter, P., R. MacCoun, and P. Murphy
1990 Money from Crime. A Study of the Economics of Drug Dealing in Washington,
D.C. Publication R-3894-RF. Santa Monica, Calif.: The Rand Corporation.
Ricks, D., and J.C. Berry
1970 Family and symptom patterns that precede schizonphrenia. In M. Roff and D.F.
Hicks, eds., Life History Research in Psychopathology. Minneapolis, Minn.: Uni-
versity of Minnesota Press.
Robins, L.N.
1966 Deviant Children Grown Up: A Sociological and Psychiatric Study of Sociopathic
Personality. Baltimore, Md.: Williams & Wilkins.
Robins, L.N.
1978 Sturdy childhood predictors of adult antisocial behavior: replications from longi-
tudinal studies. Psychological Medicine 8:611-622.
Ryan, K.
1986 The new moral education. Phi Delta Kappan (November):228-233.
Schaps, E., and V. Battistich
1991 Chapter in E. Goplerud, ea., A Practical Guide to Substance Abuse Prevention in
Adolescent. OSAP Prevention Monograph 8. DHHS Publ No. (ADM) 91-1725.
Washington, D.C.: U.S. Government Printing Office.
Schinke, S.P.
1982 A school-based model for teenage pregnancy prevention. Social Work Education
4:32-42.
Schinke, S.P., and L.D. Gilchrest
1977 Adolescent pregnancy: an interpersonal skill training approach to prevention.
Social Work in Health Care 3:159-167.
Schroeder, P.
1989 Champion of the Great American Family. New York: Random House.
Simcha-Fagen, O., J.C. Gersten, and T.S. Langer
1986 Early precursors and concurrent correlates of patterns of illicit drug use in adoles-
cents. Journal of Drug Issues 16(1):7-28.
Thomas, S.B.
1990 Social change theory: applications to community health. Pp. 45-65 in N. Bracht,
ea., Health Promotion at the Community Level. Newbury Park, Calif.: Sage
Publications.
Warner, K.E.
1977
The effects of the anti-smoking campaign on cigarette consumption. American
Journal of Public Health 67(7):645-650.
White, H.R.
1990 The drug use-delinquency nexus in adolescence. In R. Weisheit, ea., Drugs, Crime
and the Criminal Justice System. Champaign, Ill.: Anderson.
White, H.R., V. Johnson, and A. Horowitz
1986 An application of three deviance theories to adolescent substance use. Interna-
tional Journal of the Addictions 21(3):347-3 66.
Williams, T.M., and W. Kornblum
1986 Growing Up Poor. Lexington, Mass.: Lexington Books.
Willis, P.
1977
Learning to Labor: How Working Class Kids Get Working Class Jobs. New
York: Columbia University Press.
OCR for page 75
CONCEPTS OF PREVENTION
75
Zimiles, H.
1986 The changing American child: the perspective of educators. Pp. 61-84 in T.M.
Tomlinson and H.J. Walberg, eds., Academic Work and Educational Excellence.
MSSE Yearbook. Berkeley, Calif.: McCutcheon Publishing.
Zimmerman, M.A., and K.I. Maton
1992 Lifestyle and substance use among male African-American urban adolescents: a
cluster analytic approach. American Journal of Community Psychology 20:121-
138.
Zuckerman, M.
1979 Sensation Seeking: Beyond the OptimalLevel of Arousal. Hillsdale, N.J.: Erlbaum.
Zylke, J.
1987 Once identified, will high-risk families make lifestyle changes, lower coronary
disease rate? Medical News and Perspective. Journal of the American Medical
Association 258(4):
Representative terms from entire chapter:
drug abuse
