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Psychology

Family and Substance Abuse Paper

One of the most serious problems pertaining to substance abuse in the family is drug abuse by adolescents. The literature has identified a number of documented risk factors that are predictive of a young person’s likelihood of abusing illegal drugs. These factors range from individual factors, such as tendencies towards aggression and stimulus-seeking, to family factors, such as abusive, inept, or simply uncaring parents, to school and social influences, such as poor academic performance and associations with other antisocial and maladjusted young people. Fortunately, there are a number of treatments that have been studied and found to be efficacious in the treatment of drug abuse in adolescents.

To a considerable extent, drug use in adolescents can be predicted by a number of risk factors. The first group of risk factors are individual risk factors, pertaining to aspects of the individual’s personality and disposition (National Institute on Drug Abuse [NIDA], 2003, p. 6). A very important individual risk factor is out-of-control aggressive behavior, which may manifest even in very young children, and is often at least partially controlled by genetics (p. 6). If this behavior is not corrected properly, it may lead to further dysfunction in school and with peers, which in turn may contribute to such individuals turning to drugs in adolescence (p. 6). Another important risk factor is sensation-seeking: young people who display high thrill-seeking behavior and low inhibitions may be innately predisposed to seek out new experiences and new stimuli (Milkman & Wanberg, 2012, p. 40). If unchecked, these tendencies may lead them to experiment with drugs (p. 40). Adolescents with depression may also be at risk of abusing drugs, turning to them as an attempt at self-medication (p. 40). Conversely, young people who learn control and a health discipline, and who have a positive self-image, have been shown to be less at risk of abusing drugs (p. 40).

Of course, this touches on other categories of risk factors, such as familial influences: children who grow up with parents who are uncaring, inattentive and ineffective are certainly at greater risk of turning to drugs (NIDA, 2003, p. 8). Other parental influences that contribute to adolescent drug abuse include parental substance abuse, mental illness, criminal behavior, and a chaotic and even abusive home environment (p. 8). Parents who are physically or sexually abusive often produce adolescents who abuse drugs (Milkman & Wanberg, 2012, p. 66). Conversely, parents who are attentive, caring, and exercise their authority by setting boundaries and maintaining a certain amount of discipline tend to raise young people who are at much less risk for drug abuse (NIDA, 2003, p. 8). In sum, the type of environment that an adolescent experiences in their family and home life plays a major role in determining whether or not they are likely to abuse drugs (p. 8).

Other possible risk factors are found in adolescents’ social environments outside the home (NIDA, 2003, p. 9). Teenagers who engage in aggressive and/or impulsive behavior in the classroom are at higher risk, and related factors, which often cluster together, include poor academic performance, poor social coping skills, and associating with other young people with behavioral problems such as drug abuse (Milkman & Wanberg, 2012, p. 43; NIDA, 2003, p. 9). Young people who associate with antisocial peers are at elevated risk of drug abuse: in fact, this is the single strongest predictor that an adolescent will use drugs. By contrast, young people who are well-adjusted and well-behaved, work hard in school, and spend time with other young people who are similarly well-adjusted are at much lower risk of abusing drugs (Milkman & Wanberg, 2012, pp. 43, 65-66; NIDA, 2003, p. 9).

There is a rich literature on interventions for adolescent drug abuse. Individual, interpersonal therapies are commonly used, notably cognitive-behavior therapy (CBT) and motivational interviewing (MI) (Feldstein & Miller, 2006, p. 638). Both CBT and MI have been correlated with successful reductions of adolescent substance abuse (p. 638). Other therapies target parental behaviors, based on the observation that parental influences play a considerable role in predicting an adolescent’s risk of substance abuse (p. 638). Family interventions are also used, based on the recommendations of some researchers for multi-level interventions in cases of adolescent drug use (p. 638).

Parental involvement is a very important factor to consider in the evaluation of efforts to treat adolescent substance abuse, and as Bertrand et al. (2013) explained, has long been a predictor of successful interventions: when parents participate actively and are attentive to the needs of their adolescent children, the outcomes of the intervention are correspondingly more efficacious (pp. 28-29). However, surprisingly few studies have examined how improvements in parenting style could in turn facilitate positive outcomes for adolescents who are abusing drugs (p. 29).

Bertrand et al. (2013) found evidence for precisely such a correlation. In a study of treatment outcomes for adolescents who were abusing drugs, as well as the parenting styles and practices of their mothers, Bertrand et al. found that the adolescents significantly reduced consumption of drugs from the time that they were admitted to a drug treatment clinic to the three-month follow-up (pp. 31- 32). The pattern largely held to the six-month follow-up, although there was a slight regression (pp. 32-33). At the same time, the psychological distress levels of the mothers declined as well (p. 33). Moreover, the adolescents’ perceptions of self-disclosure improved, although adolescents’ reported scores of parental warmth did not change (p. 33). What this study established was that increases in the mental health of parents, coupled with greater use of relevant services, are correlated with decreased substance abuse on the part of young people (p. 33). This effectively demonstrated that there is a link between improved parental practices and improved treatment outcomes for adolescents (pp. 33-34).

Although adolescent drug abuse is a widespread problem in American society, it is especially of concern in low-income inner-city neighborhoods, which often have predominantly minority populations (Collins, Ready, Griffin, Walker, & Mascaro, 2007, p. 430). The reason for this is that youth from these populations are over-represented in the criminal justice system (p. 430). There are also important concerns about the state of current knowledge regarding substance abuse by African American youth: while surveys and studies indicate that they are not particularly more likely to abuse substances than their white peers, the argument has been advanced that perhaps substance abuse is being underreported by African American youth (p. 432).

In light of these concerns and evidence that minority populations are less likely to use mental health and substance abuse treatments, Collins et al. (2007) examined the outcomes of a specific intervention plan, Drug Abuse Treatment and Education (DATE), implemented in a setting wherein most clients were adolescent African American males from low-income communities (p. 434). Typically, clients are referred by the juvenile court system, and often have Disruptive Behavior Disorders as well as substance abuse issues (p. 434). Other problems include poor educational performance, any number of psychosocial stressors, family violence, and parental substance abuse (pp. 434-435).

In order to address these many sources of dysfunction, DATE involves the family through a special intervention called Family Power (Collins et al., 2007, pp. 435-436). Family Power encourages family involvement through the lens of multidimensional family therapy (MDFT), an ecological approach that seeks to address dysfunction in relationships between family members, and correct it (p. 436). Problem-solving is a key aspect of this approach: both the young people being treated and their families are encouraged to engage with their problems and find positive, constructive ways of resolving them (pp. 436-437). Although some of the results have been promising, high rates of incompletion (63%) raise concerns that the program is not entirely sensitive to the needs of these families, and that the court orders may have created an unfortunate power differential between therapist and client (pp. 437-438).

A very important finding in the literature on adolescent substance abuse is that adolescents who acquire generic life skills tend to evince at least short-term reductions in the use of drugs (Stoil, Hill, Jansen, Sambrano, & Winn, 2000, p. 379). These ‘life skills’ include things like “problem-solving skills, decision-making skills, resistance skills against adverse peer influences, and social and communication skills” (p. 379). The importance of these skills lies with their facility in teaching young people to confront what are often difficult situations, and to make the decision to reject drug use, making this a proven strategy for prevention (p. 379).

However, contrary to some of the older research from the 1960s and 1970s, there is no consistent pattern characterizing the relationship between self-esteem and substance abuse, with both measures being self-reported (Stoil et al., 2000, p. 379). In some studies, improved self-esteem is correlated with reduced drug usage, while others show no change in drug usage whatsoever, and a few have even shown a correlation between lower self-esteem and reduced drug use (pp. 379-380). This suggests that self-esteem and tendencies to use drugs are two very different things, and any relationship between them is highly variable, differing considerably between individuals.

An encouraging finding, however, regards the efficacy of strategies that involve strong interactions between therapist and patient (Stoil et al., 2000, p. 381). Strategies such as “interpersonal counseling, mentoring, and other forms of intensive interaction” are among the best, and most well-supported (p. 381). The reason is not difficult to parse: the literature indicates that these strategies work, because they focus on the underlying factors and help young people to improve their performance in school, decrease their associations with antisocial peers, and generally improve their attitudes and outlooks on life (p. 381).

Therapies for adolescent substance abuse are growing in sophistication and efficacy. As Winters, Leitten, Wagner, and Tevyaw (2007) explained, over the course of the past two decades a great change has taken place in the field of treating adolescent substance abuse: no longer are young people treated with interventions designed for adults; instead, they are enrolled in programs that are better informed by the developmental literature (p. 197). And the literature supports this paradigm change: the evidence clearly indicates that young people do better in programs that are specifically designed for their needs and capacities (p. 197). However, treating young people for substance abuse disorders still causes a great deal of strain on community health resources, highlighting the importance of community-based interventions, notably school-based interventions (p. 197).

For school interventions to be successful, Winters et al. (2007) argued, seven factors must be observed. The first factor concerns the importance of “timing, duration, frequency, and intensity of exposure”, all of which will determine how effective the intervention can be (p. 198). The school setting is a good venue for such interventions, because it can often catch drug abuse early, and this good timing can increase the efficacy of the therapy considerably (p. 198). However, the interventions still need to be designed with the appropriate duration and intensity: if the student does not experience the intervention for long enough, and it is not intense enough methodologically, the efficacy of the intervention will be compromised accordingly (p. 198).

The second factor concerns the fidelity with which the intervention is implemented: interventions that are not carried out correctly will typically lose therapeutic power (Winters et al., 2007, p. 198). Standardization is key if an intervention approach is to succeed in a school setting. The third factor, which is closely related, concerns the relationship between the school and the staff who are implementing the program, whether the staff are from outside the school or not (p. 198). The key here is proper training and orientation for all members of the staff involved with the intervention program (p. 198). Any role conflicts, and the possibility of role overload, must also be taken into account (p. 198).

The fourth factor concerns recognition and awareness. If the program is to succeed, it is an imperative that everyone involved with it understands fully why the program is important in the first place: in other words, they must be aware of the problem and committed to changing it (Winters et al., 2007, p. 198). Proactivity is the key if the program is to succeed: the staff who carry out the program must be extremely proactive about getting absolutely everyone to ‘buy into’ the program (p. 198). What this means is that they must be prepared to do everything in their power to reach out to the students, communicate with them, and ensure that the program comes across as relevant to their needs and their perspectives (p. 198). For school administrators, the program must appear to be effective and efficient (p. 198).

The fifth factor for a successful intervention is a clearly written policy (Winters et al., 2007, p. 198). While it may be a truism to observe that drawing up a policy on paper is not the same thing as observing it in practice, the importance of a clearly written policy is considerable: it provides a guiding document for all subsequent efforts, a blueprint of what the school is hoping to achieve through the program (p. 198). This helps to ensure consistency as well as clarity of purpose and focus.

The sixth factor concerns the importance of social ecology: if an intervention is to truly succeed, it must be connected with other aspects of students’ lives (Winters et al., 2007, p. 198). This is absolutely crucial: the best interventions draw on the social ecology of a student’s many interconnected relationships with friends, family members, and neighbors (p. 198). Involving such relationships goes a very long way towards ensuring that the changes produced by the intervention will be real and meaningful, enabling them to endure long-term rather than for just a season (p. 198).

And seventh, building off of point six, the effectiveness of any intervention is always maximized when the person is able to carry out their changed condition in their natural social environment (p. 198). Engaging programs will help young people to learn important ways to do this, including finding and cultivating positive friendships with peers who will help them to reinforce behaviors that will keep them away from drugs (p. 199). By so doing, the adolescents will derive the maximum benefit from the interventions, helping them to stay clean and away from drug abuse (p. 199).

Adolescent substance abuse can be predicted by a number of factors pertaining to individual disposition, behavior, and the familial and other social environments. However, just as importantly, those same influences can be used to help young people overcome drug abuse, or even to prevent them from experimenting with drugs in the first place. Indeed, family support in particular is of fundamental importance for preventing drug abuse and helping young people to overcome it. What successful interventions all seem to have in common is their ability to engage young people, and/or their parents and other people around them: in other words, the interventions are seen as relevant, and teach important skills. By this means, young people can learn the kinds of positive, pro-social skills that they need to avoid drug abuse.

References

Bertrand, K., et al. (2013). Substance abuse treatment for adolescents: How are family factors related to substance use change? Journal of Psychoactive Drugs, 45(1), pp. 28-38. Retrieved from http://search.ebscohost.com/

Collins, M., Ready, J., Griffin, J., Walker, K., & Mascaro, N. (2007). The challenge of transporting family-based interventions for adolescent substance abuse from research to urban community settings. The American Journal of Family Therapy, 35(5), pp. 429-445. DOI: 10.1080/01926180601057515

Feldstein, S., & Miller, W. (2006). Substance use and risk-taking among adolescents. Journal of Mental Health, 15(6), pp. 633-643. DOI: 10.1080/09638230600998896

Milkman, H.B., & Wanberg, K.W. (2012). Criminal conduct & substance abuse treatment for adolescents: Pathways to self-discovery and change (2nd ed.). Thousand Oaks, CA: SAGE Publications, Inc.

National Institute on Drug Abuse. (2003). Preventing drug use among children and adolescents: A research-based guide for parents, educators, and community leaders (2nd ed.). Bethesda, MD: U.S. Department of Health and Human Services.

Stoil, M.J., Hill, G.A., Jansen, M.A., Sambrano, S., & Winn, F.J. (2000). Benefits of community-based demonstration efforts: Knowledge gained in substance abuse prevention. Journal of Community Psychology, 28(4), pp. 375-389. Retrieved from http://search.ebscohost.com/

Winters, K.C., Leitten, W., Wagner, E., & Tevyaw, T.O. (2007). Use of brief interventions for drug abusing teenagers within a middle and high school setting. Journal of School Health, 77(4), pp. 196-206. DOI: 10.1111/j.1746-1561.2007.00191.x