of Risk Behaviors in Youth:
Adolescent Substance Abuse
Prevalence and Trends in Substance Use
Kann, L., Kinchen, S. A., Williams, B. I., Ross, J. G., Lowry, R., Grunbaum,
J. A., & Kolbe, L. J. (2000). Youth Risk Behavior Surveillance-United
States, 1999. http://www.cdc.gov/mmwr/preview/mmwrhtml/ss4905a1.htm
This report is based on the results of a CDC sponsored national survey
of 9th through 12th grade students in public and private high schools
in the United States. In 1999 approximately 16,000 students were interviewed.
Data from 33 state and 16 local school-based surveys conducted in 1999
are also included. Updated information will be accessible from this web
site as it becomes available.
Monitoring the Future Survey (1997). http://www.monitoringthefuture.org/
This web site includes data from a yearly national survey. Results include
historical as well as developmental trends in drug use and are broken
down by type of drug as well as age of participant. Students are surveyed
in 8th, 10th and 12th grades and then a sample of them are followed longitudinally.
Besides the survey results, this web site also includes press releases
and other information related to the survey findings.
Substance Use and Misuse, Special Issue: Symposium on Rural-Urban Continuum,
34 (4 & 5).
This special issue highlights the importance of examining issues of substance
abuse in rural settings as well as in the urban settings that have traditionally
been studied. The studies in this volume indicate that perhaps rural and
urban drug abuse should be studied together and that similar types of
interventions would be applicable to environments across the rural-urban
continuum. The volume also includes implications for theory, research
Theories of Substance Abuse
Brooks, J. S., Richter, L., Whiteman, M., & Cohen, P. (1999). Consequences
of adolescent marijuana use: Incompatibility with the assumption of adult
roles. Genetic, Social and General Psychology Monographs, 125, 193-207.
This longitudinal study examines adolescent marijuana use and its relationship
to the adoption of conventional adult roles in adulthood. Conventional
adult roles are defined as employment, marriage, and parenthood following
marriage. Results indicate that a history of heavy marijuana use in adolescence
is related to unconventional roles in adulthood.
Negeiros, J. (1994). Theoretical orientations in drug abuse prevention
research. Drugs: Education, Prevention and Policy, 1 (2) 135-142.
This article describes the most prominent theoretical developments in
drug abuse prevention research. This review is organized around 3 broad
theoretical models: the informative communicational model, the humanistic
model and the cognitive-behavioral perspective. The article also includes
details of prevention studies that have been done using each theoretical
perspective and the evaluation studies that have followed.
Petraitis, J., Flay, B. R., & Miller, T. Q. (1995). Reviewing theories
of adolescent substance use: Organizing pieces in the puzzle. Psychological
Bulletin, 117, 67-86.
This review discusses 14 multivariate theories of experimental substance
use. All the theories have received some empirical support, although there
is some variation in the constructs addressed. Two theories cover cognitive
causes of substance use, two cover social learning models and two deal
with weakened commitment to conventional values. Four theories deal with
interpersonal characteristics which may lead to substance use, and four
theories integrate a variety of these constructs.
White, H. R., & Bates, M. E. (1993). Self-attributed consequences of cocaine
use. International Journal of the Addictions, 28 (3), 187-209.
This study examined the reasons and consequences for cocaine use in a
sample of 1270 middle- to working-class white young adults in New Jersey.
The data were taken from a six-year longitudinal study. Analyses indicated
that adolescents and young adults who used cocaine to help cope with stress
were more likely to experience negative consequences than those individuals
who used cocaine to uplift themselves, either mentally or physically.
Risk and Protective Factors
Altman, D. G., Levine, D.W., Coeytaux, R., Slade, J., & Jaffe, R. (1996).
Tobacco promotion and susceptibility to tobacco use among adolescents
aged 12 through 17 years in a nationally representative sample. American
Journal of Public Health, 86, 1590-1593.
This article examined the relationship between adolescent susceptibility
to tobacco use and exposure to marketing campaigns that are meant to increase
tobacco use. Results from 1047 telephone interviews with a random sample
of American youth indicated that despite tobacco companies' claims that
these promotions are not intended to influence adolescents, participation
in and awareness of tobacco promotions was significantly related to tobacco
susceptibility and use among adolescents. This means that adolescents
who were aware of or participated in these promotions were more likely
to either have used tobacco products in the past or to indicate that they
would use them in the future.
Andrews, J. A., Hops, H., & Duncan, S. (1997). Adolescent modeling of
parent substance use: The moderating effect of the relationship with the
parent. Journal of Family Psychology, 11, 259-270.
This study examined the role of parent-child relationships in moderating
the relationship between adolescent cigarette, alcohol, and marijuana
use and parent substance use. Analyses were run separately for mothers
and fathers, and the authors also tested for interactions between age
and gender. Results indicated that adolescents who have good relationships
with their mothers would model their mothers' cigarette use and adolescents
who had good relationships with their fathers modeled their fathers' marijuana
use. Interactive effects between age and gender were found in all other
cases. This study highlights the importance of studying age, gender and
substance effects separately.
Bailey, S. L., Flewelling, R. L., & Rachal, J. V. (1992). Predicting continued
use of marijuana among adolescents: The relative influence of drug-specific
and social context factors. Journal of Health and Social Behaviors, 33,
This longitudinal study examined 456 adolescents who had experimented
with marijuana between one and five times. These adolescents were followed
yearly for two years to determine if they continued to use marijuana or
stopped after the initial experimentation. The study examined the factors
that predicted continued use. Social context factors, which included family
and friends' involvement in and opinions about marijuana was not a significant
predictor of continued use, whereas drug-specific factors were. In particular,
believing that the physical or mental consequences of marijuana use are
not serious and having been stoned during one's initial experimentation
with the drug did predict continued use. Background characteristics such
as being white and younger also predicted continued marijuana use.
Bertrand, L. D., & Abernathy, T. J. (1993). Predicting cigarette smoking
among adolescents using cross-sectional and longitudinal approaches. Journal
of School Health, 63, 98-102.
An examination of factors which may predict cigarette smoking in adolescents
indicated that researchers can predict with a high degree of accuracy
smoking status up to three years in advance. However, concurrent prediction
produced even more accurate findings. The parent/child relationship and
peer smoking behavior appeared to be the most useful in discriminating
between smoking status. The implications of these findings for intervention
Durant, R. H., Rickert, V. I., Ashworth, C. S., Newman, C., & Slavens,
G. (1993). Use of multiple drugs among adolescents who use anabolic steroids.
New England Journal of Medicine, 328 (13), 922-926.
To better prevent steroid use, it is important to determine if steroid
use is significantly different from the use of other types of drugs. A
study of over 1800, ethnically diverse, mostly ninth grade adolescents,
found that steroid use is highly correlated with the use of other substances,
particularly cocaine and smokeless tobacco. This research further indicates
the sharing of needles is a particularly serious problem for adolescents
who use steroids.
Frauenglass, S., Routh, D., Pantin, H. M., & Mason, C. A. (1997). Family
support decreases influence of deviant peers on Hispanic adolescents'
substance use. Journal of Clinical Child Psychology, 26, 15-23.
This article examined the importance of family support on decreasing the
influence of deviant peers on low SES, mostly Hispanic, 8th graders. Findings
indicate that deviant peer association is associated with adolescent alcohol,
tobacco and marijuana use. High family support was related to decreased
levels of alcohol use for all adolescents. High family social support
was also associated with lower levels of tobacco and marijuana use for
those adolescents with a large number of deviant (substance using) peers.
Hawkins, J. D., Catalano, R. F., & Miller, J. Y. (1992). Risk and protective
factors for alcohol and other drug problems in adolescence and early adulthood:
Implications for substance abuse prevention. Psychological Bulletin, 112,
The authors argue for a risk-focused approach to substance abuse prevention
programming for adolescents. They review the literature on 17 antecedents
to drug abuse. By developing programs which target these specific factors,
knowledge about which factors are causal will be increased. The authors
recommend prevention programming beginning in early childhood and targeting
multiple risk factors.
Johnson, E. O., Schutz, C. G., Anthony, J. C., & Ensminger, M. E. (1995).
Inhalants to heroin: A prospective analysis from adolescence to adulthood.
Drug and Alcohol Dependence, 40, 159-164.
This study examined adolescent risk factors for heroin use by age 32.
The sample consisted of nearly 600 individuals who completed both the
adolescent and adult waves of an almost 30 year longitudinal study. Inhalant
use was found to be a particularly strong predictor of heroin use, although
cigarette, marijuana, and alcohol use as well as family income during
childhood all predicted heroin use in adulthood.
McGarvey, E. L., Canterbury, R. J., & Waite, D. (1996). Delinquency and
family problems in incarcerated adolescents with and without a history
of inhalant use. Addictive Behaviors, 21, 537-542.
In a study of 619 incarcerated youth, researchers found that inhalants
were more likely to be used by non-minority than minority youth. Furthermore,
adolescents who had used inhalants were significantly more likely to engage
in delinquency and have family problems.
Newcomb, M. D., & Bentler, P. M. (1989). Substance use and abuse among
children and adolescents. American Psychologist, 44, 242-248.
This review of children and adolescents and substance abuse examines literature
on various topics with a consistent focus on differentiating between substance
use and abuse. They differentiate between use and abuse based upon the
nature of the drug and the context that it is used, the ability of the
user to deal with the drug and the consequences that result from drug
use. They go on to highlight key issues associated with the patterns and
extent of drug use, causes of drug use, as well as prevention, treatment
Newcomb, M. D., Fahy, B., & Skager, R. (1990). Reasons to avoid drug use
among teenagers: Associations with actual drug use and implications for
prevention among diverse demographic groups. Journal of Alcohol and Drug
Education, 36, 53-79.
This article focused on reasons why adolescents of various demographic
groups would choose to avoid using drugs. Five reasons not to use drugs
were examined: becoming an addict, getting into trouble, losing friends,
disappointing parents or other adults, and disappointing oneself. Adolescents
were also asked how harmful they thought alcohol and marijuana were. Overall,
perceived harmfulness was most closely related to non-use of drugs, although
there were interactions between reasons not to use drugs and gender, age,
substance type and ethnicity. This study provides important information
for targeting prevention programs to specific groups of adolescents.
Newcomb, M. D., & Felix-Ortiz, M. (1992). Multiple protective and risk
factors for drug use and abuse: Cross-sectional and prospective findings.
Journal of Personality and Social Psychology, 63, 280-296.
Fourteen factors which have been previously identified as relating to
drug use and abuse were assigned to either risk or protective indices.
Analyses examined the relation of the Risk Factor Index (RFI) and the
Protective Factor Index (PFI) and their interaction to use of various
drugs. Results indicated that risk factors were positively related to
drug use and protective factors were negatively related to drug use, although
these relationships differed as a function of the drug being examined.
Results further indicated that problems associated with drug use in young
adulthood were also related to protective and risk factors.
Santor, D.A., Messervey, D. & Kusumakar, V. (2000). Measuring peer pressure,
popularity and conformity in adolescent boys and girls: Predicting school
performance, sexual attitudes and substance abuse. Journal of Youth and
Adolescence, 29, 163-182.
Peer influence has often been discussed as an important factor in adolescent
substance abuse. However the various components that go into peer influence
have not been adequately studied. The current study first attempts to
develop validated short measures to assess 3 distinct components of peer
influence; peer pressure, peer conformity and popularity. Then these constructs
are examined in relation to risk behaviors, including substance abuse.
Results indicate that peer pressure and peer conformity are greater risk
factors for substance abuse than is the need for popularity.
Shedler, J., & Block, J. (1990). Adolescent drug use and psychological
health: A longitudinal inquiry. American Psychologist, 45, 612-630.
This study investigated the relationship between personality characteristics
at ages 7, 11 and 18 and drug use at age 18. Results indicated that adolescents
who experimented with drugs but did not engage in heavy use were the most
well-adjusted. Abstainers and frequent drug users both showed adjustment
problems that were first apparent during childhood.
Swadi, H. (1999). Individual risk factors for adolescent substance abuse.
Drug and Alcohol Dependence, 55, 209-224.
This article takes an international approach to the study of risk and
protective factors for substance use. Research from many countries was
utilized in compiling this review of recent literature. Swadi concludes
that the majority of risk factors can be broken down into 3 categories;
constitutional predisposition, environmental factors, and life events.
These risk factors can be mediated by a number of protective factors.
In addition to the specific factors this review also includes a discussion
of the specific methodological issues that should be considered when reading
research on risk and protective factors.
Botvin G. J., Dusenbury L., Baker, E., James-Ortiz, S., Botvin, E. M.,
& Kerner, J. (1992). Smoking prevention among urban minority youth: Assessing
effects on outcome and mediating variables. Health Psychology, 11, 290-299.
This article describes the results of an evaluation of a social resistance/competence
enhancement approach to preventing smoking. The program was implemented
with over 3000 urban, mostly minority, 7th graders. The curriculum addressed
the major cognitive, attitudinal, psychological and social factors which
are correlated to smoking. The intervention was shown to be effective,
lowering smoking prevalence by almost 30%. The program was also shown
to impact mediators which were closely related to behavior, but there
was no effect on more distal components.
Brown, J. H., D'Emidio-Castion, M., & Pollard, J. A. (1997). Students
and substances: Social power in drug education. Educational Evaluation
and Policy Analysis, 19, 65-82.
This study used both qualitative and quantitative methods to determine
the influence of various program delivery methods on drug use in a statewide
evaluation in California. Efforts were made to include a wide range of
demographic groups. The majority of students indicated that they were
not influenced by the program and had either neutral or negative affect
toward the educators in charge of the program. These findings were stronger
for older students (7-12 grades). The authors advocate a conceptual shift
in drug abuse education to utilize more experiential teaching and allowing
students more decision-making power.
Dielman, D. E. (1994). School-based research on the prevention of adolescent
alcohol use and misuse: Methodological issues and advances. Journal of
Research on Adolescence, 4, 271-293.
This article reviews much of the research on alcohol use and misuse prevention
programs based in the schools. Following the review Dielman discusses
those previously published findings regarding the Alcohol Misuse Prevention
Study (AMPS). Specifically addressed is the effectiveness of a refusal
skills/social skills approach, the endurance of the effect, the increased
effectiveness with teens who had already experimented with alcohol, and
the importance of peer and parent influences.
Ellickson, P. L., Bell, R. M., & McGuigan, K. (1993). Preventing adolescent
drug use: Long-term results of a junior high program. American Journal
of Public Health, 83, 856-861.
An 11-lesson drug resistance curriculum for 7th and 8th graders in highly
diverse schools, indicated significant changes in drug use behavior for
the students. Long-term follow-ups showed that these effects ceased to
exist upon completion of the program, although cognitive risk factors,
including perceived norms, risks and expectations, were significantly
reduced for those adolescents who received peer-led interventions. Despite
these cognitive changes, there was no significant behavior change once
the intervention ended.
Goldberg, L., Elliot, D., Clarke, G. N., MacKinnon, D. P., Moe, E., Zoref,
L., Green, C., Wolf, S. L., Greffrath, E., Miller, D. J., & Lapin, A.
(1996). Effects of a multidimensional anabolic steroid prevention intervention:
The adolescents training and learning to avoid steroid (ATLAS) program.
JAMA, 276 (19), 1555-1562.
This study describes a steroid use prevention program targeting high school
football players from over 30 Oregon high schools. The high schools were
matched and randomly assigned to treatment and control conditions. The
intervention consisted of three parts: 1) a seven-session classroom component
conducted by coaches and trained teen leaders discussing effects of steroid
use, sports nutrition, and strength training alternatives to steroids,
2) seven weight room training classes, and 3) an informational discussion
session for parents of football players. Results indicated that adolescents
who received the intervention altered their attitudes and behaviors in
healthy ways. Many risk factors associated with steroid use were reduced,
and follow-up studies indicated that many of these results were still
significant one year later.
Gorman, D. M. (1995). Are school-based resistance skills training programs
effective in preventing alcohol misuse? Journal of Alcohol and Drug Education,
In response to previous research indicating that knowledge-based and affective
programming are ineffective in preventing substance abuse, resistance
skills training has become one of the most widely used types of programming
to prevent substance abuse. This review of resistance skills training
programs indicates that these programs may also be ineffective with the
majority of the population. The author then critiques the methodology
of those programs that do show some effect. Suggestions for how to improve
programs are also included.
Leventhal, H., & Keeshan, P. (1993). Promoting healthy alternatives to
substance abuse. In S. Millstein, A. Peterson, & E. Nightingale (Eds.),
Promoting the Health of Adolescents: New directions in the 21st century
(pp. 260-284). New York: Oxford University Press.
Provides an overview of current substance abuse prevention strategies
and their successes and failures. Much of the work on substance abuse
prevention has focused on the construction of barriers. The authors of
this chapter advocate the development of a transactional framework conceptualizing
the adolescent as an active participant. This approach is based on the
premise of healthy alternative choices for adolescents. The authors end
the chapter by making recommendations for ways in which positive alternatives
could be applied to future prevention efforts.
Lynam, D. R., Milich, R., Zimmerman, R., Novak, R., Logan, T. K., Martin,
C., Leukefeld C., & Clayton, R. (1999). Project DARE: No effects at 10-year
follow-up. Journal of Consulting and Clinical Psychology, 67, 590-593.
This evaluation of DARE, one of the most widely administered drug abuse
prevention programs in the United States, indicated that there were not
significant benefits associated with this program as opposed to regular
school drug abuse education. This evaluation performed 10 years after
the initial program period indicated no differences in drug attitudes,
drug use or self-esteem. Also included in the article is a discussion
regarding the continued popularity of this program despite the lack of
National Assembly. (1994). Building Resiliency: What Works! A Community
Guide to Preventing Alcohol & Other Drug Abuse Through Positive Youth
Development. Washington, DC: National Assembly.
This guide provides information on bridging the gap between research and
youth development. The guide seeks to explain the concepts of prevention
and youth development as well as clarify what strategies are effective
and which are ineffective in developing resiliency in adolescents. Furthermore,
this guide reviews community programs that are used to reduce drug and
alcohol abuse while promoting positive youth development.
National Institute on Drug Abuse. (1997). Preventing Drug Use among Children
and Adolescents: A research-based guide. (DHHS Publication No. 97-4212).
Washington, DC: National Institute on Drug Abuse.
This booklet details some basic prevention principles which can be used
with either community-, school-, or family-based programming. Very basic
ideas of what questions should be answered through evaluation are also
included. This source also contains information on some widely used research-based
drug abuse prevention programs. The booklet also has numerous references
and resources including contact names and addresses to obtain more information
about the specific programs described within.
NIAAA/CSAP (1995). The challenge of participatory research: Preventing
alcohol-related problems in ethnic communities. (DHHS Publication No.
SMA 95-3042). Washington, DC: CSAP.
This book discusses the need for culturally sensitive research and programming
and provides some guidelines for this to occur. Conceptual and methodological
issues are addressed, and case studies are presented from the academic,
community researcher and ethnic community strategist points of view. Case
studies presented are African American, Native American, Asian American,
and Hispanic populations. Office of Substance Abuse Prevention (1991).
Preventing Adolescent Drug Use: From theory to practice. (DHHS Publication
No. ADM. 91-1725). Rockville, MD:
Office of Substance Abuse Prevention. This book includes many of the essential
topics regarding substance abuse prevention. It includes sections on risk
and protective factors, guidelines for prevention programming, methods
of targeting high-risk adolescents and some programs which are currently
in use. Special attention is paid to being sensitive to the needs of the
Pentz, M. A. (1999). Prevention in the community. In R.T. Ammerman, P.
J.Ott & R. E. Tarter (Eds.), Prevention and societal impact of drug and
alcohol abuse (pp. 327-344). Mahwah, NJ: Lawrence Erlbaum. This chapter
addresses the importance of considering community-based alcohol and drug
abuse prevention programming. This type of programming allows for the
collaboration between multiple community groups for a common goal. Advantages
and disadvantages of these types of programs are addressed as well as
future directions for research. Much of the information in this chapter
deals with some of the more well-known community programs currently in
Shope, J. T., Copeland, L. A., Marcoux, B. C., & Kamp, M. E. (1996). Effectiveness
of a school-based substance abuse prevention program. Journal of Drug
Education, 26, 323-337.
A school-based social pressures resistance training approach to substance
abuse prevention was utilized in 6 school districts of various ethnic
composition. Fifth through eighth graders were administered this program
for two consecutive years and then compared to a control group. The first
year consisted of 6 sessions, while the second year consisted of 8 sessions.
The sample was only large enough to test the effectiveness of the program
on the 6th/7th grade cohort. While drug use increased for all groups from
6th grade to 7th grade, it increased significantly less among students
who received the program than among those students who did not receive
Swisher, J. D. (1993). Early adolescent belief systems and substance abuse.
In R.M. Lerner (Ed.), Early adolescence (pp. 369-382). Hillsdale, NJ:
This chapter emphasizes the need to examine adolescent beliefs when developing
programs to prevent substance abuse. Intrapersonal, interpersonal, and
extrapersonal beliefs as well as interventions designed to alter them
were included in the discussion. Intrapersonal beliefs included expectations
regarding future success and the perceived risk associated with drug use.
Interpersonal beliefs have been the focus of most research and encompass
the attitudes and behavior of friends and family. Extrapersonal beliefs
refer to how adolescents view the social systems around them, including
attitudes toward drug and alcohol laws.
Tobler, N. S. (1986). Meta-analysis of 143 adolescent drug prevention
programs: Quantitative outcome results of program participants compared
to a control or comparison group. Journal of Drug Issues, 16, 537-367.
Results of a meta-analysis of 143 drug prevention programs in the secondary
schools are reported. Programs were divided into five types: knowledge
only, affective, peer, knowledge plus affective, and alternative programs.
Peer programs which aim to use peer influence to decrease drug use were
found to be most effective with average populations. Alternative programs
which make no mention of drug use but provide adolescents with alternatives
through one-on-one relationships and skill building were effective for
at-risk populations. None of the other program types were as effective
in reducing drug use.
Weinstein, S. (1999). The educator's guide to substance abuse prevention.
Mahwah, NJ: Lawrence Erlbaum.
This book is an excellent resource for any individual who deals with youth.
The book includes chapters that address issues of substance abuse theory,
but primarily focuses on actual prevention and situations that arise for
those individuals who are involved in substance abuse prevention. In addition,
attention is given to the cultural structures within our society that
impact the way children and adolescents view substance abuse prevention.
Zavela, K. J., Battistich, V., Dean, B. J., Flores, R., Barton, R., &
Delaney, R. J. (1997). Say yes first: A longitudinal, school-based alcohol
and drug prevention project for rural youth and families. Journal of Early
Adolescence, 17, 67-96.
This study describes the evaluation of a multicomponent school-based primary
and secondary drug and alcohol prevention program for rural youth. Very
few programs specifically target rural teens. The Say Yes First program
provided training for staff, as well as drug prevention through a comprehensive
health education program academic programming, parent education, alternative
activities, and case management. Results indicate that greater involvement
in the Say Yes First program led to lowered drug use over time and improved
Gruenewald, P. J., Treno, A. J., Taff, G., & Klitzner, M. (1997). Measuring
community indicators: A systems approach to drug and alcohol problems.
Thousand Oaks, CA: Sage Publications.
This book includes information on how community indicators can be used
in program evaluation. Indicators that relate to the drug and alcohol
abuse problem are used specifically to illustrate this type of methodology.
A systems perspective is used throughout the book.
National Institute on Drug Abuse. (1981). Assessing marijuana consequences:
Selected questionnaire items. (DHHS Publication No. ADM 81-1150). Washington,
DC: Superintendent of Documents, U.S. Government Printing Office.
This volume includes items developed by a group of prominent researchers.
The group never condensed the items into a single concise instrument.
Evaluations of the items by these and other researchers are a part of
this volume. The evaluations are used in development of long- and short-
form instruments to assess the consequences of marijuana use and other
Rounsaville, B. J., Tims, F. M., Horton, A. M. Jr., & Sowder, B. J. (Eds.).
(1993). Diagnostic source book on drug abuse research and treatment. Washington,
DC: National Institute of Health Publication.
This volume includes a chapter which discusses the importance of using
similar measures to assess drug use and abuse. Subsequent chapters include
descriptions of various measures which assess different areas related
to drug use.