SUBSTANCE USE amp MISUSE

Vol 39 Nos 10ndash12 pp 1971ndash2016 2004

The Motivation Skills and Decision-Making

Model of lsquolsquoDrug Abusersquorsquo1 Prevention

Steve Sussman PhD1 Mitchell Earleywine PhD2

Thomas Wills PhD3 Christine Cody4 Tony Biglan PhD4

Clyde W Dent PhD5 and Michael D Newcomb PhD6

1Departments of Preventive Medicine and Psychology Institute for

Prevention Research University of Southern California Alhambra

California USA 2Department of Psychology University of

Southern California USA 3Ferkauf Graduate School of

Psychology Epidemiology and Social Medicine at the Albert

Einstein College of Medicine Yeshiva University New York

New York USA 4Oregon Research Institute Eugene Oregon

USA 5Department of Preventive Medicine Institute for Prevention

Research University of Southern California Alhambra California

USA 6Rossier School of Education University of Southern

California and Department of Psychology University of California

Los Angeles California USA

1The journalrsquos style utilizes the category lsquolsquosubstance abusersquorsquo as a diagnostic

category Substances are used or misused living organisms are and can be abused

[Editorrsquos note]

Correspondence Steve Sussman PhD USC Institute for Prevention Research

1000 S Fremont Ave Box 8 Building A-4 Room 4124 Alhambra CA 91803

USA E-mail ssussmahscuscedu

1971

DOI 101081LSUM-200034769 1082-6084 (Print) 1532-2491 (Online)

Copyright amp 2004 by Marcel Dekker Inc wwwdekkercom

ORDER REPRINTS

ABSTRACT

This article summarizes the theoretical basis for targeted prevention

programs as they apply to different high-risk groups We explain the

advantages and disadvantages of different definitions of risk and

discuss strategies for preventing drug use related problems in high-

risk youth Productive prevention programs for many at-risk groups

share similar components including those that address motivation

skills and decision making We present key aspects of these three

components and link them to theories in clinical psychology social

psychology sociology and chemical dependence treatment Among

a total of 29 promising targeted prevention programs we describe

examples of empirically evaluated intensive interventions that have

made a positive impact on the attitudes and behavior of multiple

problem youth Incorporating the perspectives of multiple disciplines

appears essential for progress in drug abuse and other problem

behavior prevention

Key Words Targeted drug abuse prevention

INTRODUCTION

Drug abuse reflects an accumulation of adverse consequences ofdrug use and appears commonly in teenagers Adolescent drug usersfrequently meet criteria for substance abuse disorders includingdangerous behavior failure to take on appropriate roles drug relatedillegal behavior and adverse social consequences (APA 1994 Newcomband Bentler 1988 1989 Sussman and Ames 2001 Sussman et al 1997Wills et al 2002) Adolescents frequently report binges of drug usewhich lead to adverse events such as overdoses accidents and otherdangers (eg unsafe sex and violence) Drug-using teens frequently enteradult roles prematurely including marrying having children anddivorcing early in life (Newcomb 1996a) They are often ill preparedfor these adult roles because they frequently drop out of high school seekjobs requiring little skill and show relatively less stability of employmentDrug-using teens also report committing more crime including theft andvandalism

Teens who use drugs often develop unusual beliefs that interfere withsolving problems coping adaptively and achieving goals and thesebeliefs subsequently lead to greater social isolation and depressionAlthough drug involvement may not serve as the sole source of all thesetroubles (Newcomb and Bentler 1988) the prevention of drug abusehas superb potential for limiting these other adverse consequences

1972 Sussman et al

ORDER REPRINTS

ABSTRACT

This article summarizes the theoretical basis for targeted prevention

programs as they apply to different high-risk groups We explain the

advantages and disadvantages of different definitions of risk and

discuss strategies for preventing drug use related problems in high-

risk youth Productive prevention programs for many at-risk groups

share similar components including those that address motivation

skills and decision making We present key aspects of these three

components and link them to theories in clinical psychology social

psychology sociology and chemical dependence treatment Among

a total of 29 promising targeted prevention programs we describe

examples of empirically evaluated intensive interventions that have

made a positive impact on the attitudes and behavior of multiple

problem youth Incorporating the perspectives of multiple disciplines

appears essential for progress in drug abuse and other problem

behavior prevention

Key Words Targeted drug abuse prevention

INTRODUCTION

Drug abuse reflects an accumulation of adverse consequences ofdrug use and appears commonly in teenagers Adolescent drug usersfrequently meet criteria for substance abuse disorders includingdangerous behavior failure to take on appropriate roles drug relatedillegal behavior and adverse social consequences (APA 1994 Newcomband Bentler 1988 1989 Sussman and Ames 2001 Sussman et al 1997Wills et al 2002) Adolescents frequently report binges of drug usewhich lead to adverse events such as overdoses accidents and otherdangers (eg unsafe sex and violence) Drug-using teens frequently enteradult roles prematurely including marrying having children anddivorcing early in life (Newcomb 1996a) They are often ill preparedfor these adult roles because they frequently drop out of high school seekjobs requiring little skill and show relatively less stability of employmentDrug-using teens also report committing more crime including theft andvandalism

Teens who use drugs often develop unusual beliefs that interfere withsolving problems coping adaptively and achieving goals and thesebeliefs subsequently lead to greater social isolation and depressionAlthough drug involvement may not serve as the sole source of all thesetroubles (Newcomb and Bentler 1988) the prevention of drug abusehas superb potential for limiting these other adverse consequences

1972 Sussman et al

ORDER REPRINTS

(McGee and Newcomb 1992) In addition decreasing the developmentof drug use-related problems in adolescence undoubtedly improvesdevelopment into young adulthood (Bachman et al 1997 Locke andNewcomb in press)

The many types of drug-abuse prevention programs includethe universal selective and indicated (Gordon 1987 NIDA 1997)Universal programs aim to influence all subjects in a context With youththese programs generally focus on keeping an entire school or communitydrug-free by preventing youth from initiating use of alcohol tobacco orother drugs (ATOD) These programs frequently address large popula-tions of youth and are often called primary prevention because they tendto focus on nonusers or early experimenters (Chassin et al 1985 Schinkeand Gilchrist 1985) Of course universal programs could containmaterial intended to apply to youth across a spectrum of risk They alsomay inadvertently generalize to higher risk youth (Chou et al 1998Griffin et al 2003) In contrast the other two types of programs targetmore specific groups Sometimes these two types of programs aregrouped together as targeted programs On the one hand selective drug-abuse prevention programs serve groups at greater risk of ATOD usemdashfor example children of alcoholic parents They are at psychosocial riskfor drug use and abuse The goal of a selective prevention program is toimpede the onset or increase of ATOD use by these at-risk youth On theother hand indicated drug-abuse prevention programs attempt to benefitindividuals who already show signs of drug involvement or related riskfactors In indicated prevention programs the primary goal is to stem theprogression of ATOD use or reduce drug involvement among the high-risk youth

Most youth who try drugs do not escalate in their use or misuse ofdrugs in adulthood (Wills et al 1996a) Perhaps prevention programsshould focus on youth at high risk for drug abuse (Newcomb 1992a)A targeted approach may save money and effort by focusing on youthwho are posited to be most likely to abuse drugs in the future rather thanusing and wasting limited resources on those who are not likely tocontinue to use drugs (Offord 2000)

Targeted Programs Which Youth Are the Ones Targeted

Applicability of substance abuse prevention programming to higherrisk populations relies on definitions of risk This term could refer to adisadvantaged socioeconomic group children of substance-user parentsrisk-takers those suffering academic problems or persons who are

Motivation Skills and Decision Making 1973

ORDER REPRINTS

targets of drug promotions by the tobacco and alcohol industries amongothers Risk factors often appear as distal (causally more remote fromsubstance use) proximal (causally close to substance use) or somewhereintermediate in the causal chain For example parental socioeconomicstatus usually operates as a distal factor (Wills et al 1996) whereas peersmoking is a proximal factor for onset (Wills and Cleary 1999) A highlevel of substance use is a proximal factor for problem use (McCrearyet al 1999 Newcomb 1992b Wills et al 2002) Indeed targetedprevention research programs have employed definitions of risk thatfall in many locations along this distal-proximal continuum At riskgroups have included six-year old children who exhibit aggressive andoppositional behaviors at school and home (CPPRG 1999 2000) At riskgroups have also included economically disadvantaged elementary schoolyouth (Giuliano 1994 Sambrano May 1999) and young children ofsubstance abuser parents (Kumpfer 1999) Older youth targeted for drugabuse prevention include economically disadvantaged 12-year olds(Sambrano May 1999 Smith et al 1995 St Pierre et al 1992) andpregnant high school teens (Goodyear et al 2002 Palinkas et al 1996)among others Other researchers have investigated potential dropoutsamong a regular high school population (Battin-Pearson et al 2000Eggert et al 1994 Johnson et al 1990 Newcomb et al 2002)

Another common perspective of risk that is particularly easy toconceptualize and operationalize in terms of social influence theory relieson the percentage of users within a social environment (Johnson et al1990) Risk for drug use increases as the percentage of drug users within alarge (eg school community) or small (eg peer group) socialenvironment increases Members of a group known for high levels ofdrug use tend to increase their own use of drugs as well For exampleschools differing in the percentage of users at baseline reflect differentlevels of risk Thus several prevention programs target alternative highschools because these tend to manifest high levels of substance use (CDC1999 Palinkas et al 1996 Sussman et al 2002)

Will Comprehensive Social Influences Programs

(Universal Prevention) Work With High-Risk Youth

Comprehensive social influences-oriented substance use preventionprograms can either reduce onset of use or decrease consumption ofcigarettes alcohol or marijuana by 50 or more At least 10 recentstudies support this approach (Botvin 1993 Hansen 1992 Skara andSussman 2003) Such programs generally address junior high school

1974 Sussman et al

ORDER REPRINTS

youth because early onset of substance use is prognostic for substance userelated problems later (Newcomb 1996a Wills et al 2001) Programeffects can last two to seven years depending on the application ofadditional programming in senior high school (Resnicow and Botvin1993 Skara and Sussman 2003)

The success of these social influence programs may differ as afunction of risk On the one hand some researchers have not foundeffects of school-based (Graham et al 1990) or community programs(Johnson et al 1990) to vary as a function of behavior (prior use)psychosocial (use by parents and friends) and demographic (economicdisadvantage) risk Some programs have even been found to be relativelyeffective among those who are defined as being at risk due to economicdisadvantage (Graham et al 1990) On the other hand preventionprograms could create reactance effects For example reactance toprograms designed to prevent cigarette smoking has been found to varywith behavioral risk (regarding cigarette smoking) (Ellickson and Bell1990) In addition prevention programs may have less effect on those athighest risk for substance abuse as opposed to use (Newcomb andBentler 1989 Tobler 1986) though this point remains debated BothGriffin et al (2003) and Chou et al (1998) investigated the effects ofuniversal programming (Life Skills Training and the Midwest PreventionProject respectively) on higher risk youth Griffin defined high-riskyouth as those that had reported academic problems and lived in a socialenvironment that contained friends who used cigarettes or alcohol Chouexamined youth that had reported 30-day smoking alcohol or marijuanause at baseline Both studies found that program effects were achieved onthese youth at a one-year follow-up

Social influences programs rely on the theory that inoculationagainst social pressures to use drugs will help prevent later use (Sussman1989) Social influence-oriented information and skills training mighthelp counteract a high-risk social milieu which implies that using drugs iscommon and desirable among peers (Salomon et al 1984) Thisapproach serves as the foundation for the entire curriculum of socialinfluence prevention programs Comprehensive social influences pro-grams can be differentiated from more narrow-focused social influenceprograms The latter programs focus on instruction of refusal assertiontraining and combating direct social influences Comprehensive socialinfluences programs often contain other skills training (eg communica-tion skills assertiveness) provide instruction in decision making andinclude activism and public commitment components While socialinfluenced-based these additional components permit youth to act ontheir environment to change it make lower-risk friends or otherwise

Motivation Skills and Decision Making 1975

ORDER REPRINTS

targets of drug promotions by the tobacco and alcohol industries amongothers Risk factors often appear as distal (causally more remote fromsubstance use) proximal (causally close to substance use) or somewhereintermediate in the causal chain For example parental socioeconomicstatus usually operates as a distal factor (Wills et al 1996) whereas peersmoking is a proximal factor for onset (Wills and Cleary 1999) A highlevel of substance use is a proximal factor for problem use (McCrearyet al 1999 Newcomb 1992b Wills et al 2002) Indeed targetedprevention research programs have employed definitions of risk thatfall in many locations along this distal-proximal continuum At riskgroups have included six-year old children who exhibit aggressive andoppositional behaviors at school and home (CPPRG 1999 2000) At riskgroups have also included economically disadvantaged elementary schoolyouth (Giuliano 1994 Sambrano May 1999) and young children ofsubstance abuser parents (Kumpfer 1999) Older youth targeted for drugabuse prevention include economically disadvantaged 12-year olds(Sambrano May 1999 Smith et al 1995 St Pierre et al 1992) andpregnant high school teens (Goodyear et al 2002 Palinkas et al 1996)among others Other researchers have investigated potential dropoutsamong a regular high school population (Battin-Pearson et al 2000Eggert et al 1994 Johnson et al 1990 Newcomb et al 2002)

Another common perspective of risk that is particularly easy toconceptualize and operationalize in terms of social influence theory relieson the percentage of users within a social environment (Johnson et al1990) Risk for drug use increases as the percentage of drug users within alarge (eg school community) or small (eg peer group) socialenvironment increases Members of a group known for high levels ofdrug use tend to increase their own use of drugs as well For exampleschools differing in the percentage of users at baseline reflect differentlevels of risk Thus several prevention programs target alternative highschools because these tend to manifest high levels of substance use (CDC1999 Palinkas et al 1996 Sussman et al 2002)

Will Comprehensive Social Influences Programs

(Universal Prevention) Work With High-Risk Youth

Comprehensive social influences-oriented substance use preventionprograms can either reduce onset of use or decrease consumption ofcigarettes alcohol or marijuana by 50 or more At least 10 recentstudies support this approach (Botvin 1993 Hansen 1992 Skara andSussman 2003) Such programs generally address junior high school

1974 Sussman et al

ORDER REPRINTS

youth because early onset of substance use is prognostic for substance userelated problems later (Newcomb 1996a Wills et al 2001) Programeffects can last two to seven years depending on the application ofadditional programming in senior high school (Resnicow and Botvin1993 Skara and Sussman 2003)

The success of these social influence programs may differ as afunction of risk On the one hand some researchers have not foundeffects of school-based (Graham et al 1990) or community programs(Johnson et al 1990) to vary as a function of behavior (prior use)psychosocial (use by parents and friends) and demographic (economicdisadvantage) risk Some programs have even been found to be relativelyeffective among those who are defined as being at risk due to economicdisadvantage (Graham et al 1990) On the other hand preventionprograms could create reactance effects For example reactance toprograms designed to prevent cigarette smoking has been found to varywith behavioral risk (regarding cigarette smoking) (Ellickson and Bell1990) In addition prevention programs may have less effect on those athighest risk for substance abuse as opposed to use (Newcomb andBentler 1989 Tobler 1986) though this point remains debated BothGriffin et al (2003) and Chou et al (1998) investigated the effects ofuniversal programming (Life Skills Training and the Midwest PreventionProject respectively) on higher risk youth Griffin defined high-riskyouth as those that had reported academic problems and lived in a socialenvironment that contained friends who used cigarettes or alcohol Chouexamined youth that had reported 30-day smoking alcohol or marijuanause at baseline Both studies found that program effects were achieved onthese youth at a one-year follow-up

Social influences programs rely on the theory that inoculationagainst social pressures to use drugs will help prevent later use (Sussman1989) Social influence-oriented information and skills training mighthelp counteract a high-risk social milieu which implies that using drugs iscommon and desirable among peers (Salomon et al 1984) Thisapproach serves as the foundation for the entire curriculum of socialinfluence prevention programs Comprehensive social influences pro-grams can be differentiated from more narrow-focused social influenceprograms The latter programs focus on instruction of refusal assertiontraining and combating direct social influences Comprehensive socialinfluences programs often contain other skills training (eg communica-tion skills assertiveness) provide instruction in decision making andinclude activism and public commitment components While socialinfluenced-based these additional components permit youth to act ontheir environment to change it make lower-risk friends or otherwise

Motivation Skills and Decision Making 1975

ORDER REPRINTS

youth because early onset of substance use is prognostic for substance userelated problems later (Newcomb 1996a Wills et al 2001) Programeffects can last two to seven years depending on the application ofadditional programming in senior high school (Resnicow and Botvin1993 Skara and Sussman 2003)

The success of these social influence programs may differ as afunction of risk On the one hand some researchers have not foundeffects of school-based (Graham et al 1990) or community programs(Johnson et al 1990) to vary as a function of behavior (prior use)psychosocial (use by parents and friends) and demographic (economicdisadvantage) risk Some programs have even been found to be relativelyeffective among those who are defined as being at risk due to economicdisadvantage (Graham et al 1990) On the other hand preventionprograms could create reactance effects For example reactance toprograms designed to prevent cigarette smoking has been found to varywith behavioral risk (regarding cigarette smoking) (Ellickson and Bell1990) In addition prevention programs may have less effect on those athighest risk for substance abuse as opposed to use (Newcomb andBentler 1989 Tobler 1986) though this point remains debated BothGriffin et al (2003) and Chou et al (1998) investigated the effects ofuniversal programming (Life Skills Training and the Midwest PreventionProject respectively) on higher risk youth Griffin defined high-riskyouth as those that had reported academic problems and lived in a socialenvironment that contained friends who used cigarettes or alcohol Chouexamined youth that had reported 30-day smoking alcohol or marijuanause at baseline Both studies found that program effects were achieved onthese youth at a one-year follow-up

Social influences programs rely on the theory that inoculationagainst social pressures to use drugs will help prevent later use (Sussman1989) Social influence-oriented information and skills training mighthelp counteract a high-risk social milieu which implies that using drugs iscommon and desirable among peers (Salomon et al 1984) Thisapproach serves as the foundation for the entire curriculum of socialinfluence prevention programs Comprehensive social influences pro-grams can be differentiated from more narrow-focused social influenceprograms The latter programs focus on instruction of refusal assertiontraining and combating direct social influences Comprehensive socialinfluences programs often contain other skills training (eg communica-tion skills assertiveness) provide instruction in decision making andinclude activism and public commitment components While socialinfluenced-based these additional components permit youth to act ontheir environment to change it make lower-risk friends or otherwise

Motivation Skills and Decision Making 1975

ORDER REPRINTS

enter lower-risk contexts (Sussman et al 1995a) Not surprisingly theseprograms exert a stronger effect than narrow-based social influenceprograms (Tobler 1986 Tobler et al 2000)

The Comprehensive Social Influences Curriculum

These curricula typically focus on five to 20 single-hour lessonsgenerally selected based on theoretical principles and pragmatic concerns(eg school acceptance of program length financial concerns) integratedinto a semester-long health education class (Glynn 1989 Sussman1991) Comprehensive social influence programs consist of threedomains Basic information encourages involvement in the curriculumand presents physical consequences information and includes (1)program overview listening and involvement (2) instruction on physicalconsequences of drug use and (3) decision making with a publiccommitment to avoid drug use

Normative social influence programming counteracts social pressureto achieve approval by using drugs Lessons focus on (1) normativerestructuring (eg taking a class poll regarding whether or not peersapprove of drug use and learning that most peers disapprove of use) (2)assertive drug refusal training and (3) assertive drug refusal practice (torefuse direct offers of drugs) Informational social influence program-ming counteracts social pressure to share similar and favorable opinionsabout drug use In these lessons (1) instructors attempt to modifyoverestimates of the prevalence of drug use They take a poll of self-reported drug use in the class and compare the actual frequency tostudent estimates of that frequency which are often markedly higher Inaddition (2) instructors increase social awareness of adult and mediainfluences that glamorize drug use and (3) students engage in activism(eg writing letters to film makers requesting correct portrayals of druguse consequences) The constituents of these three components appear inseparate curriculum lessons Many social influence programs containnine to 10 lessons and include most of these types of components(Hansen 1992 Hansen and Graham 1991 Hansen et al 1988 Pentz etal 1989 Sussman 1991 Sussman et al 1995a)

Generic social influences programs could help high risk youth ifactual or perceived social influence processes still serve as primaryantecedents of use (Sussman et al 1995b) Nevertheless life difficultiesand academic limitations may interfere with any chance of engaging high-risk youth in programming For example youth may have readinglimitations or may only be able to attend school for a limited number of

1976 Sussman et al

ORDER REPRINTS

hours per day due to taking on work commitments In addition contextsassociated with risk may make certain aspects of the program lesseffective For example high-risk youth may be reluctant to make a publiccommitment not to use Normative social influence lessons also may notwork as planned with groups of high-risk youth The norms associatedwith the group may not include key components like a low rate of druguse and disapproval of drugs In addition these youth may not want tolearn to refuse offered drugs They may prove less likely to participate inactivism perhaps in part because they may feel less hopeful than othersthat they can change their social environment More research with higherrisk populations will better assess the potential applicability of socialinfluence prevention programming (Chou et al 1998)

Comprehensive life skill training is another variant of universalprogramming This type of programming adds material to comprehensivesocial influences programming such as coping skills and effectivecommunication skills in different situations (eg in relationshipdevelopment) This type of programming provides even more promiseperhaps for the breadth of applicability of universal preventionprogramming for high-risk youth (Griffin et al 2003) However thereis scant evidence that this programming would succeed with older teensor emerging adults who may be at highest risk for drug abuse Clearly aneed exists for much more research on the applicability of universalprogramming to different groups

What Material Appears in Targeted Drug Abuse

Prevention Programming

A model of prevention that may have greater relevance for at-riskteens incorporates motivation skills and decision making Relevantprograms attempt to enhance studentsrsquo motivations skills and decisionsto avoid drug abuse and anticipate or avoid problematic situations thatmay facilitate drug use Ideally youth learn that stereotypes about druguse are inaccurate that their perceptions of drug users are overly positiveand are not shared by other teens that their own attitudes about drugsmay reflect their attitudes about themselves and their health and thatvaluing health can facilitate other meaningful goals In addition studentscan learn skills for making changes including effective listeningcommunication and self-control (Watson and Tharp 2002 Wills et alin press-a) Finally they learn to make decisions about their behavior byweighing accurate information about drug use and by engaging in the

Motivation Skills and Decision Making 1977

ORDER REPRINTS

hours per day due to taking on work commitments In addition contextsassociated with risk may make certain aspects of the program lesseffective For example high-risk youth may be reluctant to make a publiccommitment not to use Normative social influence lessons also may notwork as planned with groups of high-risk youth The norms associatedwith the group may not include key components like a low rate of druguse and disapproval of drugs In addition these youth may not want tolearn to refuse offered drugs They may prove less likely to participate inactivism perhaps in part because they may feel less hopeful than othersthat they can change their social environment More research with higherrisk populations will better assess the potential applicability of socialinfluence prevention programming (Chou et al 1998)

Comprehensive life skill training is another variant of universalprogramming This type of programming adds material to comprehensivesocial influences programming such as coping skills and effectivecommunication skills in different situations (eg in relationshipdevelopment) This type of programming provides even more promiseperhaps for the breadth of applicability of universal preventionprogramming for high-risk youth (Griffin et al 2003) However thereis scant evidence that this programming would succeed with older teensor emerging adults who may be at highest risk for drug abuse Clearly aneed exists for much more research on the applicability of universalprogramming to different groups

What Material Appears in Targeted Drug Abuse

Prevention Programming

A model of prevention that may have greater relevance for at-riskteens incorporates motivation skills and decision making Relevantprograms attempt to enhance studentsrsquo motivations skills and decisionsto avoid drug abuse and anticipate or avoid problematic situations thatmay facilitate drug use Ideally youth learn that stereotypes about druguse are inaccurate that their perceptions of drug users are overly positiveand are not shared by other teens that their own attitudes about drugsmay reflect their attitudes about themselves and their health and thatvaluing health can facilitate other meaningful goals In addition studentscan learn skills for making changes including effective listeningcommunication and self-control (Watson and Tharp 2002 Wills et alin press-a) Finally they learn to make decisions about their behavior byweighing accurate information about drug use and by engaging in the

Motivation Skills and Decision Making 1977

ORDER REPRINTS

cognitive process of decision making These three basic elementsmdashmotivation skills and decision making (MSD model)mdashcomprise proto-typical targeted prevention programming

Is Targeted Drug Abuse Prevention Programming

A Transdisciplinary Fusion

Many research arenas provide the theoretical underpinnings fortargeted prevention programming Clinical and social psychologysociology chemical dependency studies and research on learning andmotivation all provide valuable information for these programs Clinicalpsychology supplies many of the cognitive-behavioral principles centralto these prevention programs including ideas about bonding assertive-ness self-efficacy self-talk and self-control (Miller and Brown 1991Rathus and Nevid 1977 Zimmerman 2000) Social psychologicalresearch also informs the program including work on attitudes in-groupand out-group stereotypes the false consensus effect and health beliefs(Blanton et al 1998 Sussman 1996) Relevant ideas from sociologyinclude theories pertaining to belief myth creation such as NeutralizationTheory Mystification Theory and Perceived Effects Theory Therecovery and addiction literature adds the notions of enabling familyroles and progression of chemical dependency consequences Researchon learning and motivation adds classical notions of direction and energycomponents of motivation and motivational interviewing Severalprograms have incorporated all of these ideas in their development(see Table 1) (Dent et al 2001 Fuqua et al 2004 Sussman 1996Sussman et al 1998)

Motivation

Motivation appears in behavioral science research as early as Sully(1884) who described motives as driving forces that lead to actionDewey (1886) stated that lsquolsquoa desire when chosen becomes a motiversquorsquo Theseattempts at definingmotivation influenced the work of Young (1936) whostudied the effects of motivation on human behavior Human motivesoffer answers to the question of why a person performs a given behaviorThese motives include descriptors such as lsquolsquowants needs annoyancesdiscomforts cravings which is the effect of activity to change or eliminatersquorsquo(Young 1936) Coping motives for substance use (ie using drugs to feelmore self-confident relieve boredom decrease negative affect or cheer up

1978 Sussman et al

ORDER REPRINTS

when feeling down) are an important predictor of substance use problemsin adolescence (Newcomb et al 1988 Wills et al 1999)

Conversely many also view motivation as the likelihood that anindividual will pursue and continue a specific program of behaviorchange (Council of Philosophical Studies 1981 Miller and Rollnick1991 Miller et al 1993) Motivation is essential to health promotionefforts Several independent attempts to harness motivation as an appliedresearch tool have led to some divergence in conceptions and applicationsof this construct These definitions vary as a function of considering goals(direction) or tendencies to act (energy) (Bindra and Stewart 1966)These definitions also vary as a function of whether motives areconsidered singly (Cummings et al 1988) as a series of stages(Transtheoretical Model) (Prochaska and DiClemente 1982) or systemi-cally (ie as feedback loops) (Karoly 1993 Sommers 1972) Furtherthese definitions vary as a function of the source of motivation whetherextrapersonal or intrapersonal (Curry et al 1990)

Nezami Sussman and Pentz (2003) describe direction-energycognitive-behavior intrinsicndashextrinsic and stage-homeostatic aspects ofmotivation The direction-energy model posits the need to consider twocomponents of motivation a goal and the energy to reach the goalDesire to change is a simple notion regarding how much a person wantsto achieve a goal it reflects an energy component of the classicalmodel Early statements of the direction-energy model (Bindra andStewart 1966) do not consider direction and energy componentstemporarily sequenced Rather this model considers both componentsas operating simultaneously Lichtenstein and Glasgow (1997) consider atemporal formulation of these components as readiness and persistencemotivation

The Transtheoretical Model posits a series of stages Earlier onesinvolve establishing a cognitive commitment to a goal later ones involvebehavioral effort to complete the goal Motivational interviewing acompanion to the Transtheoretical or stages-of-change model involves aseries of procedures for therapists to help clients clarify goals and persistwith their efforts to change behavior This model places an emphasis oncognitive and behavioral processes arranged in a temporal order

The intrinsicextrinsic framework generally posits that individuals aremore likely to achieve goals when they identify with their desirability asopposed to reaching the goal as an intermediate step toward some otherreward (involving some other goal) The self-efficacy theory posits thatpeople will change if they are confident that they can achieve a possibleoutcome this theory best reflects an intrinsic motive However prudentuse of extrinsic rewards might be an effective addition to a comprehensive

Motivation Skills and Decision Making 1979

ORDER REPRINTS

when feeling down) are an important predictor of substance use problemsin adolescence (Newcomb et al 1988 Wills et al 1999)

Conversely many also view motivation as the likelihood that anindividual will pursue and continue a specific program of behaviorchange (Council of Philosophical Studies 1981 Miller and Rollnick1991 Miller et al 1993) Motivation is essential to health promotionefforts Several independent attempts to harness motivation as an appliedresearch tool have led to some divergence in conceptions and applicationsof this construct These definitions vary as a function of considering goals(direction) or tendencies to act (energy) (Bindra and Stewart 1966)These definitions also vary as a function of whether motives areconsidered singly (Cummings et al 1988) as a series of stages(Transtheoretical Model) (Prochaska and DiClemente 1982) or systemi-cally (ie as feedback loops) (Karoly 1993 Sommers 1972) Furtherthese definitions vary as a function of the source of motivation whetherextrapersonal or intrapersonal (Curry et al 1990)

Nezami Sussman and Pentz (2003) describe direction-energycognitive-behavior intrinsicndashextrinsic and stage-homeostatic aspects ofmotivation The direction-energy model posits the need to consider twocomponents of motivation a goal and the energy to reach the goalDesire to change is a simple notion regarding how much a person wantsto achieve a goal it reflects an energy component of the classicalmodel Early statements of the direction-energy model (Bindra andStewart 1966) do not consider direction and energy componentstemporarily sequenced Rather this model considers both componentsas operating simultaneously Lichtenstein and Glasgow (1997) consider atemporal formulation of these components as readiness and persistencemotivation

The Transtheoretical Model posits a series of stages Earlier onesinvolve establishing a cognitive commitment to a goal later ones involvebehavioral effort to complete the goal Motivational interviewing acompanion to the Transtheoretical or stages-of-change model involves aseries of procedures for therapists to help clients clarify goals and persistwith their efforts to change behavior This model places an emphasis oncognitive and behavioral processes arranged in a temporal order

The intrinsicextrinsic framework generally posits that individuals aremore likely to achieve goals when they identify with their desirability asopposed to reaching the goal as an intermediate step toward some otherreward (involving some other goal) The self-efficacy theory posits thatpeople will change if they are confident that they can achieve a possibleoutcome this theory best reflects an intrinsic motive However prudentuse of extrinsic rewards might be an effective addition to a comprehensive

Motivation Skills and Decision Making 1979

ORDER REPRINTS

Table

1

Promisingdruguse

preventionprogramsfortargeted

effectsonchildrenandteens

Inclusion(ornot)

ofMSD

Components

Nameof

program

Baseline

gradeage

range

Definition

ofrisk

Program

modalities

Motivation

Skills

Decision

making

Other

features

Drug

effects

Across

ages

9ndash13

Disadvantaged

socioeconomic

status(SES)

Schoolfamily

community-

based

No

Yes

Yes

Adult

mentoring

community

service

Tobacco

alcohol

Big

Brothers

Big

Sisters

of

America

(BBBSA)

6ndash18

Single

parent

homes

Homeand

agency

based

mentoring

case

manager

Goal

setting

Yes

No

Adultfriend

provided

matched

with

youth

Alcoholand

anydruguse

initiation

Brief

Strategic

Family

Therapy

(BSFT)

6ndash17

Rebellious

truant

delinquent

druguse

problem

peers

Community

agencies

based

family

treatm

ent

No

Yes

No

Treatm

entcan

beatthe

agency

or

home

counselors

are

well-trained

Marijuana

StrivingTogether

toAchieve

Rew

arding

Tomorrow

(CASASTART)

8ndash13

Disadvantaged

socioeconomic

status(SES)

Case

manager

community

activities

parents

tutors

mentors

Incentives

to

participate

Yes

Yes

Alsopolice

involved

lsquolsquoGateway

drugsrsquorsquoand

lsquolsquohard

drugsrsquorsquo

(30-dayuse)

CreatingLasting

Family

Connections

(CLFC)

11ndash15

Disadvantaged

socioeconomic

status(SES)

Community

unit3parent

and3youth

training

modules

No

Yes

No

Canbe

implemented

inmany

different

settings

80hof

programming

Delayed

onset

anddecreased

use

of

substances

1980 Sussman et al

ORDER REPRINTS

Cross-site

Evaluationof

HighRisk

Youth

(CSAP-H

RY)

9ndash1766

female

Disadvantaged

socioeconomic

status(SES)

Classroom-

style

experiential

youth

parents

families

No

Yes

No

47programs

were

evaluatedasa

setan

averageof

234hof

instruction

at6-m

onth

follow-up

Cigarettes

alcohol

marijuanaon

12ndash17year

oldsnoton

9ndash11year

olds

EarlyRisers

Skillsfor

Success(ER)

6ndash10

Disadvantaged

socioeconomic

status(SES)

aggressiveor

oppositional

behavior

Parent-school-

childskills

trainingand

contingency

managem

ent

Contingent

reinforce-

mentof

aggressive

behavior

homevisits

groups

Yes

Yes

Academ

ic

instruction

Social

academ

ic

anddiscipline

improve-

mentsdrug

use

not

assessedyet

Fast

Track

Prevention

Trial

(FTPATHS)

1stndash6th

grade

(most

in1st

and5th

grade)

Impulsive

oppositional

(fighttease

disobey)

Schooland

homevisits

Notreally

Yes

Yes

Academ

icskills

too1year

follow-upof

youngest

youth

Social

emotional

academ

ic

effectsdrug

effectsnot

assessedyet

Family

Effective-ness

Training(FET)

6ndash12

Hispanic

immigrant

families

parent-child

conflict

oppositional

Parenting

skillsfamily

counseling

bicultural

skills

Cultural

tailoring

Yes

Yes

Canbe

implemented

inmany

different

settings

highly

trained

counselors

over

13weeks

Socialfamily

emotional

discipline

improve-

mentsdrug

effectsnot

assessedyet

(continued

)

Motivation Skills and Decision Making 1981

ORDER REPRINTS

Table

1

Continued

Inclusion(ornot)ofMSD

Components

Nameof

program

Baseline

gradeage

range

Definition

ofrisk

Program

modalities

Motivation

Skills

Decision

Making

Other

features

Drug

effects

Functional

Family

Therapy

(FFT)

11ndash18

Atrisk

or

presenting

multiple

problems

inconduct

Community

locations

Communica-

tiontraining

parenting

skills

contracting

response-

coststools

Yes

Yes

No

8ndash26hof

directservice

time

contexts

are

adaptable

toneeded

application

skilled

counselors

Tem

porary

effectson

druguse

preventionof

penetrating

adultcrim

inal

system

and

other

rela-

tivelysevere

system

sof

care

The

Incredible

Years

(IY)

2ndash8

Disadvantaged

socioeconomic

status(SES)

aggressiveor

oppositional

behavior

School-or

clinic-based

childparent

andteacher

programs

No

Yes

Yes

Academ

icskills

too45child

group-

therapy

hours60

child-

classroom

hours30

parenthours

28teacher

hours

Discipline

improve-

mentsdrug

use

not

assessedyet

Leadership

and

Resiliancy

Program

(LRP)

14ndash19

High

absenteeism

discipline

problems

substance

use

School

(resiliency

groups)

alternative

activities

community

service

Yes

Yes

No

Upto

4years

of

programming

Grade

school

discipline

andarrests

improve-

mentsno

druguse

effects

indicated

1982 Sussman et al

ORDER REPRINTS

LifeSkills

Training(LST)

7th

Exposedto

substance-using

(cigarettes

and

alcohol)peers

andpoor

academ

ics

School-based

classroom

Cultural

tailoring

Yes

Yes

Universalcom-

prehensive

life

skills

program

tested

with

at-risk

youth

1year

follow-up

Smoking

alcohol

inhalants

polydrug

not

marijuana

LinkingInterests

Families

andTeachers

(LIF

T)

1st

and5th

Atrisk

neighborhoods

withhigh

juvenile

delinquency

School-based

classroom

playground

6parent

meetings

No

Yes

Yes

Playground

groups

form

ed

Lessaggression

onplay-

groundand

better

classroom

behavior

druguse

not

assessedyet

Midwest

Prevention

Project

(MPP)

6th

and7th

Baselinemonthly

users

of

cigarettes

alcoholor

marijuana

School-based

classroom

parents

media

community

Notreally

maybesome

community

supports

Yes

Yes

Universalcom-

prehensive

social

influence

program

tested

with

at-risk

youth

35

year

follow-up

Smokingand

alcoholeffect

at15

years

vanished

by

35

yearsnot

marijuana

Multi-system

ic

Therapy(M

ST)

12ndash17

Chronically

violent

substance-

abusing

juvenile

offenders

Family-

oriented

home-based

increase

support

network

Empower

parents

Yes

Yes

Highly

trained

therapist

involved

in60

contact

hours

over

4months

Decreaseddrug

use

and

re-arrests

andim

proved

family

functioning

(continued

)

Motivation Skills and Decision Making 1983

ORDER REPRINTS

Table

1

Continued

Inclusion(ornot)

ofMSD

Components

Nameof

Program

Baseline

GradeAge

Range

Definition

ofRisk

Program

Modalities

Motivation

Skills

Decision

Making

Other

Features

Drug

Effects

Multi-

dim

ensional

Treatm

ent

Foster

Care

(MTFC)

9ndash18

Chronic

conduct

orem

otional

disturbance

crim

inal

behavior

Home-

and

school-based

MTFC

home

placement

case

managem

ent

Positive

reinforcers

Yes

No

Highly

trained

counselors

weekly

parent

groups

family

therapy

community

mentoring

andmonitor-

ing

behavior

modification

Decreasedhard

drugusejail

timeand

arrests

Nurse-Family

Partnership

(NFP)

First-tim

e

mothers

Motherswithno

income

often

teen

mothers

Homevisits

resource

advocacy

No

No

Yes

Highly

trained

counselors

pregnancy

to

2years

old

Decreased

smokingand

alcoholuse

among

mothers

reducedrates

ofchildabuse

Preventive

Intervention

(PI)

7th-8th

Pooracadem

ic

andschool

discipline

family

problems

School-based

skillsand

monitoring

Positive

reinforcers

Yes

No

Increase

child

teacher

parentcom-

munication

role

play

pro-social

alternatives

Lesshard

drug

useless

delinquency

higher

grades

andbetter

attendance

1984 Sussman et al

ORDER REPRINTS

Preventive

Treatm

ent

Program

(PTP)

7ndash9

Disadvantaged

socioeconomic

status(SES)

disruptive

School-based

parentand

childskills

and

monitoring

Positive

reinforcers

Yes

No

17sessionsfor

parent19for

child

separately

parent-

monitoring

andshaping

ofchild

child-

pro-social

skillsand

selfcontrol

Lesslikelihood

ofhaving

beendrunk

ortaken

drugsin

last

12months

less

fighting

andstealing

Project

PATHE

12ndash18

Disadvantaged

socioeconomic

status(SES)

low

achieving

disruptive

School-based

activitiespeer

counseling

schoolpride

jobseeking

Yes

Yes

No

Academ

ic

skillstoo

Decreaseddrug

involvem

ent

school

alienation

discipline

problems

higher

graduation

rates

Project

STATUS

12ndash18

Potential

dropouts

Schoolclim

ate

optionsclass

(socialrules

norm

s)

Accountability

No

Yes

Youth

leadership

staff

development

parent

meetings

community

resources

Lessdrug

involvem

ent

forjunior

highyouth

bettergrades

anddiscipline

(continued

)

Motivation Skills and Decision Making 1985

ORDER REPRINTS

Table

1

Continued

Inclusion(ornot)ofMSD

Components

Nameof

Program

Baseline

GradeAge

Range

Definition

ofRisk

Program

Modalities

Motivation

Skills

Decision

Making

Other

Features

Drug

Effects

Project

STEP

14ndash18

Disadvantaged

socioeconomic

status(SES)

low

achieving

disruptive

Schoolphysical

settinghome

room

teacher

role

Accountability

No

No

Homeroom

teachersact

ascounselors

andadvisors

Lessdrug

involvem

ent

bettergrades

anddiscipline

Project

SUCCESS

14ndash18

Alternativehigh

schoolyouth

School-based

counseling

and

education

SAPmodel

No

Yes

Yes

Highly

trained

counselorsasse-

ssment8-session

classgroup

counseling

parentmeeting

referral

Decreased

problem

behavioruse

ofmarijuana

tobaccoand

alcohol

Project

Towards

NoDrugAbuse

(TND)

14ndash19

Alternativehigh

schoolyouth

School-based

classroom

12

sessions

Yes

Yes

Yes

Trained

teachers

Decreaseduse

ofcigarettes

alcoholmar-

ijuanahard

drugsweapons

carrying

Quantum

Opportunities

Program

(QOP)

9thndash12th

Disadvantaged

socioeconomic

status(SES)

familieson

public

assistance

Schoolhome

and

community

contexts

skillsservice

and

education

Money

Yes

Yes

250education

hours250life

skillshoursjob

preparationcul-

turalenrichment

and250hcom-

munityservice

monetary

incentives

Nodruguse

effectsrepor-

tedincrease

inhighschool

graduation

less

likelyto

becomeateen

parentslightly

less

likelyto

be

arrested

1986 Sussman et al

ORDER REPRINTS

Reconnecting

Youth

(RY)

14ndash18

Atrisk

for

drop-out

School-based

90-session

class

Groupsupport

Yes

Yes

Smallstudent

groups

support

highly

trained

teachera

semester

Decreasedhard

druguse

perceived

stress

improved

grades

Residential

Student

Assistance

Program

(RSAP)

14ndash17

Livingin

residential

facilities

Residential-

based

education

program

assessm

ent

counseling

referral

No

Yes

Yes

Highly

trained

counselors

placedin

residential

facilities

8-session

drug

education

individual

andgroup

counseling

Decreaseduse

ofmarijuana

tobaccoand

alcohol

Strengthening

Families

Program

(SFP)

6ndash12

Childrenof

substance

users

Agency-based

14session

skillstraining

No

Yes

Yes

Highly

trained

counselors

parents

and

childseen

separately

firsthour

together

at

thesecond

hour

Reduces

aggression

increases

family

cohesion

immediate

effectson

druguse

Motivation Skills and Decision Making 1987

ORDER REPRINTS

model of drug abuse prevention We see this intrinsicextrinsic motiva-tion notion as providing intrapersonal and extrapersonal stimuli (cues)for action

Finally self-regulation models posit that one is motivated to achievean optimal state or system balance In essence an awareness of lack ofbalance will lead to efforts to restore balance (Carver and Scheier 1998Karoly 1980 1993) Drug abuse prevention may demand considerationof alternative actions in order to maintain homeostasis Affect may serveas the main homeostatic mechanism If people feel good or neutral theywill tend to maintain a given course of behavior On the other hand ifthey feel poorly they will want to change their behavior (as in the law ofeffect)

Constituents are those elements that when combined togethercompose a theoretical structure Seven constituents of motivation appearacross the four general theories (Nezami et al 2003) First the idea ofdiscrepancies appears in all theories Motivation exists as a distancebetween what is and what could be and these models assume that peopledesire to reduce such discrepancies Second motivation functions by theestablishment of goals Third motivation exists as energymdasha want ordrive Goals and the accompanying drive to achieve them usually appeartogether Fourth motivation may appear as a series of stages that lead toan end Different goals may operate at different stages Fifth motivationreflects ambivalence about two or more competing goals or behaviorsWorking through ambivalence enhances motivation Sixth motivationarises from different sources usually intrapsychic or environmentalrewards Finally a homeostatic conceptualization of motivation rests onthe idea of maintaining an optimal set point within a regulatory system

Integrations of these four models of motivation could help achievethe prevention of drug abuse One view suggests that due to lifeexperiences people consider goals or directions For example teens maystart to experiment with drugs due to curiosity perceived social pressureor as a means to induce a life change They may subsequently take risksthat injure their relations with others or impair their achievement inschool At some point a discrepancy likely develops between currentcircumstances and their goals For example teens may know that drugabuse is inconsistent with some life goals like school achievementHowever they may value social interaction and physical pleasure whichthey may reach through drug use or other means

Multiple goals may conflict with each other leading to ambivalence(Karoly 1993) Extrinsic and intrinsic sources of input may helpresolve ambivalence For example as the rewards associated with drugabuse diminish teens may experience a desire to decrease their drug

1988 Sussman et al

ORDER REPRINTS

consumption They may prove more likely to adopt a new goal ofdecreased drug use especially if they believe that they could achieve thegoal as self-efficacy theory suggests

Teens may exert energy to reduce discrepancies between currentstates and desired states They may learn new life or social skills whichcan lead them to become involved in rewarding but nondrug-usingactivities (Carroll 1996) In addition they may become involved in newtypes of social networks containing low-risk rather than high-risk peers(Valente et al 2004 Wills et al in press-b) Finally attaining a healthiergoal can create a positive optimal set point and the motivation systemprovides more positive feedback Over time through experience ofdifferent life events youth may alter the set point and begin a new goal-searching process (Sussman and Unger 2004) One may experience atraumatic life event for example and again consider drug use as a meansto return to an optimal set point or repeatedly get into trouble because ofassociating with deviant peers and realize that there is a need to turn todifferent types of associations

Research and theory from several disciplines suggest many motiva-tion strategies for a successful prevention program These motivationstrategies include myth correction stereotyping valuing life andachievement of health goals

Myth Correction

The recovery movement often refers to substance use and abuse as aproblem of perception Another closely related expression drug use mythsdescribes questionable or dysfunctional expectancies or beliefs that serveto justify drug use Myths involve more than expectancies or beliefs aboutpositive or negative outcomes they include inaccurate expectancies orbeliefs about the characteristics (or norms) of drugs and drug use and arelikely to confuse drug effects with drug experiences

Some common myths include inflated expectancies of positiveoutcomes from drug use or underestimates of negative outcomes fromdrug use Teens may believe that substance use will create peer groupacceptance or help them cope with family and school problems when infact the drug use only diverts them from actively coping with these socialand academic issues Thus in the long run drug use makes things worsenot better (Wills and Hirky 1996) Other myths include endorsement ofmisleading beliefs For example many adolescents believe that learningto manage drug intake without getting sick is a positive sign that theirbodies are growing tolerant to the drug rather than signaling the

Motivation Skills and Decision Making 1989

ORDER REPRINTS

beginnings of drug dependence or addiction In addition misperceptionsregarding physical consequences of drug use operate For example usersmistakenly believe that if they are able to regulate subjective effects of adrug they have gained control over use In reality warning systems maybe deteriorating as addiction begins (Glynn et al 1985 Sussman et al1995b) Challenging drug myths undoubtedly helps prevent drug abuse

These challenges can prove especially useful with high-risk popula-tions particularly if social influence programs are less effective in thesegroups Several prevention researchers have adopted a similar taxonomyof drug myths when attempting to prevent drug use Sussman Dent andStacy (1996) examined the internal consistency and discriminant validityof a measure of drug-related myths in 362 continuation (alternative) highschool youth They found good internal consistency and discriminantvalidity for the measure Controlling for its relations with socialdesirability perceived friendsrsquo drug use (a social influence measure)ethnicity and gender the myth measure remained significantly associatedwith four drug use measures Ames Sussman Dent and Stacy (1999)found a myth measure to be a relatively strong psychosocial predictor ofdrug use one-year later Cognitive perceptions obviously play a role indrug abuse prevention (Stein et al 1987) These findings suggest thatcontinued research on drug use myths should prove fruitful forprevention efforts (Sussman et al 1998 2003)

Some cognitive restructuring corrects faulty or self-defeatingcognitive structures (myths) In particular elaborating on the logicalsteps involved in the construction of a drug use myth may help to destroyits impact on behavior For example a common myth suggests thathaving trouble finding onersquos car after getting drunk is a funny event Ifone asks (a) lsquolsquoDid you want to find your carrsquorsquo (b) lsquolsquoWere you too drunk tofind it for a long timersquorsquo and (c) lsquolsquoAnd thatrsquos funnyrsquorsquo the apparent humorin the story may dissipate Further one may delineate the kernel of truthin the myth (not finding onersquos car is an odd event) from the falseaspects of the myth (not finding onersquos car indicates failure of functioningwhich is sad worrisome anxiety provoking not funny)

Stereotyping

Lower risk peers tend to perceive lsquolsquoat riskrsquorsquo others (eg alternativehigh school students) as being more deviant than they actually areUnderstandably youth so-labeled students resent this stereotypeAddressing this stereotype may help prevent drug abuse If lsquolsquoat riskrsquorsquoyouth begin to view themselves as being more deviant than they actually

1990 Sussman et al

ORDER REPRINTS

are the situation could lead to self-fulfilling prophesy as if they weregiving in to the stereotype However lowering the estimates of drug useamong their peers can correct this giving in This version of a prevalence-overestimation reduction lesson which includes a motivational featurehas appeared in successful prevention programs (Sussman et al 2002) Astereotype-oriented lesson may also accomplish a second goal If high-risk youth do not view themselves as being deviant as they assumedothers had judged them possibly reactions against this stereotype mayenergize an effort to avoid drug use as well as portray oneself morefavorably (Hamilton August 20 2000)

Valuing Life and Health Goals

Letrsquos consider the example of older teens Most youth report thatthey plan to graduate from high school and continue their educations orfind a job They do not view hanging out as a desirable option They alsosee that drug use could interfere with achieving their goals A lessonexplaining the negative consequences of drug use particularly oneconsistent with data (Newcomb and Bentler 1988) could reveal howearly involvement with drugs creates symptoms of abuse and dependenceand alters job opportunities marriage and family functioning These lifegoals can seem more valuable as students perceive them as attainableEnhancing the value of life goals can increase motivation for learningadaptive coping (Lau et al 1986) Youth have reported that drug usecould interfere with obtaining desired life goals In theme and componentstudies youth positively evaluated a lesson that taught that drug usecould interfere with obtaining desired goals and that placing animportance on health as a value was consistent with achievement of lifegoals (Sussman 1996) Thus it is important for prevention programs tohelp youth connect the importance of health to obtaining their life goalsand develop a sequenced plan so that they know how to proceed step-by-step (Karoly 1993 Watson and Tharp 2002)

Although modifiable understanding the source of positive life goalsis also important since these may occur earlier in life For instanceNewcomb and Harlow (1986) found that perceived loss of control andmeaninglessness in life mediated the relationship between negative lifeevents and drug use While numerous types of stressful events wereconsidered in this study other studies identify an adverse childhoodfamily environment as a potent precursor to later drug use (Locke andNewcomb in press Palinkas et al 1996) An adverse early homeenvironment a modifiable etiological factor should serve as a focus of

Motivation Skills and Decision Making 1991

ORDER REPRINTS

prevention that addresses child abuse and neglect (see later discussion ofthis topic)

Attitudinal Perspectives

Most youth consider themselves as being moderates They can alsoreliably identify drug use as being a deviant immoderate behaviorPresenting them with the disparity between their self-view as a moderateperson despite their deviant drug use can produce a desired behaviorchange (Sussman 1989 Upshaw and Ostrom 1984) An attitudinalperspective lesson can confront students with the inconsistency betweentheir general self-attitude ratings as moderates vs their more extremespecific behaviors (eg drug use) Adopting a self-perception as amoderate may inoculate youth when social pressures to experiment withdrugs arise A desire for internal consistency a similarity betweenattitudes and behavior may increase motivation to abstain from drugs(Festinger 1957 Heider 1958) Youth received lessons like these quitefavorably in previous work (Salomon et al 1984)

Skills

Direct instruction modeling practice and group reinforcementenhance social learning At least three basic kinds of skills needinstruction self-control communication and resource acquisition

Social Self-control Skills

Good self-control protects against substance use and buffers againstthe impact of risk factors (Bandura 1986 Catalano and Hawkins 1996Weissberg et al 1989 Wills et al 1998) Poor self-control involvesbehavioral affective and cognitive deficits Poor behavioral self-controlis associated with a need to regulate and stabilize mood possiblypreceding uncontrolled behavior or stemming from the consequences ofuncontrolled behavior Poor self-control behavior along with difficultiesin mood stabilization increases risk for substance use and rapidescalation to high levels of use which then can lead to physiologicaldependence (Wills and Stoolmiller 2002)

Self-control strategies cross physiological and personality boundariesbecause self-control also relates to coping motives for substance use a

1992 Sussman et al

ORDER REPRINTS

strong predictor of substance use problems (Wills et al 1999) Self-control includes cognition because developing self-control is the substratefor personality organization including not only behavioral and affectivecontrol but also attitudes values and views of the world as accepting orhostile and social perceptions about substance use as being attractive vsunattractive For example studies find poor self-control correlated withattitudinal tolerance for deviance and more favorable perceptions oftobacco and alcohol users whereas good self-control is related tofavorable perceptions of teens that abstain from drug use (Wills et alin press-a) Self-control approaches can be useful for preventionprograms by improving self and other perceptions academic perfor-mance and the impact or facilitation of negative life events goals that aresalient to teenagers and their parents (Wills and Stoolmiller 2002)

Youth often lack adequate coping skills they tend to lack restraint orplanfulness (Farrell and Danish 1993 Rutter et al 1997) Coping skillsinstruction may help increase self-control (Kendall and Braswell 1982)Coping skills instruction receives little attention in typical social influencesprogramming (Hansen 1992) although this material appears in life skillstraining (Botvin 1993 Botvin et al 1995 Wills 1986) In self-controlprogramming youth learn to assess their self-control particularly in socialcontexts (Sussman et al 2003) They learn the importance of thinkingahead and anticipating problem situations so that they are preparedbeforehand to deal with problems that may arise They also learn theimportance of context (eg not laughing at a funeral) Finally they learnassertiveness and anger management to help them better control theirreactions in social settings (Sambrano May 1999 Sussman et al 2002)

Listening and Communication Skills

Youth genuinely benefit from listening to information with an openmind and asking open-ended questions to keep a conversation goingThey can improve social skills by learning how to ask open-endedquestions establish eye contact appropriately nodding and orientingtheir body toward the other speaker (CPPRG 1999 Eggert and Herting1991 Hawkins et al 1999 Sussman et al 2002 2003) Neverthelesssocial skills training can create problems for nondrug using high-riskteens (Palinkas et al 1996 Sussman et al 1995b Wills et al in press-b)Training in drug refusal may create reactance in some samples (Sussmanet al 1996) Among high-risk youth enhancing assertiveness and datingskills may increase the scope of social entertainment options andinadvertently improve a teenrsquos ability to acquire drugs from new sources

Motivation Skills and Decision Making 1993

ORDER REPRINTS

(Wills et al 1989) Also there are cultural variations on what constitutesgood social skill (Unger et al 2004) There are good arguments forplacing high-risk teens together in activities with well-controlled teens sothat they can model adaptive social skills and problem solvingAdditionally utilizing motivation methods prior to instructing thespecific skill channels canalizes health-directed use of social skillsmastered Overall increasing social competence will have protectiveeffects for high-risk teens (Wills et al 1994) This idea is consistent withthe studies that have shown social withdrawal to increase risk for druguse (Kerr et al 1997) though there may be gender differences in theseeffects (Pulkkinen and Pitkanen 1994) Still it is most wise to includesocial skills training in conjunction with material addressing motivationand decision making Motivations regarding drug use need to beaddressed so behaviors learned are not misdirected

Resource Acquisition

Adults often assume that teens can access community services withlittle effort In fact few teens understand the availability of healthservices or other assistance Simple information including phonenumbers and locations can assist teens immensely (Carroll 1996Sussman et al 2002) Coaching teens on techniques for receivingassistance can prove productive Public assistance for drug use-relatedproblems and other life problems can help tremendously but negotiatingthe bureaucratic difficulties inherent in many of these systems can requireconsiderable skill (Eggert and Herting 1991 Sambrano May 1999Sussman et al 2002) Direct instruction modeling and structuredpractice in resource acquisition skills may help youth to increase theirknowledge and self-efficacy on how to acquire resources and to readilyaccess resources when needed (eg use of the bus system) These skillsmay generalize to comparable tasks later in life

Decision-Making

Prevention programs have employed several decision-making strate-gies For example the protocol from Project Reconnecting Youth(Project RY) is STEPS The acronym stands for Stop Think ofoptions Evaluate options Perform or take action on the chosen optionand then Self-praise for using steps for making healthy choices (Eggertand Herting 1991) The participants help set the agenda and take turns

1994 Sussman et al

ORDER REPRINTS

illustrating it on a flip chart This task helps share the leadership andfocuses the group work and time The lesson STEPS to Drug UseControl follows skills training sessions that cover understandingSTEPS as a decision-making model

Project Towards No Drug Abuse (TND)rsquos decision-making sessioninvolves four steps These steps are

1 Brainstorming (making a list of ideas without judging them)2 Weigh the pros and cons (the benefits and costs of each idea)3 Select the best option4 Follow through (try that option and reevaluate the decision)

(Sussman et al 2002)

These decision-making strategies are similar across different pro-grams except that they include some different emphases For exampleSTEPS includes a self-instruction to begin decision making and self-praise whereas the TND sequence includes more of an emphasis onfollowing through with the decision Generally each program requiresgenerating options evaluating them choosing the best and evaluatingthe outcome in an effort to make the next decision Teens tend to enjoypracticing decision making in bogus problem situations Youth soonlearn to engage in steps like these with considerable skill Training indecision making operates on variables that are intermediate in the causalprocess and thereby strengthen individual profiles of self-controlabilities so that they are more resilient in the face of proximal riskfactors for drug use such as life stresses and peer pressures

Modalities of Programming

Both school and nonschool prevention modalities have a rich andimportant history in substance abuse prevention research (Pentz 1994Pentz et al 2004) Schools provide a captive audience for educationalmaterial Youth spend 25 of their waking lives at school so thisenvironment has considerable potential Furthermore the school contextprovides a rich research history for building new studies and evaluatingtheir efficacy (Sussman et al 1995a) Community programs also offerconsiderable opportunity

Community programs often involve local leaders and organizations(eg coalitions community boards) (Goodman et al 1993 Kaftarianand Hansen 1994) that help mobilize numerous community unitsCommunity units include businesses media the family and governmental

Motivation Skills and Decision Making 1995

ORDER REPRINTS

agencies like the police or recreational departments as well as schoolsystems A network of community units working together to developpromote and implement educational programming could increase youthsrsquobonding to others across a wide variety of social contexts (Hawkins et al1992 Pentz 1994) Community units can provide numerous types ofspecific extra-classroom prevention opportunities (Pentz 1994)

Parent-or-family targeted prevention programs include offering earlychildhood education social support for parents managing crisesparenting skills training parent-child communication skills and resourceacquisition instruction or networking Mass media targeted programsinvolve programs or public service announcements with novel fastand unconventional messages (eg the American Legacy FoundationTRUTH campaign) use of the Internet and interactive CDs (eg videogames) Alternative means to involve youth include involvement in hikingclubs drug-free dances or other after-school events with prosocial adultmentors and with means to involve youth outside of school includingentry into different environments (ie outward bound) (Tobler 1986) Inaddition policy implementation and enforcement may contribute toother prevention programs (Pentz et al 1989) Indeed simultaneousprograms within and outside of schools over long periods might maintainthe positive effects that sometimes dissipate when school programsappear alone (Pentz 1994)

The Difference Between Targeted Prevention and Cessation

Targeted (secondary) prevention attempts to keep persons fromcrossing the invisible line where they funnel into a cycle of addiction andaccumulation of negative consequences Cessation programs (sometimesreferred to as tertiary prevention) take the stance that a behavior hasoccurred with definite and perhaps irreversible negative consequencesThe goal is to stop the behavior permit recovery from the damage learnhow to prevent relapse and learn how to live with permanent changes(eg neurotransmitter function drug use-related injury) It is not clearexactly where indicated prevention ends however and where cessationbegins For example an early version of the Project TND curriculum didnot achieve effects on cigarette smoking possibly because 46 of thesample already smoked cigarettes daily (while not engaging often in someother drug use) In a revised curriculum a smoking cessation componentwas added to the program and then an effect on cigarette smoking wasachieved Cessation material can appear with prevention material to

1996 Sussman et al

ORDER REPRINTS

maximize program effectiveness Careful program development can helpdetermine the best mix (Sussman et al 2002)

Summary of Evidence-based Targeted Drug Abuse Prevention

At present approximately 29 drug-use prevention programs havebeen evaluated favorably for their effects on drug use or other problembehavior (see Table 1) These 29 programs have been identified throughtwo sources Blueprints for Violence Prevention (Elliott 2003) and theSubstance Abuse and Mental Health Services Administrationrsquos(SAMSHA) science-based prevention programsrsquo guide (USDHHS2003) PsycINFO and MEDLINE searches of drug abuse preventionstudies since 1970 supplemented searches through these two guides (seeTable 1) Nine definitions of high-risk were used across these programsEleven programs focused on economic deprivation as the definition Sixprograms focused on delinquent behavior as the identifying characteristicto target Two programs each identified single-parent homes drug use orexposure to drug use family problems alternative high school attendanceor being at risk for dropout at a regular high school as the characteristicsto target subjects Finally one program each identified new immigrantstatus or residential facility placement as the defining characteristic ofbeing at high risk for drug use

Among these programs eight focused on preteens For example theEarly Risers program defined its high-risk youth as those 6ndash10 year-oldsthat suffered economic deprivation and exhibited aggressive or opposi-tional behavior Another five programs focused on a young teen agegroup For example Preventive Intervention defined its high-risk youthas those seventh to eighth graders who exhibited poor school andacademic discipline and reported family problems Another sevenprograms focused on an older teen age group For example ProjectTND defined its high-risk youth as those youth that attended alternativehigh schools Finally nine programs encompassed wide age ranges Forinstance Big Brothers Big Sisters of America defined its high-risk youthas 6ndash18 year-olds that lived in single-parent homes

Of these programs 10 involved multiple often flexible settings ofimplementation Another 13 programs focused on the school settingFour programs focused on the home setting Finally two programsfocused on a community agency setting In general these programsinvolved implementation by highly trained personnel Eighteen of theseprograms involved some motivation aspect generally motivationenhancement but sometimes including extrinsic reinforcement strategies

Motivation Skills and Decision Making 1997

ORDER REPRINTS

Twenty-six of these programs provided skills training Finally 18programs provided instruction in decision making Thus the MSDmodel tends to appear in a majority of these programs however all threecomponents were included together in only nine of these programs

Twenty of these programs involved at least one replication of theprogram and 14 involved three or more replications Further 14 of theseprograms were tested through use of experimental designs and nineinvolved use of only quasi-experimental designs Effects on drug use wereassessed and found in 22 of these programs For example theReconnecting Youth program was implemented to youth at risk fordropout This program involved 90 sessions within a comprehensive highschool class delivered generally over a semester with small studentgroups and a highly trained teacher Instruction included use of groupsupport and providing life skills training (norm setting self-esteem moodmanagement communication skills self-monitoring monitoring goalsschool bonding and social activities) with feedback to parents Programgoals were achieved through use of a quasi-experimental design showingeffects for school performance (18 improvement in grades) drug use(54 decrease in hard drug use) and suicide risk (32 decline inperceived stress) This programrsquos results have been replicated numeroustimes in numerous locations This program involved all three componentsof the MSD model except that motivation was provided through peergroup support not through provision motivation enhancement strate-gies These targeted programs present an optimistic picture for drug-useprevention that is focused on at-risk youth (see Table 1)

Not all targeted prevention programs have been found to beeffective One published program that failed to find positive effects wasProject PALS (Palinkas et al 1996) This project was developed for teengirls who were pregnant or at risk for pregnancy and drug use Theprogram consisted of school-based delivery of 16 sessions once a weekin a class The goal was to decrease drug use The PALS Skills TrainingProgram involved instruction in assertiveness providing and receivingfeedback social conversation handling requests and asking for help andmood management This program was tested against a normativeeducation program (called Facts of Life or FOL) which instructedvalues and decision making sexuality issues and contraception sexuallytransmitted diseases (STDs) drug use risks sexual assault prevalenceand norms material An experimental evaluation with a seven-monthspost-baseline was used The results indicated that the PALS programsubjects reported 29 times greater marijuana use than FOL amongbaseline nonusers No other differences were found It is possible that theprogram was not targeted to the right population that the mix of skills

1998 Sussman et al

ORDER REPRINTS

instructed was not appropriate or that skill training alone (withoutappropriate motivation material) may not be effective in drug useprevention Researchers should examine these possibilities and others tofurther understand program failures as well as program successes

Potential Limitations of Targeted Prevention

Dishion and colleagues (1995) suggest from various findings thatgrouping high-risk youth may lead to increased drug use This outcomecan result if youth come to learn deviant behavior from each other Theycan learn deviant behavior from each other in a program if they haveunstructured or unsupervised time together An essential feature ofseveral targeted programs (eg the RY and TND programs) is building apositive peer culture with group norms that decrease drug involvementand drug-use control problems The RYrsquos findings suggest that a positivepeer group component carefully fostered by a well-trained and competentRY group leader can direct the group toward lower risk behaviorSimilarly classroom management in Project TND involves developmentof positive norms of classroom behavior Further interaction betweenyouth is encouraged but is primarily teacher-directed and highlystructured (Sussman et al 2003) In both RY and Project TND theteacherrsquos role is to actively develop and maintain peer group support inthe class by modeling support positively reinforcing it among groupmembers and negatively reinforcing deviant peer bonds and activities(Eggert and Herting 1991 Vorrath and Brendtro 1985) The teachercreates and structures interactions among youth in prosocial directions(Sussman et al 2003)

Multiple Problem Behaviors of Adolescents

Acknowledging the relationship of drug use to other commonadolescent problems may facilitate identification of effective methods ofreducing drug use Researchers on tobacco alcohol and other drug useantisocial behavior high-risk sexual behavior and depression increas-ingly recognize that these problems are interrelated (McGee andNewcomb 1992) and stem to a large extent from the same environ-mental and biological factors (Biglan et al in press Eggert et al 1995Sussman and Ames 2001 Wills and Cleary 1995) Clearly it is necessaryto have strategies that address the entire range of problems and thecontext that influences those problems Indeed further reductions in

Motivation Skills and Decision Making 1999

ORDER REPRINTS

many problems require that we comprehensively target youth withmultiple problem behaviors

Biglan and colleagues (in press) provide a comprehensive review ofthe relationships among antisocial behavior tobacco alcohol and otherdrug use and high-risk sexual behavior It is clear that the same youngpeople are prone to the development of the entire range of problems In arecent review Moffitt and colleagues (2002) found that antisocialbehavior in early adolescence (rather than late adolescence) is a greaterrisk factor for developing multiple problems These findings point to theimportance of early intervention before youth develop serious problemsMoreover these different problems largely result from the same set ofenvironmental and biological factors

One implication is that disciplines dealing with these problemsother than drug abuse may contribute to dealing with the problem ofdrug use (Newcomb 1996b 1997) In particular research by dev-elopmental psychologists family social workers and sociologists onthe influence of parents on adolescent problem development and oninterventions to alter parenting practices contributes to our understandingof how to prevent or ameliorate drug abuse and other problems Onealso should note that nonsubstance use is not a guarantee for problemimmunity for the entire age range of people whatever their genderethnicity religiosity socioeconomic status (SEC) domicility etc It maybe argued that the most promising programs are those targeting thesemultiple levels of influence Several multidisciplinary programs haveachieved promising results We describe three of these empiricallyevaluated programs tested in various settings

Functional Family Therapy (FFT)FFT is an indicated intervention involving family treatment designed

for delinquent teenagers (also see Table 1) Developed in the early 1970sby Alexander and colleagues (1973) FFT focuses on family commu-nication and the establishment of rules and consequences Several studiesprovide encouraging reports of the programrsquos effectiveness (Alexander etal 1976 Barton et al 1985 Klein et al 1977 Waldron et al 2001) Inthe Waldron et al (2001) study researchers used FFT and anintervention with cognitive behavior therapy on teens referred formarijuana use Each of the interventions produced significant resultson marijuana use by the teens at four months but only the twointerventions combined maintained these results at seven months Theearlier studies found a greater number of results For example in the twoAlexander studies (1973 1976) improvement in family communicationposttreatment led to reduced delinquency Note that all the teens in these

2000 Sussman et al

ORDER REPRINTS

studies had histories of serious antisocial or delinquent behavior Thusachieving positive outcomes even if only short-term should encouragefurther research into the efficacy of FFT

Multisystemic Therapy (MST)As its name suggestsMST targets individual family peer school and

community influences of those youth offenders with serious problems thatmay include violence substance use and severe emotional problems (alsosee Table 1) Numerous researchers have published the results ofrandomized trials of MST (Henggeler et al 1996 1997 1998 Thorntonet al 2000) The most consistent findings across studies are decreased (1)drug use (2) re-arrest (3) self-reported criminal offense and (4) days inout-of-home placements Other consistent findings are improved familyrelations school attendance and psychiatric functioning One cautionarynote the programrsquos effectiveness lowers considerably if not implementedwith fidelity (Hengler et al 1997 1999) In other words all or key lessonsneed to be delivered as written by educators who are well-trained in usingthe strategies employed and youth need to be able to receive all material inan atmosphere conducive to learning the material The programdevelopers have instituted training strategies that address these fidelityissues thus shaping MST to be a very promising program for at-riskyouth

Multidimensional Treatment Foster Care (MTFC)MTFC targets family and peer factors influencing adolescents with a

pattern of repeat criminal offending (see Table 1) (Chamberlain 1994)This intervention includes placement of the youth into a foster homewith a foster parent trained in behavior management who receivessupport from intervention staff After the adolescent has begun torespond to the intervention in the foster home and after the parents havereceived the same training and support as the foster parents did theadolescent returns home Chamberlain and Reid (1998) tested theintervention with 85 boys with felony and other criminal histories andfound substantial benefits of the program Following treatment the boysassigned to MTFC (compared to those receiving community-based groupcare) showed fewer days in detention or lock-up twice as much timeliving with parents fewer misdemeanor and felony arrests and fewer self-reported index crimes felony arrests and general delinquency TheMTFC is a cost-effective alternative to incarceration however staffrequirements are extensive which may influence the ability of some

Motivation Skills and Decision Making 2001

ORDER REPRINTS

groups to apply the program with fidelity However as with each of theprograms described here the results of the randomized trials areencouraging

Future Research Needs in Targeted Prevention

Future research can help discern when and where targeted preventionprogramming will tend to work rather than produce potentiallydeleterious negative group effects or results that are irrelevant for pro-social healthy adaptation as well as what the critical necessary conditionsare for their effective operation within given de facto realities Comparedto the breadth of evaluated universal drug use prevention programs(Tobler et al 2000) relatively few targeted prevention programs havereceived empirical support Yet previous research suggests that universalschool-based drug use prevention programs implemented in junior highschool have relatively less chance of long-term success especially for thoseyouth that began using drugs before the prevention program wasimplemented Of course there are notable exceptions (eg effects lastedfor one and a half years effects lasted for six years) (Chou et al 1998Griffin et al 2003 Skara and Sussman 2003) Almost no research existsregarding maximization of booster programming with high-risk youthMore research on booster programs would help the field

While continuing to engage in this work there will be numerousissues to manage that go well beyond the scope of this article There willbe a need to avoid producing negative labeling effects while providingprogramming for those who are at risk for drug use It is possible thatcessation information needs to be included in the mix with preventionmaterial to provide better targeted-prevention effects There may be aneed to develop a teacher selection instrument to help select out teacherswho can deliver drug abuse prevention programming adequatelyCertainly definition of outcome variables needs continued explorationincluding analysis to ascertain the effects of programming on drug abusevs drug use and identification of the variables that are most closelylinked to change by targeted prevention components

A transdisciplinary approach helps to better understand the lifesituation of high-risk youth as based to some extent on both constitutionaland environmental factors (Fuqua et al 2004 Rutter et al 1997 Wills etal 1996b) From the transactional perspective their situation is in partconstitutional they may have temperamental characteristics that arepartly heritable and that have set the stage at earlier ages for decrements inself-control ability and academic performance that then increase risk for

2002 Sussman et al

ORDER REPRINTS

drug use However their situation is also part environmental based in parton family socialization and in part on the types of peers they have as well asthe type and quality of the physical and cultural environment-at-largeThere are many points at which a potential chain of failures can beinterrupted and the individualrsquos trajectory turned in a better directionProblems are not inevitable from starting level (Tarter and Vanyukov1994) and environmental modifications to support good self-controlability can help to avert an adverse impact from earlier experiences orcurrent difficulties (Brody et al 2002 Novak and Clayton 2001 Patock-Peckham et al 2001 Rutter et al 1997 Wills et al 2002)

The problems and needs of high-risk youth in our nationrsquos highschools demand our attention for designing and rigorously testingtargeted prevention approaches Substantial evidence shows that theseyouth are at greater risk for drug involvement and co-occurring problemssuch as aggression depression and suicidal behaviors as we previouslydiscussed It is hoped that the information presented in this article willstimulate others to join in extending this work including testing othermodels of targeted prevention

GLOSSARY

Universal programs Programs that aim to influence all subjects in acontext

Selective drug-abuse prevention programs Programs that servegroups at greater risk of ATOD usemdashfor example children of alcoholicparents They are at psychosocial risk for drug use and abuse

Indicated drug-abuse prevention programs Programs that attemptto benefit individuals who already show signs of drug involvement orrelated risk factors In indicated prevention programs the primary goal isto stem the progression of ATOD use or reduce drug involvementamong the high-risk youth

Targeted programming Programming that subsumes selective andindicated programming sometimes the other two types of programs thattarget specific groups lsquolsquoat riskrsquorsquo are considered together

ACKNOWLEDGMENTS

This research was supported by grants from the National Institute onDrug Abuse (DA01070 DA07601 DA13814 and DA16094) and by aResearch Scientist Development Award K02 DA00252 from theNational Institute on Drug Abuse

Motivation Skills and Decision Making 2003

ORDER REPRINTS

REFERENCES

Alexander J F Barton C Schiaro R S Parsons B V (1976)

Systems-behavioral intervention with families of delinquents

therapist characteristics family behavior and outcome Journal of

Consulting and Clinical Psychology 44(4)656ndash664Alexander J F Parsons B V (1973) Short-term behavioral interven-

tion with delinquent families impact on family process and

recidivism Journal of Abnormal Psychology 3219ndash225American psychiatric association (APA) (1994) Diagnostic and

Statistical Manual of Mental Disorders 4th edn (DSM-IV)

Washington DC American Psychiatric AssociationAmes S L Sussman S Dent C W (1999) Pro-drug-use myths and

competing constructs in the prediction of substance use among

youth at continuation high schools a one-year prospective study

Personality and Individual Differences 26987ndash1003Bachman S G Wadsworth K N OrsquoMalley P M Johnston L D

Schulenberg J E (1997) Smoking drinking and drug use in young

adulthood Mahwah NJ Lawrence Erlbaum Associates 8ndash25

153ndash190Bandura A (1986) Social Foundations of Thought and Action A Social

Cognitive Theory Englewood Cliffs NJ Prentice HallBarton C Alexander J F Waldron H Turner C W Warburton J

(1985) Generalizing treatment effects of functional family therapy

Three replications The American Journal of Family Therapy

13(3)16ndash26Battin-Pearson S R Newcomb M D Abbott R D Hill K G

Catalano R F Hawkins J D (2000) Predicting early high school

dropout Journal of Educational Psychology 92568ndash582Biglan A Brennan P A Foster S L Holder H D Miller T L

Cunningham P B et al (in press) Helping Adolescents at Risk

Prevention of Multiple Problem Behaviors New York NY Guilford

PressBindra D Stewart J (1996) Motivation Baltimore MD Penguin

BooksBlanton H Gibbons F X Gerrard M Conger K J Smith G E

(1998) The role of family and peers in the development of

prototypes associated with substance use Journal of Family

Psychology 11271ndash288

2004 Sussman et al

ORDER REPRINTS

Botvin G J (1993) School-based drug abuse prevention Long-termfollow-up results In First Annual Meeting of the Society forPrevention Research Kentuck Lexington Society for PreventionResearch

Botvin G J Baker E Dusenbury L Botvin E M Diaz T (1995)Long-term follow-up results of a randomized drug abuse preven-tion trial in a white middle-class population Journal of theAmerican Medical Association 2731106ndash1012

Brody G H Dorsey S Forehand R Armistead L (2002) Uniquecontributions of parenting and classroom processes to the self-control of AfricanndashAmerican children Child Development73274ndash286

Carroll M E (1996) Reducing drug abuse by enriching the environmentwith alternative nondrug reinforcers In Green L Kagel J Heds Advances in Behavioral Economics Norwood NJ NorwoodPublishing Corp 37ndash68

Carver C S Scheier M F (1998) On the Self-Regulation of BehaviorNew York Cambridge University Press

Catalano R F Hawkins J D (1996) The social developmental modela theory of antisocial behavior In Hawkins J D ed Delinquencyand Crime Current Theories New York Cambridge UniversityPress

Centers for Disease Control (CDC) (October 1999) Youth risk BehaviorSurveillancemdashNational Alternative High School Youth RiskBehavior Survey 1998 Morbidity and Mortality Weekly Report48 No SS-7

Chamberlain P (1994) Family connections A treatment foster caremodel for adolescents with delinquency Eugene OR CastaliaPublishing Company

Chamberlain P Reid J B (1998) Comparison of two communityalternatives to incarceration for chronic juvenile offenders Journalof Consulting and Clinical Psychology 66(4)624ndash633

Chassin L A Presson C C Sherman S J (1985) Stepping backwardin order to step forward an acquisition-oriented approach toprimary prevention Journal of Consulting and Clinical Psychology53612ndash622

Chou C-P Montgomery S Pentz M A Rohrbach L A JohnsonC A Flay B R MacKinnon D P (1998) Effects of acommunity-based prevention program on decreasing drug use inhigh-risk adolescentsAmerican Journal of Public Health 88944ndash948

Conducts Problems Prevention Research Group (CPPRG) (1999) Initialimpact of the fast track prevention trial for conduct problems I

Motivation Skills and Decision Making 2005

ORDER REPRINTS

The high-risk sample Journal of Consulting and Clinical Psychology

67631ndash647Conducts Problems Prevention Research Group (CPPRG) (2000)

Merging universal and indicated prevention programs the fast

track model Addictive Behaviors 25913ndash927Council of Philosophical Studies (1981) Psychology and the Philosophy

of Mind in the Philosophy Curriculum San Francisco San Francisco

State UniversityCummings K M Hellmann R Emont S L (1988) Correlates of

participation in a worksite stop smoking program Journal of

Behavioral Medicine 11267ndash277Curry S Wagner E H Gothaus L C (1990) Intrinsic and extrinsic

motivation for smoking cessation Journal of Consulting and

Clinical Psychology 58310ndash316Dent C W Sussman S McCuller W J Stacy A W (2001) Drug

abuse prevention among youth at comprehensive high schools

Preventive Medicine 32514ndash520Dewey J (1886) Psychology New York HarperDishion T J French D C Patterson G R (1995) The development

and ecology of antisocial behavior In Cicchetti D Cohen D

eds Manual of developmental psychopathology New York John

Wiley 421ndash471Eggert L L Herting J R (1991) Preventing teenage drug abuse

exploratory effects of network social support Youth and Society

22482ndash534 [Reprinted National Prevention Evaluation Research

CollectionRockville MD Aspen 1993]Eggert L L Herting J R Thompson E A Nicholas L J Dicker

B G (1994) Preventing adolescent drug abuse and high school

dropout through an intensive school-based social network devel-

opment program American Journal of Health Promotion

8202ndash214Eggert L L Thompson E A Herting J R Nicholas L J (1995)

Reducing suicide potential among high-risk youth tests of a school-

based prevention program Suicide amp Life-Threatening Behavior

25276ndash296Ellickson P L Bell R M (1990) Drug prevention in junior high a

multi-site longitudinal test Science 2471299ndash1305Elliott D S (Series ed) (2003) Blueprints for violence prevention

Boulder CO Institute of Behavioral Science Regents of the

University of Colorado wwwcoloradoeducspvblueprints

2006 Sussman et al

ORDER REPRINTS

Farrell A D Danish S J (1993) Peer drug associations and emotionalrestraint Causes or consequences of adolescent drug use Journal ofConsulting and Clinical Psychology 61327ndash334

Festinger L A (1957) A Theory of Cognitive Dissonance New YorkHarper amp Row

Fuqua J Stokols D Gress J Phillips K Harvey R (2004)Transdisciplinary collaboration as a basis for enhancing the scienceand prevention of substance use and abuse Substance Use ampMisuse

Giuliano J D (1994) A peer education program to promote the use ofconflict resolution skills among at-risk school-age males PublicHealth Reports 109158ndash169

Glynn K Levanthal H Hirschman R (1985) A cognitivedevelopmental approach to smoking prevention In Bell C SBattjes R eds Prevention research Deterring Drug Abuse AmongChildren and Adolescents Rockville MD NIDA ResearchMonograph 63

Glynn T J (1989) Essential elements of school-based smokingprevention programs Journal of School Health 59181ndash188

Goodman R M Burdine J N Meehan E McLeroy K R eds(1993) Community coalitions for health promotion Special issue ofHealth Education Research Theory and Practice 8309ndash453

Goodyear R D Newcomb M D Locke T F (2002) PregnantLatina teenagers psychosocial and developmental determinants ofhow they select and perceive the men who father their childrenJournal of Counseling Psychology 49187ndash201

Gordon R (1987) An operational classification of disease preventionIn Steinberg J A Silverman M M eds Preventing MentalDisorders Rockville MD DHHS 20ndash26

Graham J W Johnson C A Hansen W B Flay B R Gee M(1990) Drug use prevention programs gender and ethnicityevaluation of three seventh-grade project SMART cohortsPreventive Medicine 19305ndash313

Griffin K W Botvin G J Nichols T R Doyal M M (2003)Effectiveness of a universal drug abuse prevention approach foryouth at high risk for substance use initiation Preventive Medicine36(1)1ndash7

Hamilton S (August 20 2000) Views slowly changing on alternativeschools The Sacramento Bee 1ndash3

Hansen W B (1992) School-based substance abuse prevention a reviewof the state of the art in curriculum 1980ndash1990 Health EducationResearch 7403ndash430

Motivation Skills and Decision Making 2007

ORDER REPRINTS

Hansen W B Johnson C A Flay B R Graham J W Sobel J(1988) Affective and social influences approaches to the preventionof multiple substance abuse among seventh grade students resultsfrom project SMART Preventive Medicine 17135ndash154

Hansen W B Graham J W (1991) Preventing alcohol marijuanaand cigarette use among adolescents peer pressure and resistancetraining versus establishing conservative norms PreventiveMedicine 20414ndash430

Hawkins D H Catalano R F Miller J Y (1992) Risk andprotective factors for alcohol and other drug problems inadolescence and early adulthood Implications for substanceabuse prevention Psychological Bulletin 11254ndash105

Hawkins J D Catalano R F Kosterman R Abbott R Hill K G(1999) Preventing adolescent health-risk behaviors by strengthen-ing protection during childhood Archives of Pediatric amp AdolescentMedicine 153226ndash234

Heider F (1958) The Psychology of Interpersonal Relations New YorkWiley

Henggeler S W Pickrel S G Brondino M J Crouch J L (1996)Eliminating (almost) treatment dropout of substance abusing ordependent delinquents through home-based multisystemic therapyAmerican Journal of Psychiatry 153(3)427ndash428

Henggeler S W Melton G B Brondino M J Scherer D GHanley J H (1997) Multisystemic therapy with violent andchronic juvenile offenders and their families the role of treatmentfidelity in successful dissemination Journal of Consulting andClinical Psychology 65(5)821ndash833

Henggeler S W Schoenwald S K Borduin C M Rowland M DCunningham P B (1998) Multisystemic treatment of antisocialbehavior in children and adolescents New York The Guilford Press

Henggeler S W Pickrel S G Brondino M J (1999) Multisystemictreatment of substance-abusing and dependent delinquents out-comes treatment fidelity and transportability Mental HealthServices Residual 1(3)171ndash84

Johnson C A Pentz M A Weber M D Dwyer J H Baer NMacKinnon D P Hansen W B Flay B R (1990) Relativeeffectiveness of comprehensive community programming for drugabuse prevention with high-risk and low-risk adolescents Journalof Consulting and Clinical Psychology 58447ndash456

Kaftarian S J Hansen W B eds (1994) CSAP special issuecommunity partnership program Journal of Community Psychologypages 205

2008 Sussman et al

ORDER REPRINTS

Karoly P (1993) Mechanisms in self-regulation A systems view AnnualReview of Psychology 4423ndash51

Karoly P (1980) Person variables in therapeutic change and develop-ment In Karoly P Steffen J J eds Improving the Long-TermEffects of Psychotherapy New York Gardner Press 195ndash261

Kendall P C Braswell L (1982) Cognitive-behavioral self-controltherapy for children a components analysis Journal of Consultingand Clinical Psychology 50672ndash689

Kerr M Tremblay R E Pagani L Vitaro F (1997) Boysrsquobehavioral inhibition and the risk of later delinquency Archivesof General Psychiatry 54809ndash816

Klein N C Alexander J F Parsons B V (1977) Impact of familysystems intervention on recidivism and sibling delinquency a modelof primary prevention and program evaluation Journal ofConsulting and Clinical Psychology 45(3)469ndash474

Kumpfer K L (1999) Outcomes measures of interventions in the studyof children of substance-abusing parents Pediatrics 1031128ndash1144

Lau R R Hartman K A Ware J E (1986) Health as a valuemethodological and theoretical considerations Health Psychology525ndash43

Lichtenstein E L Glasgow R E (1997) A pragmatic framework forsmoking cessation implications for clinical and public healthprograms Psychology of Addictive Behaviors 11142ndash151

Locke T F Newcomb M D (in press) Childhood maltreatmentparent drug problems polydrug problems and parenting practicesa test of gender differences and four theoretical perspectivesJournal of Family Psychology

McCreary D R Newcomb M D Sadava S W (1999) The male rolealcohol use and alcohol problems a structural modeling examina-tion in adult women and men Journal of Counseling Psychology46109ndash124

McGee L Newcomb M D (1992) General deviance syndromeexpanded hierarchical evaluations at four ages from earlyadolescence to adulthood Journal of Consulting amp ClinicalPsychology 60766ndash776

Miller W R Brown J M (1991) Self-regulation as a conceptual basisfor the prevention of addictive behaviours In Heather N MillerW R Greeley J eds Self-control and the Addictive BehavioursSydney Australia Maxwell Macmillan 3ndash79

Miller W R Leckman A L Delaney H D Tinkcom M (1993)Long-term follow-up of behavioral self-control training forproblem drinkers Journal of Studies on Alcohol 53249ndash261

Motivation Skills and Decision Making 2009

ORDER REPRINTS

Miller W R Rollnick S (1991) Motivational InterviewingPreparing People to Change Addictive Behavior New YorkGuilford Press

Moffitt T E Caspi A Harrington H Milne B J (2002) Males onthe life-course-persistent and adolescence-limited antisocial path-ways follow-up at age 26 years Development and Psychopathology14(1)179ndash207

National Institute on Drug Abuse (NIDA) (1997) Drug abuseprevention What works NIH Publication 97-4110 DHHSNational Institutes of Health National Institute on Drug AbuseOffice of Science Policy and Communications Rockville MD

Newcomb M D (1992a) Substance abuse and control in the UnitedStates ethical and legal issues Social Science and Medicine35471ndash479

Newcomb M D (1992b) Understanding the multidimensional nature ofdrug use and abuse The role of consumption risk factors andprotective factors In Glantz M D Pickens R eds Vulnerabilityto Drug Abuse Washington DC American PsychologicalAssociation 255ndash298

Newcomb M D (1996a) Pseudomaturity among adolescents constructvalidation sex differences and associations in adulthood Journalof Drug Issues 26477ndash504

Newcomb M D (1996b) Adolescence Pathologizing a normal processThe Counseling Psychologist 24482ndash490

Newcomb M D (1997) Psychosocial predictors and consequences ofdrug use a developmental perspective within a prospective studyJournal of Addictive Diseases 1651ndash89

Newcomb M D Bentler P M (1988) Consequences of Adolescent DrugUse Impact on the Lives of Young Adults Beverly Hills CA Sage

Newcomb M D Bentler P M (1989) Substance use and abuse amongchildren and teenagers American Psychologist 44242ndash248

Newcomb M D Harlow L L (1986) Life events and substance useamong adolescents Mediating effects of perceived loss of controland meaninglessness in life Journal of Personality and SocialPsychology 51564ndash577

Newcomb M D Chou C-P Bentler P M Huba G J (1988)Cognitive motivations for drug use among adolescents longitudinaltests of gender differences and predictors of change in drug useJournal of Counseling Psychology 35426ndash438

Newcomb M D Abbott R D Catalano R F Hawkins J DBattin-Pearson S R Hill K (2002) Mediational and deviancetheories of late high school failure Process roles of structural

2010 Sussman et al

ORDER REPRINTS

strains academic competence and general versus specific problem

behaviors Journal of Counseling Psychology 49172ndash186Nezami E Sussman S Pentz M A (2003) Motivation in tobacco use

cessation research Substance Use amp Misuse 3825ndash5Novak S P Clayton R R (2001) The influence of school environment

and self-regulation on transitions between stages of cigarette

smoking Health Psychology 20196ndash207Offord D R (2000) Selection of levels of prevention Addictive

Behaviors 25833ndash842Palinkas L A Atkins C J Miller C Ferreira D (1996) Social skills

training for drug prevention in high-risk female adolescents

Preventive Medicine 25692ndash701Patock-Peckham J A Cheong J-W Balhorn M E Nagoshi C T

(2001) A model of parenting styles self-regulation perceived

drinking control and alcohol use and problems Alcoholism

Experimental and Clinical Research 251284ndash1292Pentz M A (1994) Directions for future research in drug abuse

prevention Preventive Medicine 23646ndash652Pentz M A Dwyer J H MacKinnon D Flay B R Hansen W B

Wang E Y I Johnson C A (1989) A multi-community trial for

primary prevention of adolescent drug abuse effects on drug use

prevalence JAMA 2623259ndash3266Pentz M A Mares D Schinke S Rohrbach L (in press) Political

science public policy and drug abuse prevention Substance Use amp

MisuseProchaska J O DiClemente C C (1982) Transtheoretical therapy

toward a more integrative model of change Psychotherapy Theory

Research and Practice 19275ndash288Pulkkinen L Pitkanen T (1994) A prospective study of the precursors

to problem drinking in young adulthood Journal of Studies on

Alcohol 55578ndash587Rathus S A Nevid J S (1977) Behavior Therapy Strategies for

Solving Problems in Living New York Doubleday and Company

IncResnicow K Botvin G (1993) School-based substance use prevention

programs why do effects decay Preventive Medicine 22484ndash490Rutter M Dunn J Plomin R Simonoff E Pickles A Maughan

B Ormel J Meyer J Eaves L (1997) Integrating nature and

nurture implications of person-environment interactions for

developmental psychopathology Development and Psychopathology

9335ndash364

Motivation Skills and Decision Making 2011

ORDER REPRINTS

Salomon G Stein Y Eisenberg S Klein L (1984) Adolescent

smokers and nonsmokers profiles and their changing structure

Preventive Medicine 13446ndash461Sambrano S (1999) National cross-site evaluation of high risk youth

programs In Interim findings Bulletin Washington DC CSAP

SAMSHA US DHHS May 1ndash16Schinke S P Gilchrist L D (1985) Preventing substance abuse with

children and adolescents Journal of Consulting and Clinical

Psychology 53596ndash602Skara S N Sussman S (2003) A review of 25 long-term adolescent

tobacco and other drug use prevention program evaluations

Preventive MedicineSmith C Lizotte A J Thornberry T P Krohn M D (1995)

Resilient youth identifying factors that prevent high-risk youth

from engaging in delinquency and drug use Delinquency and

Disrepute in the Life Course Greenwich CT John Hagan JAI

press 217ndash247Sommers P V (1972) The Biology of Behavior Australia Pty ltd

Sydney John Wiley amp SonsSt Pierre T L Kaltreider D L Mark M M Aikin K J (1992)

Drug prevention in a community setting a longitudinal study of the

relative effectiveness of a three-year primary prevention program in

boys and girls clubs across the nation American Journal of

Community Psychology 20673ndash706Stein J A Newcomb M D Bentler P M (1987) An eight year study

of multiple influences on drug use and drug use consequences

Journal of Personality and Social Psychology 531094ndash1105Sully J (1884) Outlines of Psychology New York D Appleton amp CoSussman S (1989) Two social influence perspectives of tobacco use

development and prevention Health Education Research Theory

and Practice 4213ndash223Sussman S (1991) Curriculum development in school-based prevention

research Health Education Research Theory and Practice

6339ndash351Sussman S (1996) Development of a school-based drug abuse

prevention curriculum for high risk youth Journal of

Psychoactive Drugs 28169ndash182Sussman S Ames S L (2001) The social psychology of drug abuse

Buckingham GB Open University PressSussman S Unger J (2004) A drug abuse theoretical integration a

transdisciplinary speculation Substance Use amp Misuse

2012 Sussman et al

ORDER REPRINTS

Sussman S Dent C W Burton D Stacy A W Flay B R (1995a)

Developing school-based tobacco use prevention and cessation

programs Thousand Oaks CA Sage Publications IncSussman S Dent C W Simon T R Stacy A W Galaif E R

Moss M A Craig S Johnson C A (1995b) Effectiveness of

social influence substance abuse prevention curricula in compre-

hensive and continuation high schools Drugs and Society 865ndash81Sussman S Dent C W Galaif E R (1997) The correlates of

substance abuse and dependence among adolescents at high risk

for drug abuse Journal of Substance Abuse 9241ndash255Sussman S Dent C W Stacy A W (1996) The relation of pro-drug

use myths with self-reported drug use among youth at continuation

high schools Journal of Applied Social Psychology 26214ndash267Sussman S Dent C W Stacy A Craig S (1998) One-year outcomes

of project towards no drug abuse Preventive Medicine 27632ndash642

(erratum 766)Sussman S Dent C W Stacy S (2002) Project towards no drug

abuse a review of the findings and future directions American

Journal of Health Behavior 26354ndash365Sussman S McCuller W J Dent C W (2003) The associations of

social self-control personality disorders and demographics with

drug use among high risk youth Addictive Behaviors 281159ndash1166Sussman S Rohrbach L Patel R Holiday K (2003) A look at an

interactive classroom-based drug abuse prevention program

Interactive contents and suggestions for research Journal of Drug

Education 33355ndash368Sussman S Sun P McCuller W J Dent C W (2003) Project

towards no drug abuse two year outcomes of a trial that compares

health educator delivery to self-instruction Preventive Medicine

37155ndash162Tarter R E Vanyukov M (1994) Alcoholism a developmental disorder

Journal of Consulting and Clinical Psychology 621096ndash1107Thornton T N Craft C A Dahlberg L L Lynch B S Baer K

(2000) Best Practices of Youth Violence Prevention A Sourcebook

for Community Action Atlanta GA Division of Violence

Prevention Centers for Disease Control and PreventionTobler N S (1986) Meta-analysis of 143 adolescent drug prevention

programs quantitative outcome of program participants compared to

a control or comparison group Journal of Drug Issues 16537ndash567Tobler N S Roona M R Ochshorn P Marshall D G Streke

A V Stackpole K M (2000) School-based adolescent drug

Motivation Skills and Decision Making 2013

ORDER REPRINTS

prevention programs 1998 Meta-analysis The Journal of Primary

Prevention 20275ndash336US Department of Health and Human Services (USDHHS) (2003)

Substance Abuse andMental Health Services Administration Center

for Substance Abuse Prevention Science-based prevention programs and

principles 2002 Rockville MD US DHHS (SMA)03-3764 Also

see httpmodelprogramssamhsagovUnger J Baezconde-Garbanati L Shakib S Palmer P H Nezami

E Mora J (2004) What are the implications of structuralcultural

theory for drug abuse prevention Substance Use amp MisuseUpshaw H S Ostrom T M (1984) Psychological perspective in

attitude research In Eiser J R ed Attitudinal Judgment New

York Springer-Verlag 23ndash42Valente T W Gallaher P Mouttapa M (2004) Using social network

theory to understand and prevent substance use a transdisciplinary

perspective Substance Use amp MisuseVorrath H Brendtro L (1985) Positive peer culture 2nd edn Aldine

ChicagoWaldron H B Slesnick N Brody J L Turner C W Peterson T R

(2001) Treatment outcomes for adolescent substance abuse at 4-

and 7-month assessments Journal of Consulting amp Clinical

Psychology 69(5)802ndash813Watson D L Tharp R G (2002) Self-directed behavior Self-

modification for personal adjustment 8th edn Belmont CA

WadsworthWeissberg R P Caplan M Z Sivo P J (1989) A new conceptual

framework for establishing school-based social competence promo-

tion programs In Bond L A Compas B E eds Primary

Prevention amp Promotion in the Schools Newbury Park CA Sage

255ndash296Wills T A (1986) Stress and coping in early adolescence relationships

to substance use in urban school samples Health Psychology

5503ndash529Wills T A Cleary S D (1995) Stress-coping model for alcohol-

tobacco interactions in adolescence In Fertig J B Allen J P

eds Alcohol and Tobacco From Basic Science to Clinical Practice

Bethesda MD National Institute on Alcohol Abuse and

Alcoholism 107ndash128Wills T A Cleary S D (1999) Peer and adolescent substance use

among 6thndash9th graders Latent growth analyses of influence versus

selection mechanisms Health Psychology 18453ndash463

2014 Sussman et al

ORDER REPRINTS

Wills T A Hirky A E (1996) Coping and substance abuse InZeidner M Endler N S eds Handbook of Coping TheoryResearch and Applications New York Wiley 279ndash302

Wills T A Stoolmiller M (2002) The role of self-control in earlyescalation of substance use a time-varying analysis Journal ofConsulting and Clinical Psychology 70986ndash997

Wills T A Baker E Botvin G J (1989) Dimensions of assertivenessdifferential relationships to substance use in early adolescenceJournal of Consulting and Clinical Psychology 57(4)473ndash478

Wills T A Vaccaro D McNamara G (1994) Novelty seeking risktaking and related constructs as predictors of adolescent substanceuse an application of Cloningerrsquos theory Journal of SubstanceAbuse 61ndash20

Wills T A McNamara G Vaccaro D Hirky A E (1996a)Escalated substance use a longitudinal grouping analysis fromearly to middle adolescence Journal of Abnormal Psychology105166ndash180

Wills T A Pierce J P Evans R I (1996b) Large-scale environmentalrisk factors for substance use American Behavioral Scientist39808ndash822

Wills T A Windle M Cleary S D (1998) Role of temperamentnovelty-seeking and self-control in adolescent substance useJournal of Personality and Social Psychology 74387ndash406

Wills T A Sandy J M Shinar O (1999) Substance use level andproblems in late adolescence a mediational model based on self-control and coping motives Experimental and ClinicalPsychopharmacology 7122ndash134

Wills T A Cleary S D Filer M Shinar O Mariani J Spera K(2001) Temperament and self-control related to early-onsetsubstance use test of a developmental model Prevention Science2145ndash163

Wills T A Sandy J M Yaeger A (2002) Moderators of therelationship between substance use level and problems test of aself-regulation model in adolescence Journal of AbnormalPsychology 1113ndash21

Wills T A Gibbons F X Gerrard M Murry V Brody G (in press-a) Family communication and religiosity related to substance useand sexual behavior in early adolescence Psychology of AddictiveBehaviors

Wills T A Resko J Ainette M Mendoza D (in press-b) The role ofparent and peer support in adolescent substance use a test ofmediated effects Psychology of Addictive Behaviors

Motivation Skills and Decision Making 2015

ORDER REPRINTS

Young P T (1936) Motivation of Behavior New York John Wiley andSons

Zimmerman B J (2000) Attaining self-regulation a social cognitivemodel In Boekaerts M Pintrich P R eds Handbook of Self-Regulation San Diego Academic Press 13ndash39

2016 Sussman et al

Request PermissionOrder Reprints

Reprints of this article can also be ordered at

httpwwwdekkercomservletproductDOI101081JA200034769

Request Permission or Order Reprints Instantly

Interested in copying and sharing this article In most cases US Copyright Law requires that you get permission from the articlersquos rightsholder before using copyrighted content

All information and materials found in this article including but not limited to text trademarks patents logos graphics and images (the Materials) are the copyrighted works and other forms of intellectual property of Marcel Dekker Inc or its licensors All rights not expressly granted are reserved

Get permission to lawfully reproduce and distribute the Materials or order reprints quickly and painlessly Simply click on the Request Permission Order Reprints link below and follow the instructions Visit the US Copyright Office for information on Fair Use limitations of US copyright law Please refer to The Association of American Publishersrsquo (AAP) website for guidelines on Fair Use in the Classroom

The Materials are for your personal use only and cannot be reformatted reposted resold or distributed by electronic means or otherwise without permission from Marcel Dekker Inc Marcel Dekker Inc grants you the limited right to display the Materials only on your personal computer or personal wireless device and to copy and download single copies of such Materials provided that any copyright trademark or other notice appearing on such Materials is also retained by displayed copied or downloaded as part of the Materials and is not removed or obscured and provided you do not edit modify alter or enhance the Materials Please refer to our Website User Agreement for more details

ORDER REPRINTS

Cross-site

Evaluationof

HighRisk

Youth

(CSAP-H

RY)

9ndash1766

female

Disadvantaged

socioeconomic

status(SES)

Classroom-

style

experiential

youth

parents

families

No

Yes

No

47programs

were

evaluatedasa

setan

averageof

234hof

instruction

at6-m

onth

follow-up

Cigarettes

alcohol

marijuanaon

12ndash17year

oldsnoton

9ndash11year

olds

EarlyRisers

Skillsfor

Success(ER)

6ndash10

Disadvantaged

socioeconomic

status(SES)

aggressiveor

oppositional

behavior

Parent-school-

childskills

trainingand

contingency

managem

ent

Contingent

reinforce-

mentof

aggressive

behavior

homevisits

groups

Yes

Yes

Academ

ic

instruction

Social

academ

ic

anddiscipline

improve-

mentsdrug

use

not

assessedyet

Fast

Track

Prevention

Trial

(FTPATHS)

1stndash6th

grade

(most

in1st

and5th

grade)

Impulsive

oppositional

(fighttease

disobey)

Schooland

homevisits

Notreally

Yes

Yes

Academ

icskills

too1year

follow-upof

youngest

youth

Social

emotional

academ

ic

effectsdrug

effectsnot

assessedyet

Family

Effective-ness

Training(FET)

6ndash12

Hispanic

immigrant

families

parent-child

conflict

oppositional

Parenting

skillsfamily

counseling

bicultural

skills

Cultural

tailoring

Yes

Yes

Canbe

implemented

inmany

different

settings

highly

trained

counselors

over

13weeks

Socialfamily

emotional

discipline

improve-

mentsdrug

effectsnot

assessedyet

(continued

)

Motivation Skills and Decision Making 1981

ORDER REPRINTS

Table

1

Continued

Inclusion(ornot)ofMSD

Components

Nameof

program

Baseline

gradeage

range

Definition

ofrisk

Program

modalities

Motivation

Skills

Decision

Making

Other

features

Drug

effects

Functional

Family

Therapy

(FFT)

11ndash18

Atrisk

or

presenting

multiple

problems

inconduct

Community

locations

Communica-

tiontraining

parenting

skills

contracting

response-

coststools

Yes

Yes

No

8ndash26hof

directservice

time

contexts

are

adaptable

toneeded

application

skilled

counselors

Tem

porary

effectson

druguse

preventionof

penetrating

adultcrim

inal

system

and

other

rela-

tivelysevere

system

sof

care

The

Incredible

Years

(IY)

2ndash8

Disadvantaged

socioeconomic

status(SES)

aggressiveor

oppositional

behavior

School-or

clinic-based

childparent

andteacher

programs

No

Yes

Yes

Academ

icskills

too45child

group-

therapy

hours60

child-

classroom

hours30

parenthours

28teacher

hours

Discipline

improve-

mentsdrug

use

not

assessedyet

Leadership

and

Resiliancy

Program

(LRP)

14ndash19

High

absenteeism

discipline

problems

substance

use

School

(resiliency

groups)

alternative

activities

community

service

Yes

Yes

No

Upto

4years

of

programming

Grade

school

discipline

andarrests

improve-

mentsno

druguse

effects

indicated

1982 Sussman et al

ORDER REPRINTS

LifeSkills

Training(LST)

7th

Exposedto

substance-using

(cigarettes

and

alcohol)peers

andpoor

academ

ics

School-based

classroom

Cultural

tailoring

Yes

Yes

Universalcom-

prehensive

life

skills

program

tested

with

at-risk

youth

1year

follow-up

Smoking

alcohol

inhalants

polydrug

not

marijuana

LinkingInterests

Families

andTeachers

(LIF

T)

1st

and5th

Atrisk

neighborhoods

withhigh

juvenile

delinquency

School-based

classroom

playground

6parent

meetings

No

Yes

Yes

Playground

groups

form

ed

Lessaggression

onplay-

groundand

better

classroom

behavior

druguse

not

assessedyet

Midwest

Prevention

Project

(MPP)

6th

and7th

Baselinemonthly

users

of

cigarettes

alcoholor

marijuana

School-based

classroom

parents

media

community

Notreally

maybesome

community

supports

Yes

Yes

Universalcom-

prehensive

social

influence

program

tested

with

at-risk

youth

35

year

follow-up

Smokingand

alcoholeffect

at15

years

vanished

by

35

yearsnot

marijuana

Multi-system

ic

Therapy(M

ST)

12ndash17

Chronically

violent

substance-

abusing

juvenile

offenders

Family-

oriented

home-based

increase

support

network

Empower

parents

Yes

Yes

Highly

trained

therapist

involved

in60

contact

hours

over

4months

Decreaseddrug

use

and

re-arrests

andim

proved

family

functioning

(continued

)

Motivation Skills and Decision Making 1983

ORDER REPRINTS

Table

1

Continued

Inclusion(ornot)

ofMSD

Components

Nameof

Program

Baseline

GradeAge

Range

Definition

ofRisk

Program

Modalities

Motivation

Skills

Decision

Making

Other

Features

Drug

Effects

Multi-

dim

ensional

Treatm

ent

Foster

Care

(MTFC)

9ndash18

Chronic

conduct

orem

otional

disturbance

crim

inal

behavior

Home-

and

school-based

MTFC

home

placement

case

managem

ent

Positive

reinforcers

Yes

No

Highly

trained

counselors

weekly

parent

groups

family

therapy

community

mentoring

andmonitor-

ing

behavior

modification

Decreasedhard

drugusejail

timeand

arrests

Nurse-Family

Partnership

(NFP)

First-tim

e

mothers

Motherswithno

income

often

teen

mothers

Homevisits

resource

advocacy

No

No

Yes

Highly

trained

counselors

pregnancy

to

2years

old

Decreased

smokingand

alcoholuse

among

mothers

reducedrates

ofchildabuse

Preventive

Intervention

(PI)

7th-8th

Pooracadem

ic

andschool

discipline

family

problems

School-based

skillsand

monitoring

Positive

reinforcers

Yes

No

Increase

child

teacher

parentcom-

munication

role

play

pro-social

alternatives

Lesshard

drug

useless

delinquency

higher

grades

andbetter

attendance

1984 Sussman et al

ORDER REPRINTS

Preventive

Treatm

ent

Program

(PTP)

7ndash9

Disadvantaged

socioeconomic

status(SES)

disruptive

School-based

parentand

childskills

and

monitoring

Positive

reinforcers

Yes

No

17sessionsfor

parent19for

child

separately

parent-

monitoring

andshaping

ofchild

child-

pro-social

skillsand

selfcontrol

Lesslikelihood

ofhaving

beendrunk

ortaken

drugsin

last

12months

less

fighting

andstealing

Project

PATHE

12ndash18

Disadvantaged

socioeconomic

status(SES)

low

achieving

disruptive

School-based

activitiespeer

counseling

schoolpride

jobseeking

Yes

Yes

No

Academ

ic

skillstoo

Decreaseddrug

involvem

ent

school

alienation

discipline

problems

higher

graduation

rates

Project

STATUS

12ndash18

Potential

dropouts

Schoolclim

ate

optionsclass

(socialrules

norm

s)

Accountability

No

Yes

Youth

leadership

staff

development

parent

meetings

community

resources

Lessdrug

involvem

ent

forjunior

highyouth

bettergrades

anddiscipline

(continued

)

Motivation Skills and Decision Making 1985

ORDER REPRINTS

Table

1

Continued

Inclusion(ornot)ofMSD

Components

Nameof

Program

Baseline

GradeAge

Range

Definition

ofRisk

Program

Modalities

Motivation

Skills

Decision

Making

Other

Features

Drug

Effects

Project

STEP

14ndash18

Disadvantaged

socioeconomic

status(SES)

low

achieving

disruptive

Schoolphysical

settinghome

room

teacher

role

Accountability

No

No

Homeroom

teachersact

ascounselors

andadvisors

Lessdrug

involvem

ent

bettergrades

anddiscipline

Project

SUCCESS

14ndash18

Alternativehigh

schoolyouth

School-based

counseling

and

education

SAPmodel

No

Yes

Yes

Highly

trained

counselorsasse-

ssment8-session

classgroup

counseling

parentmeeting

referral

Decreased

problem

behavioruse

ofmarijuana

tobaccoand

alcohol

Project

Towards

NoDrugAbuse

(TND)

14ndash19

Alternativehigh

schoolyouth

School-based

classroom

12

sessions

Yes

Yes

Yes

Trained

teachers

Decreaseduse

ofcigarettes

alcoholmar-

ijuanahard

drugsweapons

carrying

Quantum

Opportunities

Program

(QOP)

9thndash12th

Disadvantaged

socioeconomic

status(SES)

familieson

public

assistance

Schoolhome

and

community

contexts

skillsservice

and

education

Money

Yes

Yes

250education

hours250life

skillshoursjob

preparationcul-

turalenrichment

and250hcom-

munityservice

monetary

incentives

Nodruguse

effectsrepor-

tedincrease

inhighschool

graduation

less

likelyto

becomeateen

parentslightly

less

likelyto

be

arrested

1986 Sussman et al

ORDER REPRINTS

Reconnecting

Youth

(RY)

14ndash18

Atrisk

for

drop-out

School-based

90-session

class

Groupsupport

Yes

Yes

Smallstudent

groups

support

highly

trained

teachera

semester

Decreasedhard

druguse

perceived

stress

improved

grades

Residential

Student

Assistance

Program

(RSAP)

14ndash17

Livingin

residential

facilities

Residential-

based

education

program

assessm

ent

counseling

referral

No

Yes

Yes

Highly

trained

counselors

placedin

residential

facilities

8-session

drug

education

individual

andgroup

counseling

Decreaseduse

ofmarijuana

tobaccoand

alcohol

Strengthening

Families

Program

(SFP)

6ndash12

Childrenof

substance

users

Agency-based

14session

skillstraining

No

Yes

Yes

Highly

trained

counselors

parents

and

childseen

separately

firsthour

together

at

thesecond

hour

Reduces

aggression

increases

family

cohesion

immediate

effectson

druguse

Motivation Skills and Decision Making 1987

ORDER REPRINTS

model of drug abuse prevention We see this intrinsicextrinsic motiva-tion notion as providing intrapersonal and extrapersonal stimuli (cues)for action

Finally self-regulation models posit that one is motivated to achievean optimal state or system balance In essence an awareness of lack ofbalance will lead to efforts to restore balance (Carver and Scheier 1998Karoly 1980 1993) Drug abuse prevention may demand considerationof alternative actions in order to maintain homeostasis Affect may serveas the main homeostatic mechanism If people feel good or neutral theywill tend to maintain a given course of behavior On the other hand ifthey feel poorly they will want to change their behavior (as in the law ofeffect)

Constituents are those elements that when combined togethercompose a theoretical structure Seven constituents of motivation appearacross the four general theories (Nezami et al 2003) First the idea ofdiscrepancies appears in all theories Motivation exists as a distancebetween what is and what could be and these models assume that peopledesire to reduce such discrepancies Second motivation functions by theestablishment of goals Third motivation exists as energymdasha want ordrive Goals and the accompanying drive to achieve them usually appeartogether Fourth motivation may appear as a series of stages that lead toan end Different goals may operate at different stages Fifth motivationreflects ambivalence about two or more competing goals or behaviorsWorking through ambivalence enhances motivation Sixth motivationarises from different sources usually intrapsychic or environmentalrewards Finally a homeostatic conceptualization of motivation rests onthe idea of maintaining an optimal set point within a regulatory system

Integrations of these four models of motivation could help achievethe prevention of drug abuse One view suggests that due to lifeexperiences people consider goals or directions For example teens maystart to experiment with drugs due to curiosity perceived social pressureor as a means to induce a life change They may subsequently take risksthat injure their relations with others or impair their achievement inschool At some point a discrepancy likely develops between currentcircumstances and their goals For example teens may know that drugabuse is inconsistent with some life goals like school achievementHowever they may value social interaction and physical pleasure whichthey may reach through drug use or other means

Multiple goals may conflict with each other leading to ambivalence(Karoly 1993) Extrinsic and intrinsic sources of input may helpresolve ambivalence For example as the rewards associated with drugabuse diminish teens may experience a desire to decrease their drug

1988 Sussman et al

ORDER REPRINTS

consumption They may prove more likely to adopt a new goal ofdecreased drug use especially if they believe that they could achieve thegoal as self-efficacy theory suggests

Teens may exert energy to reduce discrepancies between currentstates and desired states They may learn new life or social skills whichcan lead them to become involved in rewarding but nondrug-usingactivities (Carroll 1996) In addition they may become involved in newtypes of social networks containing low-risk rather than high-risk peers(Valente et al 2004 Wills et al in press-b) Finally attaining a healthiergoal can create a positive optimal set point and the motivation systemprovides more positive feedback Over time through experience ofdifferent life events youth may alter the set point and begin a new goal-searching process (Sussman and Unger 2004) One may experience atraumatic life event for example and again consider drug use as a meansto return to an optimal set point or repeatedly get into trouble because ofassociating with deviant peers and realize that there is a need to turn todifferent types of associations

Research and theory from several disciplines suggest many motiva-tion strategies for a successful prevention program These motivationstrategies include myth correction stereotyping valuing life andachievement of health goals

Myth Correction

The recovery movement often refers to substance use and abuse as aproblem of perception Another closely related expression drug use mythsdescribes questionable or dysfunctional expectancies or beliefs that serveto justify drug use Myths involve more than expectancies or beliefs aboutpositive or negative outcomes they include inaccurate expectancies orbeliefs about the characteristics (or norms) of drugs and drug use and arelikely to confuse drug effects with drug experiences

Some common myths include inflated expectancies of positiveoutcomes from drug use or underestimates of negative outcomes fromdrug use Teens may believe that substance use will create peer groupacceptance or help them cope with family and school problems when infact the drug use only diverts them from actively coping with these socialand academic issues Thus in the long run drug use makes things worsenot better (Wills and Hirky 1996) Other myths include endorsement ofmisleading beliefs For example many adolescents believe that learningto manage drug intake without getting sick is a positive sign that theirbodies are growing tolerant to the drug rather than signaling the

Motivation Skills and Decision Making 1989

ORDER REPRINTS

beginnings of drug dependence or addiction In addition misperceptionsregarding physical consequences of drug use operate For example usersmistakenly believe that if they are able to regulate subjective effects of adrug they have gained control over use In reality warning systems maybe deteriorating as addiction begins (Glynn et al 1985 Sussman et al1995b) Challenging drug myths undoubtedly helps prevent drug abuse

These challenges can prove especially useful with high-risk popula-tions particularly if social influence programs are less effective in thesegroups Several prevention researchers have adopted a similar taxonomyof drug myths when attempting to prevent drug use Sussman Dent andStacy (1996) examined the internal consistency and discriminant validityof a measure of drug-related myths in 362 continuation (alternative) highschool youth They found good internal consistency and discriminantvalidity for the measure Controlling for its relations with socialdesirability perceived friendsrsquo drug use (a social influence measure)ethnicity and gender the myth measure remained significantly associatedwith four drug use measures Ames Sussman Dent and Stacy (1999)found a myth measure to be a relatively strong psychosocial predictor ofdrug use one-year later Cognitive perceptions obviously play a role indrug abuse prevention (Stein et al 1987) These findings suggest thatcontinued research on drug use myths should prove fruitful forprevention efforts (Sussman et al 1998 2003)

Some cognitive restructuring corrects faulty or self-defeatingcognitive structures (myths) In particular elaborating on the logicalsteps involved in the construction of a drug use myth may help to destroyits impact on behavior For example a common myth suggests thathaving trouble finding onersquos car after getting drunk is a funny event Ifone asks (a) lsquolsquoDid you want to find your carrsquorsquo (b) lsquolsquoWere you too drunk tofind it for a long timersquorsquo and (c) lsquolsquoAnd thatrsquos funnyrsquorsquo the apparent humorin the story may dissipate Further one may delineate the kernel of truthin the myth (not finding onersquos car is an odd event) from the falseaspects of the myth (not finding onersquos car indicates failure of functioningwhich is sad worrisome anxiety provoking not funny)

Stereotyping

Lower risk peers tend to perceive lsquolsquoat riskrsquorsquo others (eg alternativehigh school students) as being more deviant than they actually areUnderstandably youth so-labeled students resent this stereotypeAddressing this stereotype may help prevent drug abuse If lsquolsquoat riskrsquorsquoyouth begin to view themselves as being more deviant than they actually

1990 Sussman et al

ORDER REPRINTS

are the situation could lead to self-fulfilling prophesy as if they weregiving in to the stereotype However lowering the estimates of drug useamong their peers can correct this giving in This version of a prevalence-overestimation reduction lesson which includes a motivational featurehas appeared in successful prevention programs (Sussman et al 2002) Astereotype-oriented lesson may also accomplish a second goal If high-risk youth do not view themselves as being deviant as they assumedothers had judged them possibly reactions against this stereotype mayenergize an effort to avoid drug use as well as portray oneself morefavorably (Hamilton August 20 2000)

Valuing Life and Health Goals

Letrsquos consider the example of older teens Most youth report thatthey plan to graduate from high school and continue their educations orfind a job They do not view hanging out as a desirable option They alsosee that drug use could interfere with achieving their goals A lessonexplaining the negative consequences of drug use particularly oneconsistent with data (Newcomb and Bentler 1988) could reveal howearly involvement with drugs creates symptoms of abuse and dependenceand alters job opportunities marriage and family functioning These lifegoals can seem more valuable as students perceive them as attainableEnhancing the value of life goals can increase motivation for learningadaptive coping (Lau et al 1986) Youth have reported that drug usecould interfere with obtaining desired life goals In theme and componentstudies youth positively evaluated a lesson that taught that drug usecould interfere with obtaining desired goals and that placing animportance on health as a value was consistent with achievement of lifegoals (Sussman 1996) Thus it is important for prevention programs tohelp youth connect the importance of health to obtaining their life goalsand develop a sequenced plan so that they know how to proceed step-by-step (Karoly 1993 Watson and Tharp 2002)

Although modifiable understanding the source of positive life goalsis also important since these may occur earlier in life For instanceNewcomb and Harlow (1986) found that perceived loss of control andmeaninglessness in life mediated the relationship between negative lifeevents and drug use While numerous types of stressful events wereconsidered in this study other studies identify an adverse childhoodfamily environment as a potent precursor to later drug use (Locke andNewcomb in press Palinkas et al 1996) An adverse early homeenvironment a modifiable etiological factor should serve as a focus of

Motivation Skills and Decision Making 1991

ORDER REPRINTS

prevention that addresses child abuse and neglect (see later discussion ofthis topic)

Attitudinal Perspectives

Most youth consider themselves as being moderates They can alsoreliably identify drug use as being a deviant immoderate behaviorPresenting them with the disparity between their self-view as a moderateperson despite their deviant drug use can produce a desired behaviorchange (Sussman 1989 Upshaw and Ostrom 1984) An attitudinalperspective lesson can confront students with the inconsistency betweentheir general self-attitude ratings as moderates vs their more extremespecific behaviors (eg drug use) Adopting a self-perception as amoderate may inoculate youth when social pressures to experiment withdrugs arise A desire for internal consistency a similarity betweenattitudes and behavior may increase motivation to abstain from drugs(Festinger 1957 Heider 1958) Youth received lessons like these quitefavorably in previous work (Salomon et al 1984)

Skills

Direct instruction modeling practice and group reinforcementenhance social learning At least three basic kinds of skills needinstruction self-control communication and resource acquisition

Social Self-control Skills

Good self-control protects against substance use and buffers againstthe impact of risk factors (Bandura 1986 Catalano and Hawkins 1996Weissberg et al 1989 Wills et al 1998) Poor self-control involvesbehavioral affective and cognitive deficits Poor behavioral self-controlis associated with a need to regulate and stabilize mood possiblypreceding uncontrolled behavior or stemming from the consequences ofuncontrolled behavior Poor self-control behavior along with difficultiesin mood stabilization increases risk for substance use and rapidescalation to high levels of use which then can lead to physiologicaldependence (Wills and Stoolmiller 2002)

Self-control strategies cross physiological and personality boundariesbecause self-control also relates to coping motives for substance use a

1992 Sussman et al

ORDER REPRINTS

strong predictor of substance use problems (Wills et al 1999) Self-control includes cognition because developing self-control is the substratefor personality organization including not only behavioral and affectivecontrol but also attitudes values and views of the world as accepting orhostile and social perceptions about substance use as being attractive vsunattractive For example studies find poor self-control correlated withattitudinal tolerance for deviance and more favorable perceptions oftobacco and alcohol users whereas good self-control is related tofavorable perceptions of teens that abstain from drug use (Wills et alin press-a) Self-control approaches can be useful for preventionprograms by improving self and other perceptions academic perfor-mance and the impact or facilitation of negative life events goals that aresalient to teenagers and their parents (Wills and Stoolmiller 2002)

Youth often lack adequate coping skills they tend to lack restraint orplanfulness (Farrell and Danish 1993 Rutter et al 1997) Coping skillsinstruction may help increase self-control (Kendall and Braswell 1982)Coping skills instruction receives little attention in typical social influencesprogramming (Hansen 1992) although this material appears in life skillstraining (Botvin 1993 Botvin et al 1995 Wills 1986) In self-controlprogramming youth learn to assess their self-control particularly in socialcontexts (Sussman et al 2003) They learn the importance of thinkingahead and anticipating problem situations so that they are preparedbeforehand to deal with problems that may arise They also learn theimportance of context (eg not laughing at a funeral) Finally they learnassertiveness and anger management to help them better control theirreactions in social settings (Sambrano May 1999 Sussman et al 2002)

Listening and Communication Skills

Youth genuinely benefit from listening to information with an openmind and asking open-ended questions to keep a conversation goingThey can improve social skills by learning how to ask open-endedquestions establish eye contact appropriately nodding and orientingtheir body toward the other speaker (CPPRG 1999 Eggert and Herting1991 Hawkins et al 1999 Sussman et al 2002 2003) Neverthelesssocial skills training can create problems for nondrug using high-riskteens (Palinkas et al 1996 Sussman et al 1995b Wills et al in press-b)Training in drug refusal may create reactance in some samples (Sussmanet al 1996) Among high-risk youth enhancing assertiveness and datingskills may increase the scope of social entertainment options andinadvertently improve a teenrsquos ability to acquire drugs from new sources

Motivation Skills and Decision Making 1993

ORDER REPRINTS

(Wills et al 1989) Also there are cultural variations on what constitutesgood social skill (Unger et al 2004) There are good arguments forplacing high-risk teens together in activities with well-controlled teens sothat they can model adaptive social skills and problem solvingAdditionally utilizing motivation methods prior to instructing thespecific skill channels canalizes health-directed use of social skillsmastered Overall increasing social competence will have protectiveeffects for high-risk teens (Wills et al 1994) This idea is consistent withthe studies that have shown social withdrawal to increase risk for druguse (Kerr et al 1997) though there may be gender differences in theseeffects (Pulkkinen and Pitkanen 1994) Still it is most wise to includesocial skills training in conjunction with material addressing motivationand decision making Motivations regarding drug use need to beaddressed so behaviors learned are not misdirected

Resource Acquisition

Adults often assume that teens can access community services withlittle effort In fact few teens understand the availability of healthservices or other assistance Simple information including phonenumbers and locations can assist teens immensely (Carroll 1996Sussman et al 2002) Coaching teens on techniques for receivingassistance can prove productive Public assistance for drug use-relatedproblems and other life problems can help tremendously but negotiatingthe bureaucratic difficulties inherent in many of these systems can requireconsiderable skill (Eggert and Herting 1991 Sambrano May 1999Sussman et al 2002) Direct instruction modeling and structuredpractice in resource acquisition skills may help youth to increase theirknowledge and self-efficacy on how to acquire resources and to readilyaccess resources when needed (eg use of the bus system) These skillsmay generalize to comparable tasks later in life

Decision-Making

Prevention programs have employed several decision-making strate-gies For example the protocol from Project Reconnecting Youth(Project RY) is STEPS The acronym stands for Stop Think ofoptions Evaluate options Perform or take action on the chosen optionand then Self-praise for using steps for making healthy choices (Eggertand Herting 1991) The participants help set the agenda and take turns

1994 Sussman et al

ORDER REPRINTS

illustrating it on a flip chart This task helps share the leadership andfocuses the group work and time The lesson STEPS to Drug UseControl follows skills training sessions that cover understandingSTEPS as a decision-making model

Project Towards No Drug Abuse (TND)rsquos decision-making sessioninvolves four steps These steps are

1 Brainstorming (making a list of ideas without judging them)2 Weigh the pros and cons (the benefits and costs of each idea)3 Select the best option4 Follow through (try that option and reevaluate the decision)

(Sussman et al 2002)

These decision-making strategies are similar across different pro-grams except that they include some different emphases For exampleSTEPS includes a self-instruction to begin decision making and self-praise whereas the TND sequence includes more of an emphasis onfollowing through with the decision Generally each program requiresgenerating options evaluating them choosing the best and evaluatingthe outcome in an effort to make the next decision Teens tend to enjoypracticing decision making in bogus problem situations Youth soonlearn to engage in steps like these with considerable skill Training indecision making operates on variables that are intermediate in the causalprocess and thereby strengthen individual profiles of self-controlabilities so that they are more resilient in the face of proximal riskfactors for drug use such as life stresses and peer pressures

Modalities of Programming

Both school and nonschool prevention modalities have a rich andimportant history in substance abuse prevention research (Pentz 1994Pentz et al 2004) Schools provide a captive audience for educationalmaterial Youth spend 25 of their waking lives at school so thisenvironment has considerable potential Furthermore the school contextprovides a rich research history for building new studies and evaluatingtheir efficacy (Sussman et al 1995a) Community programs also offerconsiderable opportunity

Community programs often involve local leaders and organizations(eg coalitions community boards) (Goodman et al 1993 Kaftarianand Hansen 1994) that help mobilize numerous community unitsCommunity units include businesses media the family and governmental

Motivation Skills and Decision Making 1995

ORDER REPRINTS

agencies like the police or recreational departments as well as schoolsystems A network of community units working together to developpromote and implement educational programming could increase youthsrsquobonding to others across a wide variety of social contexts (Hawkins et al1992 Pentz 1994) Community units can provide numerous types ofspecific extra-classroom prevention opportunities (Pentz 1994)

Parent-or-family targeted prevention programs include offering earlychildhood education social support for parents managing crisesparenting skills training parent-child communication skills and resourceacquisition instruction or networking Mass media targeted programsinvolve programs or public service announcements with novel fastand unconventional messages (eg the American Legacy FoundationTRUTH campaign) use of the Internet and interactive CDs (eg videogames) Alternative means to involve youth include involvement in hikingclubs drug-free dances or other after-school events with prosocial adultmentors and with means to involve youth outside of school includingentry into different environments (ie outward bound) (Tobler 1986) Inaddition policy implementation and enforcement may contribute toother prevention programs (Pentz et al 1989) Indeed simultaneousprograms within and outside of schools over long periods might maintainthe positive effects that sometimes dissipate when school programsappear alone (Pentz 1994)

The Difference Between Targeted Prevention and Cessation

Targeted (secondary) prevention attempts to keep persons fromcrossing the invisible line where they funnel into a cycle of addiction andaccumulation of negative consequences Cessation programs (sometimesreferred to as tertiary prevention) take the stance that a behavior hasoccurred with definite and perhaps irreversible negative consequencesThe goal is to stop the behavior permit recovery from the damage learnhow to prevent relapse and learn how to live with permanent changes(eg neurotransmitter function drug use-related injury) It is not clearexactly where indicated prevention ends however and where cessationbegins For example an early version of the Project TND curriculum didnot achieve effects on cigarette smoking possibly because 46 of thesample already smoked cigarettes daily (while not engaging often in someother drug use) In a revised curriculum a smoking cessation componentwas added to the program and then an effect on cigarette smoking wasachieved Cessation material can appear with prevention material to

1996 Sussman et al

ORDER REPRINTS

maximize program effectiveness Careful program development can helpdetermine the best mix (Sussman et al 2002)

Summary of Evidence-based Targeted Drug Abuse Prevention

At present approximately 29 drug-use prevention programs havebeen evaluated favorably for their effects on drug use or other problembehavior (see Table 1) These 29 programs have been identified throughtwo sources Blueprints for Violence Prevention (Elliott 2003) and theSubstance Abuse and Mental Health Services Administrationrsquos(SAMSHA) science-based prevention programsrsquo guide (USDHHS2003) PsycINFO and MEDLINE searches of drug abuse preventionstudies since 1970 supplemented searches through these two guides (seeTable 1) Nine definitions of high-risk were used across these programsEleven programs focused on economic deprivation as the definition Sixprograms focused on delinquent behavior as the identifying characteristicto target Two programs each identified single-parent homes drug use orexposure to drug use family problems alternative high school attendanceor being at risk for dropout at a regular high school as the characteristicsto target subjects Finally one program each identified new immigrantstatus or residential facility placement as the defining characteristic ofbeing at high risk for drug use

Among these programs eight focused on preteens For example theEarly Risers program defined its high-risk youth as those 6ndash10 year-oldsthat suffered economic deprivation and exhibited aggressive or opposi-tional behavior Another five programs focused on a young teen agegroup For example Preventive Intervention defined its high-risk youthas those seventh to eighth graders who exhibited poor school andacademic discipline and reported family problems Another sevenprograms focused on an older teen age group For example ProjectTND defined its high-risk youth as those youth that attended alternativehigh schools Finally nine programs encompassed wide age ranges Forinstance Big Brothers Big Sisters of America defined its high-risk youthas 6ndash18 year-olds that lived in single-parent homes

Of these programs 10 involved multiple often flexible settings ofimplementation Another 13 programs focused on the school settingFour programs focused on the home setting Finally two programsfocused on a community agency setting In general these programsinvolved implementation by highly trained personnel Eighteen of theseprograms involved some motivation aspect generally motivationenhancement but sometimes including extrinsic reinforcement strategies

Motivation Skills and Decision Making 1997

ORDER REPRINTS

Twenty-six of these programs provided skills training Finally 18programs provided instruction in decision making Thus the MSDmodel tends to appear in a majority of these programs however all threecomponents were included together in only nine of these programs

Twenty of these programs involved at least one replication of theprogram and 14 involved three or more replications Further 14 of theseprograms were tested through use of experimental designs and nineinvolved use of only quasi-experimental designs Effects on drug use wereassessed and found in 22 of these programs For example theReconnecting Youth program was implemented to youth at risk fordropout This program involved 90 sessions within a comprehensive highschool class delivered generally over a semester with small studentgroups and a highly trained teacher Instruction included use of groupsupport and providing life skills training (norm setting self-esteem moodmanagement communication skills self-monitoring monitoring goalsschool bonding and social activities) with feedback to parents Programgoals were achieved through use of a quasi-experimental design showingeffects for school performance (18 improvement in grades) drug use(54 decrease in hard drug use) and suicide risk (32 decline inperceived stress) This programrsquos results have been replicated numeroustimes in numerous locations This program involved all three componentsof the MSD model except that motivation was provided through peergroup support not through provision motivation enhancement strate-gies These targeted programs present an optimistic picture for drug-useprevention that is focused on at-risk youth (see Table 1)

Not all targeted prevention programs have been found to beeffective One published program that failed to find positive effects wasProject PALS (Palinkas et al 1996) This project was developed for teengirls who were pregnant or at risk for pregnancy and drug use Theprogram consisted of school-based delivery of 16 sessions once a weekin a class The goal was to decrease drug use The PALS Skills TrainingProgram involved instruction in assertiveness providing and receivingfeedback social conversation handling requests and asking for help andmood management This program was tested against a normativeeducation program (called Facts of Life or FOL) which instructedvalues and decision making sexuality issues and contraception sexuallytransmitted diseases (STDs) drug use risks sexual assault prevalenceand norms material An experimental evaluation with a seven-monthspost-baseline was used The results indicated that the PALS programsubjects reported 29 times greater marijuana use than FOL amongbaseline nonusers No other differences were found It is possible that theprogram was not targeted to the right population that the mix of skills

1998 Sussman et al

ORDER REPRINTS

instructed was not appropriate or that skill training alone (withoutappropriate motivation material) may not be effective in drug useprevention Researchers should examine these possibilities and others tofurther understand program failures as well as program successes

Potential Limitations of Targeted Prevention

Dishion and colleagues (1995) suggest from various findings thatgrouping high-risk youth may lead to increased drug use This outcomecan result if youth come to learn deviant behavior from each other Theycan learn deviant behavior from each other in a program if they haveunstructured or unsupervised time together An essential feature ofseveral targeted programs (eg the RY and TND programs) is building apositive peer culture with group norms that decrease drug involvementand drug-use control problems The RYrsquos findings suggest that a positivepeer group component carefully fostered by a well-trained and competentRY group leader can direct the group toward lower risk behaviorSimilarly classroom management in Project TND involves developmentof positive norms of classroom behavior Further interaction betweenyouth is encouraged but is primarily teacher-directed and highlystructured (Sussman et al 2003) In both RY and Project TND theteacherrsquos role is to actively develop and maintain peer group support inthe class by modeling support positively reinforcing it among groupmembers and negatively reinforcing deviant peer bonds and activities(Eggert and Herting 1991 Vorrath and Brendtro 1985) The teachercreates and structures interactions among youth in prosocial directions(Sussman et al 2003)

Multiple Problem Behaviors of Adolescents

Acknowledging the relationship of drug use to other commonadolescent problems may facilitate identification of effective methods ofreducing drug use Researchers on tobacco alcohol and other drug useantisocial behavior high-risk sexual behavior and depression increas-ingly recognize that these problems are interrelated (McGee andNewcomb 1992) and stem to a large extent from the same environ-mental and biological factors (Biglan et al in press Eggert et al 1995Sussman and Ames 2001 Wills and Cleary 1995) Clearly it is necessaryto have strategies that address the entire range of problems and thecontext that influences those problems Indeed further reductions in

Motivation Skills and Decision Making 1999

ORDER REPRINTS

many problems require that we comprehensively target youth withmultiple problem behaviors

Biglan and colleagues (in press) provide a comprehensive review ofthe relationships among antisocial behavior tobacco alcohol and otherdrug use and high-risk sexual behavior It is clear that the same youngpeople are prone to the development of the entire range of problems In arecent review Moffitt and colleagues (2002) found that antisocialbehavior in early adolescence (rather than late adolescence) is a greaterrisk factor for developing multiple problems These findings point to theimportance of early intervention before youth develop serious problemsMoreover these different problems largely result from the same set ofenvironmental and biological factors

One implication is that disciplines dealing with these problemsother than drug abuse may contribute to dealing with the problem ofdrug use (Newcomb 1996b 1997) In particular research by dev-elopmental psychologists family social workers and sociologists onthe influence of parents on adolescent problem development and oninterventions to alter parenting practices contributes to our understandingof how to prevent or ameliorate drug abuse and other problems Onealso should note that nonsubstance use is not a guarantee for problemimmunity for the entire age range of people whatever their genderethnicity religiosity socioeconomic status (SEC) domicility etc It maybe argued that the most promising programs are those targeting thesemultiple levels of influence Several multidisciplinary programs haveachieved promising results We describe three of these empiricallyevaluated programs tested in various settings

Functional Family Therapy (FFT)FFT is an indicated intervention involving family treatment designed

for delinquent teenagers (also see Table 1) Developed in the early 1970sby Alexander and colleagues (1973) FFT focuses on family commu-nication and the establishment of rules and consequences Several studiesprovide encouraging reports of the programrsquos effectiveness (Alexander etal 1976 Barton et al 1985 Klein et al 1977 Waldron et al 2001) Inthe Waldron et al (2001) study researchers used FFT and anintervention with cognitive behavior therapy on teens referred formarijuana use Each of the interventions produced significant resultson marijuana use by the teens at four months but only the twointerventions combined maintained these results at seven months Theearlier studies found a greater number of results For example in the twoAlexander studies (1973 1976) improvement in family communicationposttreatment led to reduced delinquency Note that all the teens in these

2000 Sussman et al

ORDER REPRINTS

studies had histories of serious antisocial or delinquent behavior Thusachieving positive outcomes even if only short-term should encouragefurther research into the efficacy of FFT

Multisystemic Therapy (MST)As its name suggestsMST targets individual family peer school and

community influences of those youth offenders with serious problems thatmay include violence substance use and severe emotional problems (alsosee Table 1) Numerous researchers have published the results ofrandomized trials of MST (Henggeler et al 1996 1997 1998 Thorntonet al 2000) The most consistent findings across studies are decreased (1)drug use (2) re-arrest (3) self-reported criminal offense and (4) days inout-of-home placements Other consistent findings are improved familyrelations school attendance and psychiatric functioning One cautionarynote the programrsquos effectiveness lowers considerably if not implementedwith fidelity (Hengler et al 1997 1999) In other words all or key lessonsneed to be delivered as written by educators who are well-trained in usingthe strategies employed and youth need to be able to receive all material inan atmosphere conducive to learning the material The programdevelopers have instituted training strategies that address these fidelityissues thus shaping MST to be a very promising program for at-riskyouth

Multidimensional Treatment Foster Care (MTFC)MTFC targets family and peer factors influencing adolescents with a

pattern of repeat criminal offending (see Table 1) (Chamberlain 1994)This intervention includes placement of the youth into a foster homewith a foster parent trained in behavior management who receivessupport from intervention staff After the adolescent has begun torespond to the intervention in the foster home and after the parents havereceived the same training and support as the foster parents did theadolescent returns home Chamberlain and Reid (1998) tested theintervention with 85 boys with felony and other criminal histories andfound substantial benefits of the program Following treatment the boysassigned to MTFC (compared to those receiving community-based groupcare) showed fewer days in detention or lock-up twice as much timeliving with parents fewer misdemeanor and felony arrests and fewer self-reported index crimes felony arrests and general delinquency TheMTFC is a cost-effective alternative to incarceration however staffrequirements are extensive which may influence the ability of some

Motivation Skills and Decision Making 2001

ORDER REPRINTS

groups to apply the program with fidelity However as with each of theprograms described here the results of the randomized trials areencouraging

Future Research Needs in Targeted Prevention

Future research can help discern when and where targeted preventionprogramming will tend to work rather than produce potentiallydeleterious negative group effects or results that are irrelevant for pro-social healthy adaptation as well as what the critical necessary conditionsare for their effective operation within given de facto realities Comparedto the breadth of evaluated universal drug use prevention programs(Tobler et al 2000) relatively few targeted prevention programs havereceived empirical support Yet previous research suggests that universalschool-based drug use prevention programs implemented in junior highschool have relatively less chance of long-term success especially for thoseyouth that began using drugs before the prevention program wasimplemented Of course there are notable exceptions (eg effects lastedfor one and a half years effects lasted for six years) (Chou et al 1998Griffin et al 2003 Skara and Sussman 2003) Almost no research existsregarding maximization of booster programming with high-risk youthMore research on booster programs would help the field

While continuing to engage in this work there will be numerousissues to manage that go well beyond the scope of this article There willbe a need to avoid producing negative labeling effects while providingprogramming for those who are at risk for drug use It is possible thatcessation information needs to be included in the mix with preventionmaterial to provide better targeted-prevention effects There may be aneed to develop a teacher selection instrument to help select out teacherswho can deliver drug abuse prevention programming adequatelyCertainly definition of outcome variables needs continued explorationincluding analysis to ascertain the effects of programming on drug abusevs drug use and identification of the variables that are most closelylinked to change by targeted prevention components

A transdisciplinary approach helps to better understand the lifesituation of high-risk youth as based to some extent on both constitutionaland environmental factors (Fuqua et al 2004 Rutter et al 1997 Wills etal 1996b) From the transactional perspective their situation is in partconstitutional they may have temperamental characteristics that arepartly heritable and that have set the stage at earlier ages for decrements inself-control ability and academic performance that then increase risk for

2002 Sussman et al

ORDER REPRINTS

drug use However their situation is also part environmental based in parton family socialization and in part on the types of peers they have as well asthe type and quality of the physical and cultural environment-at-largeThere are many points at which a potential chain of failures can beinterrupted and the individualrsquos trajectory turned in a better directionProblems are not inevitable from starting level (Tarter and Vanyukov1994) and environmental modifications to support good self-controlability can help to avert an adverse impact from earlier experiences orcurrent difficulties (Brody et al 2002 Novak and Clayton 2001 Patock-Peckham et al 2001 Rutter et al 1997 Wills et al 2002)

The problems and needs of high-risk youth in our nationrsquos highschools demand our attention for designing and rigorously testingtargeted prevention approaches Substantial evidence shows that theseyouth are at greater risk for drug involvement and co-occurring problemssuch as aggression depression and suicidal behaviors as we previouslydiscussed It is hoped that the information presented in this article willstimulate others to join in extending this work including testing othermodels of targeted prevention

GLOSSARY

Universal programs Programs that aim to influence all subjects in acontext

Selective drug-abuse prevention programs Programs that servegroups at greater risk of ATOD usemdashfor example children of alcoholicparents They are at psychosocial risk for drug use and abuse

Indicated drug-abuse prevention programs Programs that attemptto benefit individuals who already show signs of drug involvement orrelated risk factors In indicated prevention programs the primary goal isto stem the progression of ATOD use or reduce drug involvementamong the high-risk youth

Targeted programming Programming that subsumes selective andindicated programming sometimes the other two types of programs thattarget specific groups lsquolsquoat riskrsquorsquo are considered together

ACKNOWLEDGMENTS

This research was supported by grants from the National Institute onDrug Abuse (DA01070 DA07601 DA13814 and DA16094) and by aResearch Scientist Development Award K02 DA00252 from theNational Institute on Drug Abuse

Motivation Skills and Decision Making 2003

ORDER REPRINTS

REFERENCES

Alexander J F Barton C Schiaro R S Parsons B V (1976)

Systems-behavioral intervention with families of delinquents

therapist characteristics family behavior and outcome Journal of

Consulting and Clinical Psychology 44(4)656ndash664Alexander J F Parsons B V (1973) Short-term behavioral interven-

tion with delinquent families impact on family process and

recidivism Journal of Abnormal Psychology 3219ndash225American psychiatric association (APA) (1994) Diagnostic and

Statistical Manual of Mental Disorders 4th edn (DSM-IV)

Washington DC American Psychiatric AssociationAmes S L Sussman S Dent C W (1999) Pro-drug-use myths and

competing constructs in the prediction of substance use among

youth at continuation high schools a one-year prospective study

Personality and Individual Differences 26987ndash1003Bachman S G Wadsworth K N OrsquoMalley P M Johnston L D

Schulenberg J E (1997) Smoking drinking and drug use in young

adulthood Mahwah NJ Lawrence Erlbaum Associates 8ndash25

153ndash190Bandura A (1986) Social Foundations of Thought and Action A Social

Cognitive Theory Englewood Cliffs NJ Prentice HallBarton C Alexander J F Waldron H Turner C W Warburton J

(1985) Generalizing treatment effects of functional family therapy

Three replications The American Journal of Family Therapy

13(3)16ndash26Battin-Pearson S R Newcomb M D Abbott R D Hill K G

Catalano R F Hawkins J D (2000) Predicting early high school

dropout Journal of Educational Psychology 92568ndash582Biglan A Brennan P A Foster S L Holder H D Miller T L

Cunningham P B et al (in press) Helping Adolescents at Risk

Prevention of Multiple Problem Behaviors New York NY Guilford

PressBindra D Stewart J (1996) Motivation Baltimore MD Penguin

BooksBlanton H Gibbons F X Gerrard M Conger K J Smith G E

(1998) The role of family and peers in the development of

prototypes associated with substance use Journal of Family

Psychology 11271ndash288

2004 Sussman et al

ORDER REPRINTS

Botvin G J (1993) School-based drug abuse prevention Long-termfollow-up results In First Annual Meeting of the Society forPrevention Research Kentuck Lexington Society for PreventionResearch

Botvin G J Baker E Dusenbury L Botvin E M Diaz T (1995)Long-term follow-up results of a randomized drug abuse preven-tion trial in a white middle-class population Journal of theAmerican Medical Association 2731106ndash1012

Brody G H Dorsey S Forehand R Armistead L (2002) Uniquecontributions of parenting and classroom processes to the self-control of AfricanndashAmerican children Child Development73274ndash286

Carroll M E (1996) Reducing drug abuse by enriching the environmentwith alternative nondrug reinforcers In Green L Kagel J Heds Advances in Behavioral Economics Norwood NJ NorwoodPublishing Corp 37ndash68

Carver C S Scheier M F (1998) On the Self-Regulation of BehaviorNew York Cambridge University Press

Catalano R F Hawkins J D (1996) The social developmental modela theory of antisocial behavior In Hawkins J D ed Delinquencyand Crime Current Theories New York Cambridge UniversityPress

Centers for Disease Control (CDC) (October 1999) Youth risk BehaviorSurveillancemdashNational Alternative High School Youth RiskBehavior Survey 1998 Morbidity and Mortality Weekly Report48 No SS-7

Chamberlain P (1994) Family connections A treatment foster caremodel for adolescents with delinquency Eugene OR CastaliaPublishing Company

Chamberlain P Reid J B (1998) Comparison of two communityalternatives to incarceration for chronic juvenile offenders Journalof Consulting and Clinical Psychology 66(4)624ndash633

Chassin L A Presson C C Sherman S J (1985) Stepping backwardin order to step forward an acquisition-oriented approach toprimary prevention Journal of Consulting and Clinical Psychology53612ndash622

Chou C-P Montgomery S Pentz M A Rohrbach L A JohnsonC A Flay B R MacKinnon D P (1998) Effects of acommunity-based prevention program on decreasing drug use inhigh-risk adolescentsAmerican Journal of Public Health 88944ndash948

Conducts Problems Prevention Research Group (CPPRG) (1999) Initialimpact of the fast track prevention trial for conduct problems I

Motivation Skills and Decision Making 2005

ORDER REPRINTS

The high-risk sample Journal of Consulting and Clinical Psychology

67631ndash647Conducts Problems Prevention Research Group (CPPRG) (2000)

Merging universal and indicated prevention programs the fast

track model Addictive Behaviors 25913ndash927Council of Philosophical Studies (1981) Psychology and the Philosophy

of Mind in the Philosophy Curriculum San Francisco San Francisco

State UniversityCummings K M Hellmann R Emont S L (1988) Correlates of

participation in a worksite stop smoking program Journal of

Behavioral Medicine 11267ndash277Curry S Wagner E H Gothaus L C (1990) Intrinsic and extrinsic

motivation for smoking cessation Journal of Consulting and

Clinical Psychology 58310ndash316Dent C W Sussman S McCuller W J Stacy A W (2001) Drug

abuse prevention among youth at comprehensive high schools

Preventive Medicine 32514ndash520Dewey J (1886) Psychology New York HarperDishion T J French D C Patterson G R (1995) The development

and ecology of antisocial behavior In Cicchetti D Cohen D

eds Manual of developmental psychopathology New York John

Wiley 421ndash471Eggert L L Herting J R (1991) Preventing teenage drug abuse

exploratory effects of network social support Youth and Society

22482ndash534 [Reprinted National Prevention Evaluation Research

CollectionRockville MD Aspen 1993]Eggert L L Herting J R Thompson E A Nicholas L J Dicker

B G (1994) Preventing adolescent drug abuse and high school

dropout through an intensive school-based social network devel-

opment program American Journal of Health Promotion

8202ndash214Eggert L L Thompson E A Herting J R Nicholas L J (1995)

Reducing suicide potential among high-risk youth tests of a school-

based prevention program Suicide amp Life-Threatening Behavior

25276ndash296Ellickson P L Bell R M (1990) Drug prevention in junior high a

multi-site longitudinal test Science 2471299ndash1305Elliott D S (Series ed) (2003) Blueprints for violence prevention

Boulder CO Institute of Behavioral Science Regents of the

University of Colorado wwwcoloradoeducspvblueprints

2006 Sussman et al

ORDER REPRINTS

Farrell A D Danish S J (1993) Peer drug associations and emotionalrestraint Causes or consequences of adolescent drug use Journal ofConsulting and Clinical Psychology 61327ndash334

Festinger L A (1957) A Theory of Cognitive Dissonance New YorkHarper amp Row

Fuqua J Stokols D Gress J Phillips K Harvey R (2004)Transdisciplinary collaboration as a basis for enhancing the scienceand prevention of substance use and abuse Substance Use ampMisuse

Giuliano J D (1994) A peer education program to promote the use ofconflict resolution skills among at-risk school-age males PublicHealth Reports 109158ndash169

Glynn K Levanthal H Hirschman R (1985) A cognitivedevelopmental approach to smoking prevention In Bell C SBattjes R eds Prevention research Deterring Drug Abuse AmongChildren and Adolescents Rockville MD NIDA ResearchMonograph 63

Glynn T J (1989) Essential elements of school-based smokingprevention programs Journal of School Health 59181ndash188

Goodman R M Burdine J N Meehan E McLeroy K R eds(1993) Community coalitions for health promotion Special issue ofHealth Education Research Theory and Practice 8309ndash453

Goodyear R D Newcomb M D Locke T F (2002) PregnantLatina teenagers psychosocial and developmental determinants ofhow they select and perceive the men who father their childrenJournal of Counseling Psychology 49187ndash201

Gordon R (1987) An operational classification of disease preventionIn Steinberg J A Silverman M M eds Preventing MentalDisorders Rockville MD DHHS 20ndash26

Graham J W Johnson C A Hansen W B Flay B R Gee M(1990) Drug use prevention programs gender and ethnicityevaluation of three seventh-grade project SMART cohortsPreventive Medicine 19305ndash313

Griffin K W Botvin G J Nichols T R Doyal M M (2003)Effectiveness of a universal drug abuse prevention approach foryouth at high risk for substance use initiation Preventive Medicine36(1)1ndash7

Hamilton S (August 20 2000) Views slowly changing on alternativeschools The Sacramento Bee 1ndash3

Hansen W B (1992) School-based substance abuse prevention a reviewof the state of the art in curriculum 1980ndash1990 Health EducationResearch 7403ndash430

Motivation Skills and Decision Making 2007

ORDER REPRINTS

Hansen W B Johnson C A Flay B R Graham J W Sobel J(1988) Affective and social influences approaches to the preventionof multiple substance abuse among seventh grade students resultsfrom project SMART Preventive Medicine 17135ndash154

Hansen W B Graham J W (1991) Preventing alcohol marijuanaand cigarette use among adolescents peer pressure and resistancetraining versus establishing conservative norms PreventiveMedicine 20414ndash430

Hawkins D H Catalano R F Miller J Y (1992) Risk andprotective factors for alcohol and other drug problems inadolescence and early adulthood Implications for substanceabuse prevention Psychological Bulletin 11254ndash105

Hawkins J D Catalano R F Kosterman R Abbott R Hill K G(1999) Preventing adolescent health-risk behaviors by strengthen-ing protection during childhood Archives of Pediatric amp AdolescentMedicine 153226ndash234

Heider F (1958) The Psychology of Interpersonal Relations New YorkWiley

Henggeler S W Pickrel S G Brondino M J Crouch J L (1996)Eliminating (almost) treatment dropout of substance abusing ordependent delinquents through home-based multisystemic therapyAmerican Journal of Psychiatry 153(3)427ndash428

Henggeler S W Melton G B Brondino M J Scherer D GHanley J H (1997) Multisystemic therapy with violent andchronic juvenile offenders and their families the role of treatmentfidelity in successful dissemination Journal of Consulting andClinical Psychology 65(5)821ndash833

Henggeler S W Schoenwald S K Borduin C M Rowland M DCunningham P B (1998) Multisystemic treatment of antisocialbehavior in children and adolescents New York The Guilford Press

Henggeler S W Pickrel S G Brondino M J (1999) Multisystemictreatment of substance-abusing and dependent delinquents out-comes treatment fidelity and transportability Mental HealthServices Residual 1(3)171ndash84

Johnson C A Pentz M A Weber M D Dwyer J H Baer NMacKinnon D P Hansen W B Flay B R (1990) Relativeeffectiveness of comprehensive community programming for drugabuse prevention with high-risk and low-risk adolescents Journalof Consulting and Clinical Psychology 58447ndash456

Kaftarian S J Hansen W B eds (1994) CSAP special issuecommunity partnership program Journal of Community Psychologypages 205

2008 Sussman et al

ORDER REPRINTS

Karoly P (1993) Mechanisms in self-regulation A systems view AnnualReview of Psychology 4423ndash51

Karoly P (1980) Person variables in therapeutic change and develop-ment In Karoly P Steffen J J eds Improving the Long-TermEffects of Psychotherapy New York Gardner Press 195ndash261

Kendall P C Braswell L (1982) Cognitive-behavioral self-controltherapy for children a components analysis Journal of Consultingand Clinical Psychology 50672ndash689

Kerr M Tremblay R E Pagani L Vitaro F (1997) Boysrsquobehavioral inhibition and the risk of later delinquency Archivesof General Psychiatry 54809ndash816

Klein N C Alexander J F Parsons B V (1977) Impact of familysystems intervention on recidivism and sibling delinquency a modelof primary prevention and program evaluation Journal ofConsulting and Clinical Psychology 45(3)469ndash474

Kumpfer K L (1999) Outcomes measures of interventions in the studyof children of substance-abusing parents Pediatrics 1031128ndash1144

Lau R R Hartman K A Ware J E (1986) Health as a valuemethodological and theoretical considerations Health Psychology525ndash43

Lichtenstein E L Glasgow R E (1997) A pragmatic framework forsmoking cessation implications for clinical and public healthprograms Psychology of Addictive Behaviors 11142ndash151

Locke T F Newcomb M D (in press) Childhood maltreatmentparent drug problems polydrug problems and parenting practicesa test of gender differences and four theoretical perspectivesJournal of Family Psychology

McCreary D R Newcomb M D Sadava S W (1999) The male rolealcohol use and alcohol problems a structural modeling examina-tion in adult women and men Journal of Counseling Psychology46109ndash124

McGee L Newcomb M D (1992) General deviance syndromeexpanded hierarchical evaluations at four ages from earlyadolescence to adulthood Journal of Consulting amp ClinicalPsychology 60766ndash776

Miller W R Brown J M (1991) Self-regulation as a conceptual basisfor the prevention of addictive behaviours In Heather N MillerW R Greeley J eds Self-control and the Addictive BehavioursSydney Australia Maxwell Macmillan 3ndash79

Miller W R Leckman A L Delaney H D Tinkcom M (1993)Long-term follow-up of behavioral self-control training forproblem drinkers Journal of Studies on Alcohol 53249ndash261

Motivation Skills and Decision Making 2009

ORDER REPRINTS

Miller W R Rollnick S (1991) Motivational InterviewingPreparing People to Change Addictive Behavior New YorkGuilford Press

Moffitt T E Caspi A Harrington H Milne B J (2002) Males onthe life-course-persistent and adolescence-limited antisocial path-ways follow-up at age 26 years Development and Psychopathology14(1)179ndash207

National Institute on Drug Abuse (NIDA) (1997) Drug abuseprevention What works NIH Publication 97-4110 DHHSNational Institutes of Health National Institute on Drug AbuseOffice of Science Policy and Communications Rockville MD

Newcomb M D (1992a) Substance abuse and control in the UnitedStates ethical and legal issues Social Science and Medicine35471ndash479

Newcomb M D (1992b) Understanding the multidimensional nature ofdrug use and abuse The role of consumption risk factors andprotective factors In Glantz M D Pickens R eds Vulnerabilityto Drug Abuse Washington DC American PsychologicalAssociation 255ndash298

Newcomb M D (1996a) Pseudomaturity among adolescents constructvalidation sex differences and associations in adulthood Journalof Drug Issues 26477ndash504

Newcomb M D (1996b) Adolescence Pathologizing a normal processThe Counseling Psychologist 24482ndash490

Newcomb M D (1997) Psychosocial predictors and consequences ofdrug use a developmental perspective within a prospective studyJournal of Addictive Diseases 1651ndash89

Newcomb M D Bentler P M (1988) Consequences of Adolescent DrugUse Impact on the Lives of Young Adults Beverly Hills CA Sage

Newcomb M D Bentler P M (1989) Substance use and abuse amongchildren and teenagers American Psychologist 44242ndash248

Newcomb M D Harlow L L (1986) Life events and substance useamong adolescents Mediating effects of perceived loss of controland meaninglessness in life Journal of Personality and SocialPsychology 51564ndash577

Newcomb M D Chou C-P Bentler P M Huba G J (1988)Cognitive motivations for drug use among adolescents longitudinaltests of gender differences and predictors of change in drug useJournal of Counseling Psychology 35426ndash438

Newcomb M D Abbott R D Catalano R F Hawkins J DBattin-Pearson S R Hill K (2002) Mediational and deviancetheories of late high school failure Process roles of structural

2010 Sussman et al

ORDER REPRINTS

strains academic competence and general versus specific problem

behaviors Journal of Counseling Psychology 49172ndash186Nezami E Sussman S Pentz M A (2003) Motivation in tobacco use

cessation research Substance Use amp Misuse 3825ndash5Novak S P Clayton R R (2001) The influence of school environment

and self-regulation on transitions between stages of cigarette

smoking Health Psychology 20196ndash207Offord D R (2000) Selection of levels of prevention Addictive

Behaviors 25833ndash842Palinkas L A Atkins C J Miller C Ferreira D (1996) Social skills

training for drug prevention in high-risk female adolescents

Preventive Medicine 25692ndash701Patock-Peckham J A Cheong J-W Balhorn M E Nagoshi C T

(2001) A model of parenting styles self-regulation perceived

drinking control and alcohol use and problems Alcoholism

Experimental and Clinical Research 251284ndash1292Pentz M A (1994) Directions for future research in drug abuse

prevention Preventive Medicine 23646ndash652Pentz M A Dwyer J H MacKinnon D Flay B R Hansen W B

Wang E Y I Johnson C A (1989) A multi-community trial for

primary prevention of adolescent drug abuse effects on drug use

prevalence JAMA 2623259ndash3266Pentz M A Mares D Schinke S Rohrbach L (in press) Political

science public policy and drug abuse prevention Substance Use amp

MisuseProchaska J O DiClemente C C (1982) Transtheoretical therapy

toward a more integrative model of change Psychotherapy Theory

Research and Practice 19275ndash288Pulkkinen L Pitkanen T (1994) A prospective study of the precursors

to problem drinking in young adulthood Journal of Studies on

Alcohol 55578ndash587Rathus S A Nevid J S (1977) Behavior Therapy Strategies for

Solving Problems in Living New York Doubleday and Company

IncResnicow K Botvin G (1993) School-based substance use prevention

programs why do effects decay Preventive Medicine 22484ndash490Rutter M Dunn J Plomin R Simonoff E Pickles A Maughan

B Ormel J Meyer J Eaves L (1997) Integrating nature and

nurture implications of person-environment interactions for

developmental psychopathology Development and Psychopathology

9335ndash364

Motivation Skills and Decision Making 2011

ORDER REPRINTS

Salomon G Stein Y Eisenberg S Klein L (1984) Adolescent

smokers and nonsmokers profiles and their changing structure

Preventive Medicine 13446ndash461Sambrano S (1999) National cross-site evaluation of high risk youth

programs In Interim findings Bulletin Washington DC CSAP

SAMSHA US DHHS May 1ndash16Schinke S P Gilchrist L D (1985) Preventing substance abuse with

children and adolescents Journal of Consulting and Clinical

Psychology 53596ndash602Skara S N Sussman S (2003) A review of 25 long-term adolescent

tobacco and other drug use prevention program evaluations

Preventive MedicineSmith C Lizotte A J Thornberry T P Krohn M D (1995)

Resilient youth identifying factors that prevent high-risk youth

from engaging in delinquency and drug use Delinquency and

Disrepute in the Life Course Greenwich CT John Hagan JAI

press 217ndash247Sommers P V (1972) The Biology of Behavior Australia Pty ltd

Sydney John Wiley amp SonsSt Pierre T L Kaltreider D L Mark M M Aikin K J (1992)

Drug prevention in a community setting a longitudinal study of the

relative effectiveness of a three-year primary prevention program in

boys and girls clubs across the nation American Journal of

Community Psychology 20673ndash706Stein J A Newcomb M D Bentler P M (1987) An eight year study

of multiple influences on drug use and drug use consequences

Journal of Personality and Social Psychology 531094ndash1105Sully J (1884) Outlines of Psychology New York D Appleton amp CoSussman S (1989) Two social influence perspectives of tobacco use

development and prevention Health Education Research Theory

and Practice 4213ndash223Sussman S (1991) Curriculum development in school-based prevention

research Health Education Research Theory and Practice

6339ndash351Sussman S (1996) Development of a school-based drug abuse

prevention curriculum for high risk youth Journal of

Psychoactive Drugs 28169ndash182Sussman S Ames S L (2001) The social psychology of drug abuse

Buckingham GB Open University PressSussman S Unger J (2004) A drug abuse theoretical integration a

transdisciplinary speculation Substance Use amp Misuse

2012 Sussman et al

ORDER REPRINTS

Sussman S Dent C W Burton D Stacy A W Flay B R (1995a)

Developing school-based tobacco use prevention and cessation

programs Thousand Oaks CA Sage Publications IncSussman S Dent C W Simon T R Stacy A W Galaif E R

Moss M A Craig S Johnson C A (1995b) Effectiveness of

social influence substance abuse prevention curricula in compre-

hensive and continuation high schools Drugs and Society 865ndash81Sussman S Dent C W Galaif E R (1997) The correlates of

substance abuse and dependence among adolescents at high risk

for drug abuse Journal of Substance Abuse 9241ndash255Sussman S Dent C W Stacy A W (1996) The relation of pro-drug

use myths with self-reported drug use among youth at continuation

high schools Journal of Applied Social Psychology 26214ndash267Sussman S Dent C W Stacy A Craig S (1998) One-year outcomes

of project towards no drug abuse Preventive Medicine 27632ndash642

(erratum 766)Sussman S Dent C W Stacy S (2002) Project towards no drug

abuse a review of the findings and future directions American

Journal of Health Behavior 26354ndash365Sussman S McCuller W J Dent C W (2003) The associations of

social self-control personality disorders and demographics with

drug use among high risk youth Addictive Behaviors 281159ndash1166Sussman S Rohrbach L Patel R Holiday K (2003) A look at an

interactive classroom-based drug abuse prevention program

Interactive contents and suggestions for research Journal of Drug

Education 33355ndash368Sussman S Sun P McCuller W J Dent C W (2003) Project

towards no drug abuse two year outcomes of a trial that compares

health educator delivery to self-instruction Preventive Medicine

37155ndash162Tarter R E Vanyukov M (1994) Alcoholism a developmental disorder

Journal of Consulting and Clinical Psychology 621096ndash1107Thornton T N Craft C A Dahlberg L L Lynch B S Baer K

(2000) Best Practices of Youth Violence Prevention A Sourcebook

for Community Action Atlanta GA Division of Violence

Prevention Centers for Disease Control and PreventionTobler N S (1986) Meta-analysis of 143 adolescent drug prevention

programs quantitative outcome of program participants compared to

a control or comparison group Journal of Drug Issues 16537ndash567Tobler N S Roona M R Ochshorn P Marshall D G Streke

A V Stackpole K M (2000) School-based adolescent drug

Motivation Skills and Decision Making 2013

ORDER REPRINTS

prevention programs 1998 Meta-analysis The Journal of Primary

Prevention 20275ndash336US Department of Health and Human Services (USDHHS) (2003)

Substance Abuse andMental Health Services Administration Center

for Substance Abuse Prevention Science-based prevention programs and

principles 2002 Rockville MD US DHHS (SMA)03-3764 Also

see httpmodelprogramssamhsagovUnger J Baezconde-Garbanati L Shakib S Palmer P H Nezami

E Mora J (2004) What are the implications of structuralcultural

theory for drug abuse prevention Substance Use amp MisuseUpshaw H S Ostrom T M (1984) Psychological perspective in

attitude research In Eiser J R ed Attitudinal Judgment New

York Springer-Verlag 23ndash42Valente T W Gallaher P Mouttapa M (2004) Using social network

theory to understand and prevent substance use a transdisciplinary

perspective Substance Use amp MisuseVorrath H Brendtro L (1985) Positive peer culture 2nd edn Aldine

ChicagoWaldron H B Slesnick N Brody J L Turner C W Peterson T R

(2001) Treatment outcomes for adolescent substance abuse at 4-

and 7-month assessments Journal of Consulting amp Clinical

Psychology 69(5)802ndash813Watson D L Tharp R G (2002) Self-directed behavior Self-

modification for personal adjustment 8th edn Belmont CA

WadsworthWeissberg R P Caplan M Z Sivo P J (1989) A new conceptual

framework for establishing school-based social competence promo-

tion programs In Bond L A Compas B E eds Primary

Prevention amp Promotion in the Schools Newbury Park CA Sage

255ndash296Wills T A (1986) Stress and coping in early adolescence relationships

to substance use in urban school samples Health Psychology

5503ndash529Wills T A Cleary S D (1995) Stress-coping model for alcohol-

tobacco interactions in adolescence In Fertig J B Allen J P

eds Alcohol and Tobacco From Basic Science to Clinical Practice

Bethesda MD National Institute on Alcohol Abuse and

Alcoholism 107ndash128Wills T A Cleary S D (1999) Peer and adolescent substance use

among 6thndash9th graders Latent growth analyses of influence versus

selection mechanisms Health Psychology 18453ndash463

2014 Sussman et al

ORDER REPRINTS

Wills T A Hirky A E (1996) Coping and substance abuse InZeidner M Endler N S eds Handbook of Coping TheoryResearch and Applications New York Wiley 279ndash302

Wills T A Stoolmiller M (2002) The role of self-control in earlyescalation of substance use a time-varying analysis Journal ofConsulting and Clinical Psychology 70986ndash997

Wills T A Baker E Botvin G J (1989) Dimensions of assertivenessdifferential relationships to substance use in early adolescenceJournal of Consulting and Clinical Psychology 57(4)473ndash478

Wills T A Vaccaro D McNamara G (1994) Novelty seeking risktaking and related constructs as predictors of adolescent substanceuse an application of Cloningerrsquos theory Journal of SubstanceAbuse 61ndash20

Wills T A McNamara G Vaccaro D Hirky A E (1996a)Escalated substance use a longitudinal grouping analysis fromearly to middle adolescence Journal of Abnormal Psychology105166ndash180

Wills T A Pierce J P Evans R I (1996b) Large-scale environmentalrisk factors for substance use American Behavioral Scientist39808ndash822

Wills T A Windle M Cleary S D (1998) Role of temperamentnovelty-seeking and self-control in adolescent substance useJournal of Personality and Social Psychology 74387ndash406

Wills T A Sandy J M Shinar O (1999) Substance use level andproblems in late adolescence a mediational model based on self-control and coping motives Experimental and ClinicalPsychopharmacology 7122ndash134

Wills T A Cleary S D Filer M Shinar O Mariani J Spera K(2001) Temperament and self-control related to early-onsetsubstance use test of a developmental model Prevention Science2145ndash163

Wills T A Sandy J M Yaeger A (2002) Moderators of therelationship between substance use level and problems test of aself-regulation model in adolescence Journal of AbnormalPsychology 1113ndash21

Wills T A Gibbons F X Gerrard M Murry V Brody G (in press-a) Family communication and religiosity related to substance useand sexual behavior in early adolescence Psychology of AddictiveBehaviors

Wills T A Resko J Ainette M Mendoza D (in press-b) The role ofparent and peer support in adolescent substance use a test ofmediated effects Psychology of Addictive Behaviors

Motivation Skills and Decision Making 2015

ORDER REPRINTS

Young P T (1936) Motivation of Behavior New York John Wiley andSons

Zimmerman B J (2000) Attaining self-regulation a social cognitivemodel In Boekaerts M Pintrich P R eds Handbook of Self-Regulation San Diego Academic Press 13ndash39

2016 Sussman et al

Request PermissionOrder Reprints

Reprints of this article can also be ordered at

httpwwwdekkercomservletproductDOI101081JA200034769

Request Permission or Order Reprints Instantly

Interested in copying and sharing this article In most cases US Copyright Law requires that you get permission from the articlersquos rightsholder before using copyrighted content

All information and materials found in this article including but not limited to text trademarks patents logos graphics and images (the Materials) are the copyrighted works and other forms of intellectual property of Marcel Dekker Inc or its licensors All rights not expressly granted are reserved

Get permission to lawfully reproduce and distribute the Materials or order reprints quickly and painlessly Simply click on the Request Permission Order Reprints link below and follow the instructions Visit the US Copyright Office for information on Fair Use limitations of US copyright law Please refer to The Association of American Publishersrsquo (AAP) website for guidelines on Fair Use in the Classroom

The Materials are for your personal use only and cannot be reformatted reposted resold or distributed by electronic means or otherwise without permission from Marcel Dekker Inc Marcel Dekker Inc grants you the limited right to display the Materials only on your personal computer or personal wireless device and to copy and download single copies of such Materials provided that any copyright trademark or other notice appearing on such Materials is also retained by displayed copied or downloaded as part of the Materials and is not removed or obscured and provided you do not edit modify alter or enhance the Materials Please refer to our Website User Agreement for more details

ORDER REPRINTS

Table

1

Continued

Inclusion(ornot)ofMSD

Components

Nameof

program

Baseline

gradeage

range

Definition

ofrisk

Program

modalities

Motivation

Skills

Decision

Making

Other

features

Drug

effects

Functional

Family

Therapy

(FFT)

11ndash18

Atrisk

or

presenting

multiple

problems

inconduct

Community

locations

Communica-

tiontraining

parenting

skills

contracting

response-

coststools

Yes

Yes

No

8ndash26hof

directservice

time

contexts

are

adaptable

toneeded

application

skilled

counselors

Tem

porary

effectson

druguse

preventionof

penetrating

adultcrim

inal

system

and

other

rela-

tivelysevere

system

sof

care

The

Incredible

Years

(IY)

2ndash8

Disadvantaged

socioeconomic

status(SES)

aggressiveor

oppositional

behavior

School-or

clinic-based

childparent

andteacher

programs

No

Yes

Yes

Academ

icskills

too45child

group-

therapy

hours60

child-

classroom

hours30

parenthours

28teacher

hours

Discipline

improve-

mentsdrug

use

not

assessedyet

Leadership

and

Resiliancy

Program

(LRP)

14ndash19

High

absenteeism

discipline

problems

substance

use

School

(resiliency

groups)

alternative

activities

community

service

Yes

Yes

No

Upto

4years

of

programming

Grade

school

discipline

andarrests

improve-

mentsno

druguse

effects

indicated

1982 Sussman et al

ORDER REPRINTS

LifeSkills

Training(LST)

7th

Exposedto

substance-using

(cigarettes

and

alcohol)peers

andpoor

academ

ics

School-based

classroom

Cultural

tailoring

Yes

Yes

Universalcom-

prehensive

life

skills

program

tested

with

at-risk

youth

1year

follow-up

Smoking

alcohol

inhalants

polydrug

not

marijuana

LinkingInterests

Families

andTeachers

(LIF

T)

1st

and5th

Atrisk

neighborhoods

withhigh

juvenile

delinquency

School-based

classroom

playground

6parent

meetings

No

Yes

Yes

Playground

groups

form

ed

Lessaggression

onplay-

groundand

better

classroom

behavior

druguse

not

assessedyet

Midwest

Prevention

Project

(MPP)

6th

and7th

Baselinemonthly

users

of

cigarettes

alcoholor

marijuana

School-based

classroom

parents

media

community

Notreally

maybesome

community

supports

Yes

Yes

Universalcom-

prehensive

social

influence

program

tested

with

at-risk

youth

35

year

follow-up

Smokingand

alcoholeffect

at15

years

vanished

by

35

yearsnot

marijuana

Multi-system

ic

Therapy(M

ST)

12ndash17

Chronically

violent

substance-

abusing

juvenile

offenders

Family-

oriented

home-based

increase

support

network

Empower

parents

Yes

Yes

Highly

trained

therapist

involved

in60

contact

hours

over

4months

Decreaseddrug

use

and

re-arrests

andim

proved

family

functioning

(continued

)

Motivation Skills and Decision Making 1983

ORDER REPRINTS

Table

1

Continued

Inclusion(ornot)

ofMSD

Components

Nameof

Program

Baseline

GradeAge

Range

Definition

ofRisk

Program

Modalities

Motivation

Skills

Decision

Making

Other

Features

Drug

Effects

Multi-

dim

ensional

Treatm

ent

Foster

Care

(MTFC)

9ndash18

Chronic

conduct

orem

otional

disturbance

crim

inal

behavior

Home-

and

school-based

MTFC

home

placement

case

managem

ent

Positive

reinforcers

Yes

No

Highly

trained

counselors

weekly

parent

groups

family

therapy

community

mentoring

andmonitor-

ing

behavior

modification

Decreasedhard

drugusejail

timeand

arrests

Nurse-Family

Partnership

(NFP)

First-tim

e

mothers

Motherswithno

income

often

teen

mothers

Homevisits

resource

advocacy

No

No

Yes

Highly

trained

counselors

pregnancy

to

2years

old

Decreased

smokingand

alcoholuse

among

mothers

reducedrates

ofchildabuse

Preventive

Intervention

(PI)

7th-8th

Pooracadem

ic

andschool

discipline

family

problems

School-based

skillsand

monitoring

Positive

reinforcers

Yes

No

Increase

child

teacher

parentcom-

munication

role

play

pro-social

alternatives

Lesshard

drug

useless

delinquency

higher

grades

andbetter

attendance

1984 Sussman et al

ORDER REPRINTS

Preventive

Treatm

ent

Program

(PTP)

7ndash9

Disadvantaged

socioeconomic

status(SES)

disruptive

School-based

parentand

childskills

and

monitoring

Positive

reinforcers

Yes

No

17sessionsfor

parent19for

child

separately

parent-

monitoring

andshaping

ofchild

child-

pro-social

skillsand

selfcontrol

Lesslikelihood

ofhaving

beendrunk

ortaken

drugsin

last

12months

less

fighting

andstealing

Project

PATHE

12ndash18

Disadvantaged

socioeconomic

status(SES)

low

achieving

disruptive

School-based

activitiespeer

counseling

schoolpride

jobseeking

Yes

Yes

No

Academ

ic

skillstoo

Decreaseddrug

involvem

ent

school

alienation

discipline

problems

higher

graduation

rates

Project

STATUS

12ndash18

Potential

dropouts

Schoolclim

ate

optionsclass

(socialrules

norm

s)

Accountability

No

Yes

Youth

leadership

staff

development

parent

meetings

community

resources

Lessdrug

involvem

ent

forjunior

highyouth

bettergrades

anddiscipline

(continued

)

Motivation Skills and Decision Making 1985

ORDER REPRINTS

Table

1

Continued

Inclusion(ornot)ofMSD

Components

Nameof

Program

Baseline

GradeAge

Range

Definition

ofRisk

Program

Modalities

Motivation

Skills

Decision

Making

Other

Features

Drug

Effects

Project

STEP

14ndash18

Disadvantaged

socioeconomic

status(SES)

low

achieving

disruptive

Schoolphysical

settinghome

room

teacher

role

Accountability

No

No

Homeroom

teachersact

ascounselors

andadvisors

Lessdrug

involvem

ent

bettergrades

anddiscipline

Project

SUCCESS

14ndash18

Alternativehigh

schoolyouth

School-based

counseling

and

education

SAPmodel

No

Yes

Yes

Highly

trained

counselorsasse-

ssment8-session

classgroup

counseling

parentmeeting

referral

Decreased

problem

behavioruse

ofmarijuana

tobaccoand

alcohol

Project

Towards

NoDrugAbuse

(TND)

14ndash19

Alternativehigh

schoolyouth

School-based

classroom

12

sessions

Yes

Yes

Yes

Trained

teachers

Decreaseduse

ofcigarettes

alcoholmar-

ijuanahard

drugsweapons

carrying

Quantum

Opportunities

Program

(QOP)

9thndash12th

Disadvantaged

socioeconomic

status(SES)

familieson

public

assistance

Schoolhome

and

community

contexts

skillsservice

and

education

Money

Yes

Yes

250education

hours250life

skillshoursjob

preparationcul-

turalenrichment

and250hcom-

munityservice

monetary

incentives

Nodruguse

effectsrepor-

tedincrease

inhighschool

graduation

less

likelyto

becomeateen

parentslightly

less

likelyto

be

arrested

1986 Sussman et al

ORDER REPRINTS

Reconnecting

Youth

(RY)

14ndash18

Atrisk

for

drop-out

School-based

90-session

class

Groupsupport

Yes

Yes

Smallstudent

groups

support

highly

trained

teachera

semester

Decreasedhard

druguse

perceived

stress

improved

grades

Residential

Student

Assistance

Program

(RSAP)

14ndash17

Livingin

residential

facilities

Residential-

based

education

program

assessm

ent

counseling

referral

No

Yes

Yes

Highly

trained

counselors

placedin

residential

facilities

8-session

drug

education

individual

andgroup

counseling

Decreaseduse

ofmarijuana

tobaccoand

alcohol

Strengthening

Families

Program

(SFP)

6ndash12

Childrenof

substance

users

Agency-based

14session

skillstraining

No

Yes

Yes

Highly

trained

counselors

parents

and

childseen

separately

firsthour

together

at

thesecond

hour

Reduces

aggression

increases

family

cohesion

immediate

effectson

druguse

Motivation Skills and Decision Making 1987

ORDER REPRINTS

model of drug abuse prevention We see this intrinsicextrinsic motiva-tion notion as providing intrapersonal and extrapersonal stimuli (cues)for action

Finally self-regulation models posit that one is motivated to achievean optimal state or system balance In essence an awareness of lack ofbalance will lead to efforts to restore balance (Carver and Scheier 1998Karoly 1980 1993) Drug abuse prevention may demand considerationof alternative actions in order to maintain homeostasis Affect may serveas the main homeostatic mechanism If people feel good or neutral theywill tend to maintain a given course of behavior On the other hand ifthey feel poorly they will want to change their behavior (as in the law ofeffect)

Constituents are those elements that when combined togethercompose a theoretical structure Seven constituents of motivation appearacross the four general theories (Nezami et al 2003) First the idea ofdiscrepancies appears in all theories Motivation exists as a distancebetween what is and what could be and these models assume that peopledesire to reduce such discrepancies Second motivation functions by theestablishment of goals Third motivation exists as energymdasha want ordrive Goals and the accompanying drive to achieve them usually appeartogether Fourth motivation may appear as a series of stages that lead toan end Different goals may operate at different stages Fifth motivationreflects ambivalence about two or more competing goals or behaviorsWorking through ambivalence enhances motivation Sixth motivationarises from different sources usually intrapsychic or environmentalrewards Finally a homeostatic conceptualization of motivation rests onthe idea of maintaining an optimal set point within a regulatory system

Integrations of these four models of motivation could help achievethe prevention of drug abuse One view suggests that due to lifeexperiences people consider goals or directions For example teens maystart to experiment with drugs due to curiosity perceived social pressureor as a means to induce a life change They may subsequently take risksthat injure their relations with others or impair their achievement inschool At some point a discrepancy likely develops between currentcircumstances and their goals For example teens may know that drugabuse is inconsistent with some life goals like school achievementHowever they may value social interaction and physical pleasure whichthey may reach through drug use or other means

Multiple goals may conflict with each other leading to ambivalence(Karoly 1993) Extrinsic and intrinsic sources of input may helpresolve ambivalence For example as the rewards associated with drugabuse diminish teens may experience a desire to decrease their drug

1988 Sussman et al

ORDER REPRINTS

consumption They may prove more likely to adopt a new goal ofdecreased drug use especially if they believe that they could achieve thegoal as self-efficacy theory suggests

Teens may exert energy to reduce discrepancies between currentstates and desired states They may learn new life or social skills whichcan lead them to become involved in rewarding but nondrug-usingactivities (Carroll 1996) In addition they may become involved in newtypes of social networks containing low-risk rather than high-risk peers(Valente et al 2004 Wills et al in press-b) Finally attaining a healthiergoal can create a positive optimal set point and the motivation systemprovides more positive feedback Over time through experience ofdifferent life events youth may alter the set point and begin a new goal-searching process (Sussman and Unger 2004) One may experience atraumatic life event for example and again consider drug use as a meansto return to an optimal set point or repeatedly get into trouble because ofassociating with deviant peers and realize that there is a need to turn todifferent types of associations

Research and theory from several disciplines suggest many motiva-tion strategies for a successful prevention program These motivationstrategies include myth correction stereotyping valuing life andachievement of health goals

Myth Correction

The recovery movement often refers to substance use and abuse as aproblem of perception Another closely related expression drug use mythsdescribes questionable or dysfunctional expectancies or beliefs that serveto justify drug use Myths involve more than expectancies or beliefs aboutpositive or negative outcomes they include inaccurate expectancies orbeliefs about the characteristics (or norms) of drugs and drug use and arelikely to confuse drug effects with drug experiences

Some common myths include inflated expectancies of positiveoutcomes from drug use or underestimates of negative outcomes fromdrug use Teens may believe that substance use will create peer groupacceptance or help them cope with family and school problems when infact the drug use only diverts them from actively coping with these socialand academic issues Thus in the long run drug use makes things worsenot better (Wills and Hirky 1996) Other myths include endorsement ofmisleading beliefs For example many adolescents believe that learningto manage drug intake without getting sick is a positive sign that theirbodies are growing tolerant to the drug rather than signaling the

Motivation Skills and Decision Making 1989

ORDER REPRINTS

beginnings of drug dependence or addiction In addition misperceptionsregarding physical consequences of drug use operate For example usersmistakenly believe that if they are able to regulate subjective effects of adrug they have gained control over use In reality warning systems maybe deteriorating as addiction begins (Glynn et al 1985 Sussman et al1995b) Challenging drug myths undoubtedly helps prevent drug abuse

These challenges can prove especially useful with high-risk popula-tions particularly if social influence programs are less effective in thesegroups Several prevention researchers have adopted a similar taxonomyof drug myths when attempting to prevent drug use Sussman Dent andStacy (1996) examined the internal consistency and discriminant validityof a measure of drug-related myths in 362 continuation (alternative) highschool youth They found good internal consistency and discriminantvalidity for the measure Controlling for its relations with socialdesirability perceived friendsrsquo drug use (a social influence measure)ethnicity and gender the myth measure remained significantly associatedwith four drug use measures Ames Sussman Dent and Stacy (1999)found a myth measure to be a relatively strong psychosocial predictor ofdrug use one-year later Cognitive perceptions obviously play a role indrug abuse prevention (Stein et al 1987) These findings suggest thatcontinued research on drug use myths should prove fruitful forprevention efforts (Sussman et al 1998 2003)

Some cognitive restructuring corrects faulty or self-defeatingcognitive structures (myths) In particular elaborating on the logicalsteps involved in the construction of a drug use myth may help to destroyits impact on behavior For example a common myth suggests thathaving trouble finding onersquos car after getting drunk is a funny event Ifone asks (a) lsquolsquoDid you want to find your carrsquorsquo (b) lsquolsquoWere you too drunk tofind it for a long timersquorsquo and (c) lsquolsquoAnd thatrsquos funnyrsquorsquo the apparent humorin the story may dissipate Further one may delineate the kernel of truthin the myth (not finding onersquos car is an odd event) from the falseaspects of the myth (not finding onersquos car indicates failure of functioningwhich is sad worrisome anxiety provoking not funny)

Stereotyping

Lower risk peers tend to perceive lsquolsquoat riskrsquorsquo others (eg alternativehigh school students) as being more deviant than they actually areUnderstandably youth so-labeled students resent this stereotypeAddressing this stereotype may help prevent drug abuse If lsquolsquoat riskrsquorsquoyouth begin to view themselves as being more deviant than they actually

1990 Sussman et al

ORDER REPRINTS

are the situation could lead to self-fulfilling prophesy as if they weregiving in to the stereotype However lowering the estimates of drug useamong their peers can correct this giving in This version of a prevalence-overestimation reduction lesson which includes a motivational featurehas appeared in successful prevention programs (Sussman et al 2002) Astereotype-oriented lesson may also accomplish a second goal If high-risk youth do not view themselves as being deviant as they assumedothers had judged them possibly reactions against this stereotype mayenergize an effort to avoid drug use as well as portray oneself morefavorably (Hamilton August 20 2000)

Valuing Life and Health Goals

Letrsquos consider the example of older teens Most youth report thatthey plan to graduate from high school and continue their educations orfind a job They do not view hanging out as a desirable option They alsosee that drug use could interfere with achieving their goals A lessonexplaining the negative consequences of drug use particularly oneconsistent with data (Newcomb and Bentler 1988) could reveal howearly involvement with drugs creates symptoms of abuse and dependenceand alters job opportunities marriage and family functioning These lifegoals can seem more valuable as students perceive them as attainableEnhancing the value of life goals can increase motivation for learningadaptive coping (Lau et al 1986) Youth have reported that drug usecould interfere with obtaining desired life goals In theme and componentstudies youth positively evaluated a lesson that taught that drug usecould interfere with obtaining desired goals and that placing animportance on health as a value was consistent with achievement of lifegoals (Sussman 1996) Thus it is important for prevention programs tohelp youth connect the importance of health to obtaining their life goalsand develop a sequenced plan so that they know how to proceed step-by-step (Karoly 1993 Watson and Tharp 2002)

Although modifiable understanding the source of positive life goalsis also important since these may occur earlier in life For instanceNewcomb and Harlow (1986) found that perceived loss of control andmeaninglessness in life mediated the relationship between negative lifeevents and drug use While numerous types of stressful events wereconsidered in this study other studies identify an adverse childhoodfamily environment as a potent precursor to later drug use (Locke andNewcomb in press Palinkas et al 1996) An adverse early homeenvironment a modifiable etiological factor should serve as a focus of

Motivation Skills and Decision Making 1991

ORDER REPRINTS

prevention that addresses child abuse and neglect (see later discussion ofthis topic)

Attitudinal Perspectives

Most youth consider themselves as being moderates They can alsoreliably identify drug use as being a deviant immoderate behaviorPresenting them with the disparity between their self-view as a moderateperson despite their deviant drug use can produce a desired behaviorchange (Sussman 1989 Upshaw and Ostrom 1984) An attitudinalperspective lesson can confront students with the inconsistency betweentheir general self-attitude ratings as moderates vs their more extremespecific behaviors (eg drug use) Adopting a self-perception as amoderate may inoculate youth when social pressures to experiment withdrugs arise A desire for internal consistency a similarity betweenattitudes and behavior may increase motivation to abstain from drugs(Festinger 1957 Heider 1958) Youth received lessons like these quitefavorably in previous work (Salomon et al 1984)

Skills

Direct instruction modeling practice and group reinforcementenhance social learning At least three basic kinds of skills needinstruction self-control communication and resource acquisition

Social Self-control Skills

Good self-control protects against substance use and buffers againstthe impact of risk factors (Bandura 1986 Catalano and Hawkins 1996Weissberg et al 1989 Wills et al 1998) Poor self-control involvesbehavioral affective and cognitive deficits Poor behavioral self-controlis associated with a need to regulate and stabilize mood possiblypreceding uncontrolled behavior or stemming from the consequences ofuncontrolled behavior Poor self-control behavior along with difficultiesin mood stabilization increases risk for substance use and rapidescalation to high levels of use which then can lead to physiologicaldependence (Wills and Stoolmiller 2002)

Self-control strategies cross physiological and personality boundariesbecause self-control also relates to coping motives for substance use a

1992 Sussman et al

ORDER REPRINTS

strong predictor of substance use problems (Wills et al 1999) Self-control includes cognition because developing self-control is the substratefor personality organization including not only behavioral and affectivecontrol but also attitudes values and views of the world as accepting orhostile and social perceptions about substance use as being attractive vsunattractive For example studies find poor self-control correlated withattitudinal tolerance for deviance and more favorable perceptions oftobacco and alcohol users whereas good self-control is related tofavorable perceptions of teens that abstain from drug use (Wills et alin press-a) Self-control approaches can be useful for preventionprograms by improving self and other perceptions academic perfor-mance and the impact or facilitation of negative life events goals that aresalient to teenagers and their parents (Wills and Stoolmiller 2002)

Youth often lack adequate coping skills they tend to lack restraint orplanfulness (Farrell and Danish 1993 Rutter et al 1997) Coping skillsinstruction may help increase self-control (Kendall and Braswell 1982)Coping skills instruction receives little attention in typical social influencesprogramming (Hansen 1992) although this material appears in life skillstraining (Botvin 1993 Botvin et al 1995 Wills 1986) In self-controlprogramming youth learn to assess their self-control particularly in socialcontexts (Sussman et al 2003) They learn the importance of thinkingahead and anticipating problem situations so that they are preparedbeforehand to deal with problems that may arise They also learn theimportance of context (eg not laughing at a funeral) Finally they learnassertiveness and anger management to help them better control theirreactions in social settings (Sambrano May 1999 Sussman et al 2002)

Listening and Communication Skills

Youth genuinely benefit from listening to information with an openmind and asking open-ended questions to keep a conversation goingThey can improve social skills by learning how to ask open-endedquestions establish eye contact appropriately nodding and orientingtheir body toward the other speaker (CPPRG 1999 Eggert and Herting1991 Hawkins et al 1999 Sussman et al 2002 2003) Neverthelesssocial skills training can create problems for nondrug using high-riskteens (Palinkas et al 1996 Sussman et al 1995b Wills et al in press-b)Training in drug refusal may create reactance in some samples (Sussmanet al 1996) Among high-risk youth enhancing assertiveness and datingskills may increase the scope of social entertainment options andinadvertently improve a teenrsquos ability to acquire drugs from new sources

Motivation Skills and Decision Making 1993

ORDER REPRINTS

(Wills et al 1989) Also there are cultural variations on what constitutesgood social skill (Unger et al 2004) There are good arguments forplacing high-risk teens together in activities with well-controlled teens sothat they can model adaptive social skills and problem solvingAdditionally utilizing motivation methods prior to instructing thespecific skill channels canalizes health-directed use of social skillsmastered Overall increasing social competence will have protectiveeffects for high-risk teens (Wills et al 1994) This idea is consistent withthe studies that have shown social withdrawal to increase risk for druguse (Kerr et al 1997) though there may be gender differences in theseeffects (Pulkkinen and Pitkanen 1994) Still it is most wise to includesocial skills training in conjunction with material addressing motivationand decision making Motivations regarding drug use need to beaddressed so behaviors learned are not misdirected

Resource Acquisition

Adults often assume that teens can access community services withlittle effort In fact few teens understand the availability of healthservices or other assistance Simple information including phonenumbers and locations can assist teens immensely (Carroll 1996Sussman et al 2002) Coaching teens on techniques for receivingassistance can prove productive Public assistance for drug use-relatedproblems and other life problems can help tremendously but negotiatingthe bureaucratic difficulties inherent in many of these systems can requireconsiderable skill (Eggert and Herting 1991 Sambrano May 1999Sussman et al 2002) Direct instruction modeling and structuredpractice in resource acquisition skills may help youth to increase theirknowledge and self-efficacy on how to acquire resources and to readilyaccess resources when needed (eg use of the bus system) These skillsmay generalize to comparable tasks later in life

Decision-Making

Prevention programs have employed several decision-making strate-gies For example the protocol from Project Reconnecting Youth(Project RY) is STEPS The acronym stands for Stop Think ofoptions Evaluate options Perform or take action on the chosen optionand then Self-praise for using steps for making healthy choices (Eggertand Herting 1991) The participants help set the agenda and take turns

1994 Sussman et al

ORDER REPRINTS

illustrating it on a flip chart This task helps share the leadership andfocuses the group work and time The lesson STEPS to Drug UseControl follows skills training sessions that cover understandingSTEPS as a decision-making model

Project Towards No Drug Abuse (TND)rsquos decision-making sessioninvolves four steps These steps are

1 Brainstorming (making a list of ideas without judging them)2 Weigh the pros and cons (the benefits and costs of each idea)3 Select the best option4 Follow through (try that option and reevaluate the decision)

(Sussman et al 2002)

These decision-making strategies are similar across different pro-grams except that they include some different emphases For exampleSTEPS includes a self-instruction to begin decision making and self-praise whereas the TND sequence includes more of an emphasis onfollowing through with the decision Generally each program requiresgenerating options evaluating them choosing the best and evaluatingthe outcome in an effort to make the next decision Teens tend to enjoypracticing decision making in bogus problem situations Youth soonlearn to engage in steps like these with considerable skill Training indecision making operates on variables that are intermediate in the causalprocess and thereby strengthen individual profiles of self-controlabilities so that they are more resilient in the face of proximal riskfactors for drug use such as life stresses and peer pressures

Modalities of Programming

Both school and nonschool prevention modalities have a rich andimportant history in substance abuse prevention research (Pentz 1994Pentz et al 2004) Schools provide a captive audience for educationalmaterial Youth spend 25 of their waking lives at school so thisenvironment has considerable potential Furthermore the school contextprovides a rich research history for building new studies and evaluatingtheir efficacy (Sussman et al 1995a) Community programs also offerconsiderable opportunity

Community programs often involve local leaders and organizations(eg coalitions community boards) (Goodman et al 1993 Kaftarianand Hansen 1994) that help mobilize numerous community unitsCommunity units include businesses media the family and governmental

Motivation Skills and Decision Making 1995

ORDER REPRINTS

agencies like the police or recreational departments as well as schoolsystems A network of community units working together to developpromote and implement educational programming could increase youthsrsquobonding to others across a wide variety of social contexts (Hawkins et al1992 Pentz 1994) Community units can provide numerous types ofspecific extra-classroom prevention opportunities (Pentz 1994)

Parent-or-family targeted prevention programs include offering earlychildhood education social support for parents managing crisesparenting skills training parent-child communication skills and resourceacquisition instruction or networking Mass media targeted programsinvolve programs or public service announcements with novel fastand unconventional messages (eg the American Legacy FoundationTRUTH campaign) use of the Internet and interactive CDs (eg videogames) Alternative means to involve youth include involvement in hikingclubs drug-free dances or other after-school events with prosocial adultmentors and with means to involve youth outside of school includingentry into different environments (ie outward bound) (Tobler 1986) Inaddition policy implementation and enforcement may contribute toother prevention programs (Pentz et al 1989) Indeed simultaneousprograms within and outside of schools over long periods might maintainthe positive effects that sometimes dissipate when school programsappear alone (Pentz 1994)

The Difference Between Targeted Prevention and Cessation

Targeted (secondary) prevention attempts to keep persons fromcrossing the invisible line where they funnel into a cycle of addiction andaccumulation of negative consequences Cessation programs (sometimesreferred to as tertiary prevention) take the stance that a behavior hasoccurred with definite and perhaps irreversible negative consequencesThe goal is to stop the behavior permit recovery from the damage learnhow to prevent relapse and learn how to live with permanent changes(eg neurotransmitter function drug use-related injury) It is not clearexactly where indicated prevention ends however and where cessationbegins For example an early version of the Project TND curriculum didnot achieve effects on cigarette smoking possibly because 46 of thesample already smoked cigarettes daily (while not engaging often in someother drug use) In a revised curriculum a smoking cessation componentwas added to the program and then an effect on cigarette smoking wasachieved Cessation material can appear with prevention material to

1996 Sussman et al

ORDER REPRINTS

maximize program effectiveness Careful program development can helpdetermine the best mix (Sussman et al 2002)

Summary of Evidence-based Targeted Drug Abuse Prevention

At present approximately 29 drug-use prevention programs havebeen evaluated favorably for their effects on drug use or other problembehavior (see Table 1) These 29 programs have been identified throughtwo sources Blueprints for Violence Prevention (Elliott 2003) and theSubstance Abuse and Mental Health Services Administrationrsquos(SAMSHA) science-based prevention programsrsquo guide (USDHHS2003) PsycINFO and MEDLINE searches of drug abuse preventionstudies since 1970 supplemented searches through these two guides (seeTable 1) Nine definitions of high-risk were used across these programsEleven programs focused on economic deprivation as the definition Sixprograms focused on delinquent behavior as the identifying characteristicto target Two programs each identified single-parent homes drug use orexposure to drug use family problems alternative high school attendanceor being at risk for dropout at a regular high school as the characteristicsto target subjects Finally one program each identified new immigrantstatus or residential facility placement as the defining characteristic ofbeing at high risk for drug use

Among these programs eight focused on preteens For example theEarly Risers program defined its high-risk youth as those 6ndash10 year-oldsthat suffered economic deprivation and exhibited aggressive or opposi-tional behavior Another five programs focused on a young teen agegroup For example Preventive Intervention defined its high-risk youthas those seventh to eighth graders who exhibited poor school andacademic discipline and reported family problems Another sevenprograms focused on an older teen age group For example ProjectTND defined its high-risk youth as those youth that attended alternativehigh schools Finally nine programs encompassed wide age ranges Forinstance Big Brothers Big Sisters of America defined its high-risk youthas 6ndash18 year-olds that lived in single-parent homes

Of these programs 10 involved multiple often flexible settings ofimplementation Another 13 programs focused on the school settingFour programs focused on the home setting Finally two programsfocused on a community agency setting In general these programsinvolved implementation by highly trained personnel Eighteen of theseprograms involved some motivation aspect generally motivationenhancement but sometimes including extrinsic reinforcement strategies

Motivation Skills and Decision Making 1997

ORDER REPRINTS

Twenty-six of these programs provided skills training Finally 18programs provided instruction in decision making Thus the MSDmodel tends to appear in a majority of these programs however all threecomponents were included together in only nine of these programs

Twenty of these programs involved at least one replication of theprogram and 14 involved three or more replications Further 14 of theseprograms were tested through use of experimental designs and nineinvolved use of only quasi-experimental designs Effects on drug use wereassessed and found in 22 of these programs For example theReconnecting Youth program was implemented to youth at risk fordropout This program involved 90 sessions within a comprehensive highschool class delivered generally over a semester with small studentgroups and a highly trained teacher Instruction included use of groupsupport and providing life skills training (norm setting self-esteem moodmanagement communication skills self-monitoring monitoring goalsschool bonding and social activities) with feedback to parents Programgoals were achieved through use of a quasi-experimental design showingeffects for school performance (18 improvement in grades) drug use(54 decrease in hard drug use) and suicide risk (32 decline inperceived stress) This programrsquos results have been replicated numeroustimes in numerous locations This program involved all three componentsof the MSD model except that motivation was provided through peergroup support not through provision motivation enhancement strate-gies These targeted programs present an optimistic picture for drug-useprevention that is focused on at-risk youth (see Table 1)

Not all targeted prevention programs have been found to beeffective One published program that failed to find positive effects wasProject PALS (Palinkas et al 1996) This project was developed for teengirls who were pregnant or at risk for pregnancy and drug use Theprogram consisted of school-based delivery of 16 sessions once a weekin a class The goal was to decrease drug use The PALS Skills TrainingProgram involved instruction in assertiveness providing and receivingfeedback social conversation handling requests and asking for help andmood management This program was tested against a normativeeducation program (called Facts of Life or FOL) which instructedvalues and decision making sexuality issues and contraception sexuallytransmitted diseases (STDs) drug use risks sexual assault prevalenceand norms material An experimental evaluation with a seven-monthspost-baseline was used The results indicated that the PALS programsubjects reported 29 times greater marijuana use than FOL amongbaseline nonusers No other differences were found It is possible that theprogram was not targeted to the right population that the mix of skills

1998 Sussman et al

ORDER REPRINTS

instructed was not appropriate or that skill training alone (withoutappropriate motivation material) may not be effective in drug useprevention Researchers should examine these possibilities and others tofurther understand program failures as well as program successes

Potential Limitations of Targeted Prevention

Dishion and colleagues (1995) suggest from various findings thatgrouping high-risk youth may lead to increased drug use This outcomecan result if youth come to learn deviant behavior from each other Theycan learn deviant behavior from each other in a program if they haveunstructured or unsupervised time together An essential feature ofseveral targeted programs (eg the RY and TND programs) is building apositive peer culture with group norms that decrease drug involvementand drug-use control problems The RYrsquos findings suggest that a positivepeer group component carefully fostered by a well-trained and competentRY group leader can direct the group toward lower risk behaviorSimilarly classroom management in Project TND involves developmentof positive norms of classroom behavior Further interaction betweenyouth is encouraged but is primarily teacher-directed and highlystructured (Sussman et al 2003) In both RY and Project TND theteacherrsquos role is to actively develop and maintain peer group support inthe class by modeling support positively reinforcing it among groupmembers and negatively reinforcing deviant peer bonds and activities(Eggert and Herting 1991 Vorrath and Brendtro 1985) The teachercreates and structures interactions among youth in prosocial directions(Sussman et al 2003)

Multiple Problem Behaviors of Adolescents

Acknowledging the relationship of drug use to other commonadolescent problems may facilitate identification of effective methods ofreducing drug use Researchers on tobacco alcohol and other drug useantisocial behavior high-risk sexual behavior and depression increas-ingly recognize that these problems are interrelated (McGee andNewcomb 1992) and stem to a large extent from the same environ-mental and biological factors (Biglan et al in press Eggert et al 1995Sussman and Ames 2001 Wills and Cleary 1995) Clearly it is necessaryto have strategies that address the entire range of problems and thecontext that influences those problems Indeed further reductions in

Motivation Skills and Decision Making 1999

ORDER REPRINTS

many problems require that we comprehensively target youth withmultiple problem behaviors

Biglan and colleagues (in press) provide a comprehensive review ofthe relationships among antisocial behavior tobacco alcohol and otherdrug use and high-risk sexual behavior It is clear that the same youngpeople are prone to the development of the entire range of problems In arecent review Moffitt and colleagues (2002) found that antisocialbehavior in early adolescence (rather than late adolescence) is a greaterrisk factor for developing multiple problems These findings point to theimportance of early intervention before youth develop serious problemsMoreover these different problems largely result from the same set ofenvironmental and biological factors

One implication is that disciplines dealing with these problemsother than drug abuse may contribute to dealing with the problem ofdrug use (Newcomb 1996b 1997) In particular research by dev-elopmental psychologists family social workers and sociologists onthe influence of parents on adolescent problem development and oninterventions to alter parenting practices contributes to our understandingof how to prevent or ameliorate drug abuse and other problems Onealso should note that nonsubstance use is not a guarantee for problemimmunity for the entire age range of people whatever their genderethnicity religiosity socioeconomic status (SEC) domicility etc It maybe argued that the most promising programs are those targeting thesemultiple levels of influence Several multidisciplinary programs haveachieved promising results We describe three of these empiricallyevaluated programs tested in various settings

Functional Family Therapy (FFT)FFT is an indicated intervention involving family treatment designed

for delinquent teenagers (also see Table 1) Developed in the early 1970sby Alexander and colleagues (1973) FFT focuses on family commu-nication and the establishment of rules and consequences Several studiesprovide encouraging reports of the programrsquos effectiveness (Alexander etal 1976 Barton et al 1985 Klein et al 1977 Waldron et al 2001) Inthe Waldron et al (2001) study researchers used FFT and anintervention with cognitive behavior therapy on teens referred formarijuana use Each of the interventions produced significant resultson marijuana use by the teens at four months but only the twointerventions combined maintained these results at seven months Theearlier studies found a greater number of results For example in the twoAlexander studies (1973 1976) improvement in family communicationposttreatment led to reduced delinquency Note that all the teens in these

2000 Sussman et al

ORDER REPRINTS

studies had histories of serious antisocial or delinquent behavior Thusachieving positive outcomes even if only short-term should encouragefurther research into the efficacy of FFT

Multisystemic Therapy (MST)As its name suggestsMST targets individual family peer school and

community influences of those youth offenders with serious problems thatmay include violence substance use and severe emotional problems (alsosee Table 1) Numerous researchers have published the results ofrandomized trials of MST (Henggeler et al 1996 1997 1998 Thorntonet al 2000) The most consistent findings across studies are decreased (1)drug use (2) re-arrest (3) self-reported criminal offense and (4) days inout-of-home placements Other consistent findings are improved familyrelations school attendance and psychiatric functioning One cautionarynote the programrsquos effectiveness lowers considerably if not implementedwith fidelity (Hengler et al 1997 1999) In other words all or key lessonsneed to be delivered as written by educators who are well-trained in usingthe strategies employed and youth need to be able to receive all material inan atmosphere conducive to learning the material The programdevelopers have instituted training strategies that address these fidelityissues thus shaping MST to be a very promising program for at-riskyouth

Multidimensional Treatment Foster Care (MTFC)MTFC targets family and peer factors influencing adolescents with a

pattern of repeat criminal offending (see Table 1) (Chamberlain 1994)This intervention includes placement of the youth into a foster homewith a foster parent trained in behavior management who receivessupport from intervention staff After the adolescent has begun torespond to the intervention in the foster home and after the parents havereceived the same training and support as the foster parents did theadolescent returns home Chamberlain and Reid (1998) tested theintervention with 85 boys with felony and other criminal histories andfound substantial benefits of the program Following treatment the boysassigned to MTFC (compared to those receiving community-based groupcare) showed fewer days in detention or lock-up twice as much timeliving with parents fewer misdemeanor and felony arrests and fewer self-reported index crimes felony arrests and general delinquency TheMTFC is a cost-effective alternative to incarceration however staffrequirements are extensive which may influence the ability of some

Motivation Skills and Decision Making 2001

ORDER REPRINTS

groups to apply the program with fidelity However as with each of theprograms described here the results of the randomized trials areencouraging

Future Research Needs in Targeted Prevention

Future research can help discern when and where targeted preventionprogramming will tend to work rather than produce potentiallydeleterious negative group effects or results that are irrelevant for pro-social healthy adaptation as well as what the critical necessary conditionsare for their effective operation within given de facto realities Comparedto the breadth of evaluated universal drug use prevention programs(Tobler et al 2000) relatively few targeted prevention programs havereceived empirical support Yet previous research suggests that universalschool-based drug use prevention programs implemented in junior highschool have relatively less chance of long-term success especially for thoseyouth that began using drugs before the prevention program wasimplemented Of course there are notable exceptions (eg effects lastedfor one and a half years effects lasted for six years) (Chou et al 1998Griffin et al 2003 Skara and Sussman 2003) Almost no research existsregarding maximization of booster programming with high-risk youthMore research on booster programs would help the field

While continuing to engage in this work there will be numerousissues to manage that go well beyond the scope of this article There willbe a need to avoid producing negative labeling effects while providingprogramming for those who are at risk for drug use It is possible thatcessation information needs to be included in the mix with preventionmaterial to provide better targeted-prevention effects There may be aneed to develop a teacher selection instrument to help select out teacherswho can deliver drug abuse prevention programming adequatelyCertainly definition of outcome variables needs continued explorationincluding analysis to ascertain the effects of programming on drug abusevs drug use and identification of the variables that are most closelylinked to change by targeted prevention components

A transdisciplinary approach helps to better understand the lifesituation of high-risk youth as based to some extent on both constitutionaland environmental factors (Fuqua et al 2004 Rutter et al 1997 Wills etal 1996b) From the transactional perspective their situation is in partconstitutional they may have temperamental characteristics that arepartly heritable and that have set the stage at earlier ages for decrements inself-control ability and academic performance that then increase risk for

2002 Sussman et al

ORDER REPRINTS

drug use However their situation is also part environmental based in parton family socialization and in part on the types of peers they have as well asthe type and quality of the physical and cultural environment-at-largeThere are many points at which a potential chain of failures can beinterrupted and the individualrsquos trajectory turned in a better directionProblems are not inevitable from starting level (Tarter and Vanyukov1994) and environmental modifications to support good self-controlability can help to avert an adverse impact from earlier experiences orcurrent difficulties (Brody et al 2002 Novak and Clayton 2001 Patock-Peckham et al 2001 Rutter et al 1997 Wills et al 2002)

The problems and needs of high-risk youth in our nationrsquos highschools demand our attention for designing and rigorously testingtargeted prevention approaches Substantial evidence shows that theseyouth are at greater risk for drug involvement and co-occurring problemssuch as aggression depression and suicidal behaviors as we previouslydiscussed It is hoped that the information presented in this article willstimulate others to join in extending this work including testing othermodels of targeted prevention

GLOSSARY

Universal programs Programs that aim to influence all subjects in acontext

Selective drug-abuse prevention programs Programs that servegroups at greater risk of ATOD usemdashfor example children of alcoholicparents They are at psychosocial risk for drug use and abuse

Indicated drug-abuse prevention programs Programs that attemptto benefit individuals who already show signs of drug involvement orrelated risk factors In indicated prevention programs the primary goal isto stem the progression of ATOD use or reduce drug involvementamong the high-risk youth

Targeted programming Programming that subsumes selective andindicated programming sometimes the other two types of programs thattarget specific groups lsquolsquoat riskrsquorsquo are considered together

ACKNOWLEDGMENTS

This research was supported by grants from the National Institute onDrug Abuse (DA01070 DA07601 DA13814 and DA16094) and by aResearch Scientist Development Award K02 DA00252 from theNational Institute on Drug Abuse

Motivation Skills and Decision Making 2003

ORDER REPRINTS

REFERENCES

Alexander J F Barton C Schiaro R S Parsons B V (1976)

Systems-behavioral intervention with families of delinquents

therapist characteristics family behavior and outcome Journal of

Consulting and Clinical Psychology 44(4)656ndash664Alexander J F Parsons B V (1973) Short-term behavioral interven-

tion with delinquent families impact on family process and

recidivism Journal of Abnormal Psychology 3219ndash225American psychiatric association (APA) (1994) Diagnostic and

Statistical Manual of Mental Disorders 4th edn (DSM-IV)

Washington DC American Psychiatric AssociationAmes S L Sussman S Dent C W (1999) Pro-drug-use myths and

competing constructs in the prediction of substance use among

youth at continuation high schools a one-year prospective study

Personality and Individual Differences 26987ndash1003Bachman S G Wadsworth K N OrsquoMalley P M Johnston L D

Schulenberg J E (1997) Smoking drinking and drug use in young

adulthood Mahwah NJ Lawrence Erlbaum Associates 8ndash25

153ndash190Bandura A (1986) Social Foundations of Thought and Action A Social

Cognitive Theory Englewood Cliffs NJ Prentice HallBarton C Alexander J F Waldron H Turner C W Warburton J

(1985) Generalizing treatment effects of functional family therapy

Three replications The American Journal of Family Therapy

13(3)16ndash26Battin-Pearson S R Newcomb M D Abbott R D Hill K G

Catalano R F Hawkins J D (2000) Predicting early high school

dropout Journal of Educational Psychology 92568ndash582Biglan A Brennan P A Foster S L Holder H D Miller T L

Cunningham P B et al (in press) Helping Adolescents at Risk

Prevention of Multiple Problem Behaviors New York NY Guilford

PressBindra D Stewart J (1996) Motivation Baltimore MD Penguin

BooksBlanton H Gibbons F X Gerrard M Conger K J Smith G E

(1998) The role of family and peers in the development of

prototypes associated with substance use Journal of Family

Psychology 11271ndash288

2004 Sussman et al

ORDER REPRINTS

Botvin G J (1993) School-based drug abuse prevention Long-termfollow-up results In First Annual Meeting of the Society forPrevention Research Kentuck Lexington Society for PreventionResearch

Botvin G J Baker E Dusenbury L Botvin E M Diaz T (1995)Long-term follow-up results of a randomized drug abuse preven-tion trial in a white middle-class population Journal of theAmerican Medical Association 2731106ndash1012

Brody G H Dorsey S Forehand R Armistead L (2002) Uniquecontributions of parenting and classroom processes to the self-control of AfricanndashAmerican children Child Development73274ndash286

Carroll M E (1996) Reducing drug abuse by enriching the environmentwith alternative nondrug reinforcers In Green L Kagel J Heds Advances in Behavioral Economics Norwood NJ NorwoodPublishing Corp 37ndash68

Carver C S Scheier M F (1998) On the Self-Regulation of BehaviorNew York Cambridge University Press

Catalano R F Hawkins J D (1996) The social developmental modela theory of antisocial behavior In Hawkins J D ed Delinquencyand Crime Current Theories New York Cambridge UniversityPress

Centers for Disease Control (CDC) (October 1999) Youth risk BehaviorSurveillancemdashNational Alternative High School Youth RiskBehavior Survey 1998 Morbidity and Mortality Weekly Report48 No SS-7

Chamberlain P (1994) Family connections A treatment foster caremodel for adolescents with delinquency Eugene OR CastaliaPublishing Company

Chamberlain P Reid J B (1998) Comparison of two communityalternatives to incarceration for chronic juvenile offenders Journalof Consulting and Clinical Psychology 66(4)624ndash633

Chassin L A Presson C C Sherman S J (1985) Stepping backwardin order to step forward an acquisition-oriented approach toprimary prevention Journal of Consulting and Clinical Psychology53612ndash622

Chou C-P Montgomery S Pentz M A Rohrbach L A JohnsonC A Flay B R MacKinnon D P (1998) Effects of acommunity-based prevention program on decreasing drug use inhigh-risk adolescentsAmerican Journal of Public Health 88944ndash948

Conducts Problems Prevention Research Group (CPPRG) (1999) Initialimpact of the fast track prevention trial for conduct problems I

Motivation Skills and Decision Making 2005

ORDER REPRINTS

The high-risk sample Journal of Consulting and Clinical Psychology

67631ndash647Conducts Problems Prevention Research Group (CPPRG) (2000)

Merging universal and indicated prevention programs the fast

track model Addictive Behaviors 25913ndash927Council of Philosophical Studies (1981) Psychology and the Philosophy

of Mind in the Philosophy Curriculum San Francisco San Francisco

State UniversityCummings K M Hellmann R Emont S L (1988) Correlates of

participation in a worksite stop smoking program Journal of

Behavioral Medicine 11267ndash277Curry S Wagner E H Gothaus L C (1990) Intrinsic and extrinsic

motivation for smoking cessation Journal of Consulting and

Clinical Psychology 58310ndash316Dent C W Sussman S McCuller W J Stacy A W (2001) Drug

abuse prevention among youth at comprehensive high schools

Preventive Medicine 32514ndash520Dewey J (1886) Psychology New York HarperDishion T J French D C Patterson G R (1995) The development

and ecology of antisocial behavior In Cicchetti D Cohen D

eds Manual of developmental psychopathology New York John

Wiley 421ndash471Eggert L L Herting J R (1991) Preventing teenage drug abuse

exploratory effects of network social support Youth and Society

22482ndash534 [Reprinted National Prevention Evaluation Research

CollectionRockville MD Aspen 1993]Eggert L L Herting J R Thompson E A Nicholas L J Dicker

B G (1994) Preventing adolescent drug abuse and high school

dropout through an intensive school-based social network devel-

opment program American Journal of Health Promotion

8202ndash214Eggert L L Thompson E A Herting J R Nicholas L J (1995)

Reducing suicide potential among high-risk youth tests of a school-

based prevention program Suicide amp Life-Threatening Behavior

25276ndash296Ellickson P L Bell R M (1990) Drug prevention in junior high a

multi-site longitudinal test Science 2471299ndash1305Elliott D S (Series ed) (2003) Blueprints for violence prevention

Boulder CO Institute of Behavioral Science Regents of the

University of Colorado wwwcoloradoeducspvblueprints

2006 Sussman et al

ORDER REPRINTS

Farrell A D Danish S J (1993) Peer drug associations and emotionalrestraint Causes or consequences of adolescent drug use Journal ofConsulting and Clinical Psychology 61327ndash334

Festinger L A (1957) A Theory of Cognitive Dissonance New YorkHarper amp Row

Fuqua J Stokols D Gress J Phillips K Harvey R (2004)Transdisciplinary collaboration as a basis for enhancing the scienceand prevention of substance use and abuse Substance Use ampMisuse

Giuliano J D (1994) A peer education program to promote the use ofconflict resolution skills among at-risk school-age males PublicHealth Reports 109158ndash169

Glynn K Levanthal H Hirschman R (1985) A cognitivedevelopmental approach to smoking prevention In Bell C SBattjes R eds Prevention research Deterring Drug Abuse AmongChildren and Adolescents Rockville MD NIDA ResearchMonograph 63

Glynn T J (1989) Essential elements of school-based smokingprevention programs Journal of School Health 59181ndash188

Goodman R M Burdine J N Meehan E McLeroy K R eds(1993) Community coalitions for health promotion Special issue ofHealth Education Research Theory and Practice 8309ndash453

Goodyear R D Newcomb M D Locke T F (2002) PregnantLatina teenagers psychosocial and developmental determinants ofhow they select and perceive the men who father their childrenJournal of Counseling Psychology 49187ndash201

Gordon R (1987) An operational classification of disease preventionIn Steinberg J A Silverman M M eds Preventing MentalDisorders Rockville MD DHHS 20ndash26

Graham J W Johnson C A Hansen W B Flay B R Gee M(1990) Drug use prevention programs gender and ethnicityevaluation of three seventh-grade project SMART cohortsPreventive Medicine 19305ndash313

Griffin K W Botvin G J Nichols T R Doyal M M (2003)Effectiveness of a universal drug abuse prevention approach foryouth at high risk for substance use initiation Preventive Medicine36(1)1ndash7

Hamilton S (August 20 2000) Views slowly changing on alternativeschools The Sacramento Bee 1ndash3

Hansen W B (1992) School-based substance abuse prevention a reviewof the state of the art in curriculum 1980ndash1990 Health EducationResearch 7403ndash430

Motivation Skills and Decision Making 2007

ORDER REPRINTS

Hansen W B Johnson C A Flay B R Graham J W Sobel J(1988) Affective and social influences approaches to the preventionof multiple substance abuse among seventh grade students resultsfrom project SMART Preventive Medicine 17135ndash154

Hansen W B Graham J W (1991) Preventing alcohol marijuanaand cigarette use among adolescents peer pressure and resistancetraining versus establishing conservative norms PreventiveMedicine 20414ndash430

Hawkins D H Catalano R F Miller J Y (1992) Risk andprotective factors for alcohol and other drug problems inadolescence and early adulthood Implications for substanceabuse prevention Psychological Bulletin 11254ndash105

Hawkins J D Catalano R F Kosterman R Abbott R Hill K G(1999) Preventing adolescent health-risk behaviors by strengthen-ing protection during childhood Archives of Pediatric amp AdolescentMedicine 153226ndash234

Heider F (1958) The Psychology of Interpersonal Relations New YorkWiley

Henggeler S W Pickrel S G Brondino M J Crouch J L (1996)Eliminating (almost) treatment dropout of substance abusing ordependent delinquents through home-based multisystemic therapyAmerican Journal of Psychiatry 153(3)427ndash428

Henggeler S W Melton G B Brondino M J Scherer D GHanley J H (1997) Multisystemic therapy with violent andchronic juvenile offenders and their families the role of treatmentfidelity in successful dissemination Journal of Consulting andClinical Psychology 65(5)821ndash833

Henggeler S W Schoenwald S K Borduin C M Rowland M DCunningham P B (1998) Multisystemic treatment of antisocialbehavior in children and adolescents New York The Guilford Press

Henggeler S W Pickrel S G Brondino M J (1999) Multisystemictreatment of substance-abusing and dependent delinquents out-comes treatment fidelity and transportability Mental HealthServices Residual 1(3)171ndash84

Johnson C A Pentz M A Weber M D Dwyer J H Baer NMacKinnon D P Hansen W B Flay B R (1990) Relativeeffectiveness of comprehensive community programming for drugabuse prevention with high-risk and low-risk adolescents Journalof Consulting and Clinical Psychology 58447ndash456

Kaftarian S J Hansen W B eds (1994) CSAP special issuecommunity partnership program Journal of Community Psychologypages 205

2008 Sussman et al

ORDER REPRINTS

Karoly P (1993) Mechanisms in self-regulation A systems view AnnualReview of Psychology 4423ndash51

Karoly P (1980) Person variables in therapeutic change and develop-ment In Karoly P Steffen J J eds Improving the Long-TermEffects of Psychotherapy New York Gardner Press 195ndash261

Kendall P C Braswell L (1982) Cognitive-behavioral self-controltherapy for children a components analysis Journal of Consultingand Clinical Psychology 50672ndash689

Kerr M Tremblay R E Pagani L Vitaro F (1997) Boysrsquobehavioral inhibition and the risk of later delinquency Archivesof General Psychiatry 54809ndash816

Klein N C Alexander J F Parsons B V (1977) Impact of familysystems intervention on recidivism and sibling delinquency a modelof primary prevention and program evaluation Journal ofConsulting and Clinical Psychology 45(3)469ndash474

Kumpfer K L (1999) Outcomes measures of interventions in the studyof children of substance-abusing parents Pediatrics 1031128ndash1144

Lau R R Hartman K A Ware J E (1986) Health as a valuemethodological and theoretical considerations Health Psychology525ndash43

Lichtenstein E L Glasgow R E (1997) A pragmatic framework forsmoking cessation implications for clinical and public healthprograms Psychology of Addictive Behaviors 11142ndash151

Locke T F Newcomb M D (in press) Childhood maltreatmentparent drug problems polydrug problems and parenting practicesa test of gender differences and four theoretical perspectivesJournal of Family Psychology

McCreary D R Newcomb M D Sadava S W (1999) The male rolealcohol use and alcohol problems a structural modeling examina-tion in adult women and men Journal of Counseling Psychology46109ndash124

McGee L Newcomb M D (1992) General deviance syndromeexpanded hierarchical evaluations at four ages from earlyadolescence to adulthood Journal of Consulting amp ClinicalPsychology 60766ndash776

Miller W R Brown J M (1991) Self-regulation as a conceptual basisfor the prevention of addictive behaviours In Heather N MillerW R Greeley J eds Self-control and the Addictive BehavioursSydney Australia Maxwell Macmillan 3ndash79

Miller W R Leckman A L Delaney H D Tinkcom M (1993)Long-term follow-up of behavioral self-control training forproblem drinkers Journal of Studies on Alcohol 53249ndash261

Motivation Skills and Decision Making 2009

ORDER REPRINTS

Miller W R Rollnick S (1991) Motivational InterviewingPreparing People to Change Addictive Behavior New YorkGuilford Press

Moffitt T E Caspi A Harrington H Milne B J (2002) Males onthe life-course-persistent and adolescence-limited antisocial path-ways follow-up at age 26 years Development and Psychopathology14(1)179ndash207

National Institute on Drug Abuse (NIDA) (1997) Drug abuseprevention What works NIH Publication 97-4110 DHHSNational Institutes of Health National Institute on Drug AbuseOffice of Science Policy and Communications Rockville MD

Newcomb M D (1992a) Substance abuse and control in the UnitedStates ethical and legal issues Social Science and Medicine35471ndash479

Newcomb M D (1992b) Understanding the multidimensional nature ofdrug use and abuse The role of consumption risk factors andprotective factors In Glantz M D Pickens R eds Vulnerabilityto Drug Abuse Washington DC American PsychologicalAssociation 255ndash298

Newcomb M D (1996a) Pseudomaturity among adolescents constructvalidation sex differences and associations in adulthood Journalof Drug Issues 26477ndash504

Newcomb M D (1996b) Adolescence Pathologizing a normal processThe Counseling Psychologist 24482ndash490

Newcomb M D (1997) Psychosocial predictors and consequences ofdrug use a developmental perspective within a prospective studyJournal of Addictive Diseases 1651ndash89

Newcomb M D Bentler P M (1988) Consequences of Adolescent DrugUse Impact on the Lives of Young Adults Beverly Hills CA Sage

Newcomb M D Bentler P M (1989) Substance use and abuse amongchildren and teenagers American Psychologist 44242ndash248

Newcomb M D Harlow L L (1986) Life events and substance useamong adolescents Mediating effects of perceived loss of controland meaninglessness in life Journal of Personality and SocialPsychology 51564ndash577

Newcomb M D Chou C-P Bentler P M Huba G J (1988)Cognitive motivations for drug use among adolescents longitudinaltests of gender differences and predictors of change in drug useJournal of Counseling Psychology 35426ndash438

Newcomb M D Abbott R D Catalano R F Hawkins J DBattin-Pearson S R Hill K (2002) Mediational and deviancetheories of late high school failure Process roles of structural

2010 Sussman et al

ORDER REPRINTS

strains academic competence and general versus specific problem

behaviors Journal of Counseling Psychology 49172ndash186Nezami E Sussman S Pentz M A (2003) Motivation in tobacco use

cessation research Substance Use amp Misuse 3825ndash5Novak S P Clayton R R (2001) The influence of school environment

and self-regulation on transitions between stages of cigarette

smoking Health Psychology 20196ndash207Offord D R (2000) Selection of levels of prevention Addictive

Behaviors 25833ndash842Palinkas L A Atkins C J Miller C Ferreira D (1996) Social skills

training for drug prevention in high-risk female adolescents

Preventive Medicine 25692ndash701Patock-Peckham J A Cheong J-W Balhorn M E Nagoshi C T

(2001) A model of parenting styles self-regulation perceived

drinking control and alcohol use and problems Alcoholism

Experimental and Clinical Research 251284ndash1292Pentz M A (1994) Directions for future research in drug abuse

prevention Preventive Medicine 23646ndash652Pentz M A Dwyer J H MacKinnon D Flay B R Hansen W B

Wang E Y I Johnson C A (1989) A multi-community trial for

primary prevention of adolescent drug abuse effects on drug use

prevalence JAMA 2623259ndash3266Pentz M A Mares D Schinke S Rohrbach L (in press) Political

science public policy and drug abuse prevention Substance Use amp

MisuseProchaska J O DiClemente C C (1982) Transtheoretical therapy

toward a more integrative model of change Psychotherapy Theory

Research and Practice 19275ndash288Pulkkinen L Pitkanen T (1994) A prospective study of the precursors

to problem drinking in young adulthood Journal of Studies on

Alcohol 55578ndash587Rathus S A Nevid J S (1977) Behavior Therapy Strategies for

Solving Problems in Living New York Doubleday and Company

IncResnicow K Botvin G (1993) School-based substance use prevention

programs why do effects decay Preventive Medicine 22484ndash490Rutter M Dunn J Plomin R Simonoff E Pickles A Maughan

B Ormel J Meyer J Eaves L (1997) Integrating nature and

nurture implications of person-environment interactions for

developmental psychopathology Development and Psychopathology

9335ndash364

Motivation Skills and Decision Making 2011

ORDER REPRINTS

Salomon G Stein Y Eisenberg S Klein L (1984) Adolescent

smokers and nonsmokers profiles and their changing structure

Preventive Medicine 13446ndash461Sambrano S (1999) National cross-site evaluation of high risk youth

programs In Interim findings Bulletin Washington DC CSAP

SAMSHA US DHHS May 1ndash16Schinke S P Gilchrist L D (1985) Preventing substance abuse with

children and adolescents Journal of Consulting and Clinical

Psychology 53596ndash602Skara S N Sussman S (2003) A review of 25 long-term adolescent

tobacco and other drug use prevention program evaluations

Preventive MedicineSmith C Lizotte A J Thornberry T P Krohn M D (1995)

Resilient youth identifying factors that prevent high-risk youth

from engaging in delinquency and drug use Delinquency and

Disrepute in the Life Course Greenwich CT John Hagan JAI

press 217ndash247Sommers P V (1972) The Biology of Behavior Australia Pty ltd

Sydney John Wiley amp SonsSt Pierre T L Kaltreider D L Mark M M Aikin K J (1992)

Drug prevention in a community setting a longitudinal study of the

relative effectiveness of a three-year primary prevention program in

boys and girls clubs across the nation American Journal of

Community Psychology 20673ndash706Stein J A Newcomb M D Bentler P M (1987) An eight year study

of multiple influences on drug use and drug use consequences

Journal of Personality and Social Psychology 531094ndash1105Sully J (1884) Outlines of Psychology New York D Appleton amp CoSussman S (1989) Two social influence perspectives of tobacco use

development and prevention Health Education Research Theory

and Practice 4213ndash223Sussman S (1991) Curriculum development in school-based prevention

research Health Education Research Theory and Practice

6339ndash351Sussman S (1996) Development of a school-based drug abuse

prevention curriculum for high risk youth Journal of

Psychoactive Drugs 28169ndash182Sussman S Ames S L (2001) The social psychology of drug abuse

Buckingham GB Open University PressSussman S Unger J (2004) A drug abuse theoretical integration a

transdisciplinary speculation Substance Use amp Misuse

2012 Sussman et al

ORDER REPRINTS

Sussman S Dent C W Burton D Stacy A W Flay B R (1995a)

Developing school-based tobacco use prevention and cessation

programs Thousand Oaks CA Sage Publications IncSussman S Dent C W Simon T R Stacy A W Galaif E R

Moss M A Craig S Johnson C A (1995b) Effectiveness of

social influence substance abuse prevention curricula in compre-

hensive and continuation high schools Drugs and Society 865ndash81Sussman S Dent C W Galaif E R (1997) The correlates of

substance abuse and dependence among adolescents at high risk

for drug abuse Journal of Substance Abuse 9241ndash255Sussman S Dent C W Stacy A W (1996) The relation of pro-drug

use myths with self-reported drug use among youth at continuation

high schools Journal of Applied Social Psychology 26214ndash267Sussman S Dent C W Stacy A Craig S (1998) One-year outcomes

of project towards no drug abuse Preventive Medicine 27632ndash642

(erratum 766)Sussman S Dent C W Stacy S (2002) Project towards no drug

abuse a review of the findings and future directions American

Journal of Health Behavior 26354ndash365Sussman S McCuller W J Dent C W (2003) The associations of

social self-control personality disorders and demographics with

drug use among high risk youth Addictive Behaviors 281159ndash1166Sussman S Rohrbach L Patel R Holiday K (2003) A look at an

interactive classroom-based drug abuse prevention program

Interactive contents and suggestions for research Journal of Drug

Education 33355ndash368Sussman S Sun P McCuller W J Dent C W (2003) Project

towards no drug abuse two year outcomes of a trial that compares

health educator delivery to self-instruction Preventive Medicine

37155ndash162Tarter R E Vanyukov M (1994) Alcoholism a developmental disorder

Journal of Consulting and Clinical Psychology 621096ndash1107Thornton T N Craft C A Dahlberg L L Lynch B S Baer K

(2000) Best Practices of Youth Violence Prevention A Sourcebook

for Community Action Atlanta GA Division of Violence

Prevention Centers for Disease Control and PreventionTobler N S (1986) Meta-analysis of 143 adolescent drug prevention

programs quantitative outcome of program participants compared to

a control or comparison group Journal of Drug Issues 16537ndash567Tobler N S Roona M R Ochshorn P Marshall D G Streke

A V Stackpole K M (2000) School-based adolescent drug

Motivation Skills and Decision Making 2013

ORDER REPRINTS

prevention programs 1998 Meta-analysis The Journal of Primary

Prevention 20275ndash336US Department of Health and Human Services (USDHHS) (2003)

Substance Abuse andMental Health Services Administration Center

for Substance Abuse Prevention Science-based prevention programs and

principles 2002 Rockville MD US DHHS (SMA)03-3764 Also

see httpmodelprogramssamhsagovUnger J Baezconde-Garbanati L Shakib S Palmer P H Nezami

E Mora J (2004) What are the implications of structuralcultural

theory for drug abuse prevention Substance Use amp MisuseUpshaw H S Ostrom T M (1984) Psychological perspective in

attitude research In Eiser J R ed Attitudinal Judgment New

York Springer-Verlag 23ndash42Valente T W Gallaher P Mouttapa M (2004) Using social network

theory to understand and prevent substance use a transdisciplinary

perspective Substance Use amp MisuseVorrath H Brendtro L (1985) Positive peer culture 2nd edn Aldine

ChicagoWaldron H B Slesnick N Brody J L Turner C W Peterson T R

(2001) Treatment outcomes for adolescent substance abuse at 4-

and 7-month assessments Journal of Consulting amp Clinical

Psychology 69(5)802ndash813Watson D L Tharp R G (2002) Self-directed behavior Self-

modification for personal adjustment 8th edn Belmont CA

WadsworthWeissberg R P Caplan M Z Sivo P J (1989) A new conceptual

framework for establishing school-based social competence promo-

tion programs In Bond L A Compas B E eds Primary

Prevention amp Promotion in the Schools Newbury Park CA Sage

255ndash296Wills T A (1986) Stress and coping in early adolescence relationships

to substance use in urban school samples Health Psychology

5503ndash529Wills T A Cleary S D (1995) Stress-coping model for alcohol-

tobacco interactions in adolescence In Fertig J B Allen J P

eds Alcohol and Tobacco From Basic Science to Clinical Practice

Bethesda MD National Institute on Alcohol Abuse and

Alcoholism 107ndash128Wills T A Cleary S D (1999) Peer and adolescent substance use

among 6thndash9th graders Latent growth analyses of influence versus

selection mechanisms Health Psychology 18453ndash463

2014 Sussman et al

ORDER REPRINTS

Wills T A Hirky A E (1996) Coping and substance abuse InZeidner M Endler N S eds Handbook of Coping TheoryResearch and Applications New York Wiley 279ndash302

Wills T A Stoolmiller M (2002) The role of self-control in earlyescalation of substance use a time-varying analysis Journal ofConsulting and Clinical Psychology 70986ndash997

Wills T A Baker E Botvin G J (1989) Dimensions of assertivenessdifferential relationships to substance use in early adolescenceJournal of Consulting and Clinical Psychology 57(4)473ndash478

Wills T A Vaccaro D McNamara G (1994) Novelty seeking risktaking and related constructs as predictors of adolescent substanceuse an application of Cloningerrsquos theory Journal of SubstanceAbuse 61ndash20

Wills T A McNamara G Vaccaro D Hirky A E (1996a)Escalated substance use a longitudinal grouping analysis fromearly to middle adolescence Journal of Abnormal Psychology105166ndash180

Wills T A Pierce J P Evans R I (1996b) Large-scale environmentalrisk factors for substance use American Behavioral Scientist39808ndash822

Wills T A Windle M Cleary S D (1998) Role of temperamentnovelty-seeking and self-control in adolescent substance useJournal of Personality and Social Psychology 74387ndash406

Wills T A Sandy J M Shinar O (1999) Substance use level andproblems in late adolescence a mediational model based on self-control and coping motives Experimental and ClinicalPsychopharmacology 7122ndash134

Wills T A Cleary S D Filer M Shinar O Mariani J Spera K(2001) Temperament and self-control related to early-onsetsubstance use test of a developmental model Prevention Science2145ndash163

Wills T A Sandy J M Yaeger A (2002) Moderators of therelationship between substance use level and problems test of aself-regulation model in adolescence Journal of AbnormalPsychology 1113ndash21

Wills T A Gibbons F X Gerrard M Murry V Brody G (in press-a) Family communication and religiosity related to substance useand sexual behavior in early adolescence Psychology of AddictiveBehaviors

Wills T A Resko J Ainette M Mendoza D (in press-b) The role ofparent and peer support in adolescent substance use a test ofmediated effects Psychology of Addictive Behaviors

Motivation Skills and Decision Making 2015

ORDER REPRINTS

Young P T (1936) Motivation of Behavior New York John Wiley andSons

Zimmerman B J (2000) Attaining self-regulation a social cognitivemodel In Boekaerts M Pintrich P R eds Handbook of Self-Regulation San Diego Academic Press 13ndash39

2016 Sussman et al

Request PermissionOrder Reprints

Reprints of this article can also be ordered at

httpwwwdekkercomservletproductDOI101081JA200034769

Request Permission or Order Reprints Instantly

Interested in copying and sharing this article In most cases US Copyright Law requires that you get permission from the articlersquos rightsholder before using copyrighted content

All information and materials found in this article including but not limited to text trademarks patents logos graphics and images (the Materials) are the copyrighted works and other forms of intellectual property of Marcel Dekker Inc or its licensors All rights not expressly granted are reserved

Get permission to lawfully reproduce and distribute the Materials or order reprints quickly and painlessly Simply click on the Request Permission Order Reprints link below and follow the instructions Visit the US Copyright Office for information on Fair Use limitations of US copyright law Please refer to The Association of American Publishersrsquo (AAP) website for guidelines on Fair Use in the Classroom

The Materials are for your personal use only and cannot be reformatted reposted resold or distributed by electronic means or otherwise without permission from Marcel Dekker Inc Marcel Dekker Inc grants you the limited right to display the Materials only on your personal computer or personal wireless device and to copy and download single copies of such Materials provided that any copyright trademark or other notice appearing on such Materials is also retained by displayed copied or downloaded as part of the Materials and is not removed or obscured and provided you do not edit modify alter or enhance the Materials Please refer to our Website User Agreement for more details

ORDER REPRINTS

LifeSkills

Training(LST)

7th

Exposedto

substance-using

(cigarettes

and

alcohol)peers

andpoor

academ

ics

School-based

classroom

Cultural

tailoring

Yes

Yes

Universalcom-

prehensive

life

skills

program

tested

with

at-risk

youth

1year

follow-up

Smoking

alcohol

inhalants

polydrug

not

marijuana

LinkingInterests

Families

andTeachers

(LIF

T)

1st

and5th

Atrisk

neighborhoods

withhigh

juvenile

delinquency

School-based

classroom

playground

6parent

meetings

No

Yes

Yes

Playground

groups

form

ed

Lessaggression

onplay-

groundand

better

classroom

behavior

druguse

not

assessedyet

Midwest

Prevention

Project

(MPP)

6th

and7th

Baselinemonthly

users

of

cigarettes

alcoholor

marijuana

School-based

classroom

parents

media

community

Notreally

maybesome

community

supports

Yes

Yes

Universalcom-

prehensive

social

influence

program

tested

with

at-risk

youth

35

year

follow-up

Smokingand

alcoholeffect

at15

years

vanished

by

35

yearsnot

marijuana

Multi-system

ic

Therapy(M

ST)

12ndash17

Chronically

violent

substance-

abusing

juvenile

offenders

Family-

oriented

home-based

increase

support

network

Empower

parents

Yes

Yes

Highly

trained

therapist

involved

in60

contact

hours

over

4months

Decreaseddrug

use

and

re-arrests

andim

proved

family

functioning

(continued

)

Motivation Skills and Decision Making 1983

ORDER REPRINTS

Table

1

Continued

Inclusion(ornot)

ofMSD

Components

Nameof

Program

Baseline

GradeAge

Range

Definition

ofRisk

Program

Modalities

Motivation

Skills

Decision

Making

Other

Features

Drug

Effects

Multi-

dim

ensional

Treatm

ent

Foster

Care

(MTFC)

9ndash18

Chronic

conduct

orem

otional

disturbance

crim

inal

behavior

Home-

and

school-based

MTFC

home

placement

case

managem

ent

Positive

reinforcers

Yes

No

Highly

trained

counselors

weekly

parent

groups

family

therapy

community

mentoring

andmonitor-

ing

behavior

modification

Decreasedhard

drugusejail

timeand

arrests

Nurse-Family

Partnership

(NFP)

First-tim

e

mothers

Motherswithno

income

often

teen

mothers

Homevisits

resource

advocacy

No

No

Yes

Highly

trained

counselors

pregnancy

to

2years

old

Decreased

smokingand

alcoholuse

among

mothers

reducedrates

ofchildabuse

Preventive

Intervention

(PI)

7th-8th

Pooracadem

ic

andschool

discipline

family

problems

School-based

skillsand

monitoring

Positive

reinforcers

Yes

No

Increase

child

teacher

parentcom-

munication

role

play

pro-social

alternatives

Lesshard

drug

useless

delinquency

higher

grades

andbetter

attendance

1984 Sussman et al

ORDER REPRINTS

Preventive

Treatm

ent

Program

(PTP)

7ndash9

Disadvantaged

socioeconomic

status(SES)

disruptive

School-based

parentand

childskills

and

monitoring

Positive

reinforcers

Yes

No

17sessionsfor

parent19for

child

separately

parent-

monitoring

andshaping

ofchild

child-

pro-social

skillsand

selfcontrol

Lesslikelihood

ofhaving

beendrunk

ortaken

drugsin

last

12months

less

fighting

andstealing

Project

PATHE

12ndash18

Disadvantaged

socioeconomic

status(SES)

low

achieving

disruptive

School-based

activitiespeer

counseling

schoolpride

jobseeking

Yes

Yes

No

Academ

ic

skillstoo

Decreaseddrug

involvem

ent

school

alienation

discipline

problems

higher

graduation

rates

Project

STATUS

12ndash18

Potential

dropouts

Schoolclim

ate

optionsclass

(socialrules

norm

s)

Accountability

No

Yes

Youth

leadership

staff

development

parent

meetings

community

resources

Lessdrug

involvem

ent

forjunior

highyouth

bettergrades

anddiscipline

(continued

)

Motivation Skills and Decision Making 1985

ORDER REPRINTS

Table

1

Continued

Inclusion(ornot)ofMSD

Components

Nameof

Program

Baseline

GradeAge

Range

Definition

ofRisk

Program

Modalities

Motivation

Skills

Decision

Making

Other

Features

Drug

Effects

Project

STEP

14ndash18

Disadvantaged

socioeconomic

status(SES)

low

achieving

disruptive

Schoolphysical

settinghome

room

teacher

role

Accountability

No

No

Homeroom

teachersact

ascounselors

andadvisors

Lessdrug

involvem

ent

bettergrades

anddiscipline

Project

SUCCESS

14ndash18

Alternativehigh

schoolyouth

School-based

counseling

and

education

SAPmodel

No

Yes

Yes

Highly

trained

counselorsasse-

ssment8-session

classgroup

counseling

parentmeeting

referral

Decreased

problem

behavioruse

ofmarijuana

tobaccoand

alcohol

Project

Towards

NoDrugAbuse

(TND)

14ndash19

Alternativehigh

schoolyouth

School-based

classroom

12

sessions

Yes

Yes

Yes

Trained

teachers

Decreaseduse

ofcigarettes

alcoholmar-

ijuanahard

drugsweapons

carrying

Quantum

Opportunities

Program

(QOP)

9thndash12th

Disadvantaged

socioeconomic

status(SES)

familieson

public

assistance

Schoolhome

and

community

contexts

skillsservice

and

education

Money

Yes

Yes

250education

hours250life

skillshoursjob

preparationcul-

turalenrichment

and250hcom-

munityservice

monetary

incentives

Nodruguse

effectsrepor-

tedincrease

inhighschool

graduation

less

likelyto

becomeateen

parentslightly

less

likelyto

be

arrested

1986 Sussman et al

ORDER REPRINTS

Reconnecting

Youth

(RY)

14ndash18

Atrisk

for

drop-out

School-based

90-session

class

Groupsupport

Yes

Yes

Smallstudent

groups

support

highly

trained

teachera

semester

Decreasedhard

druguse

perceived

stress

improved

grades

Residential

Student

Assistance

Program

(RSAP)

14ndash17

Livingin

residential

facilities

Residential-

based

education

program

assessm

ent

counseling

referral

No

Yes

Yes

Highly

trained

counselors

placedin

residential

facilities

8-session

drug

education

individual

andgroup

counseling

Decreaseduse

ofmarijuana

tobaccoand

alcohol

Strengthening

Families

Program

(SFP)

6ndash12

Childrenof

substance

users

Agency-based

14session

skillstraining

No

Yes

Yes

Highly

trained

counselors

parents

and

childseen

separately

firsthour

together

at

thesecond

hour

Reduces

aggression

increases

family

cohesion

immediate

effectson

druguse

Motivation Skills and Decision Making 1987

ORDER REPRINTS

model of drug abuse prevention We see this intrinsicextrinsic motiva-tion notion as providing intrapersonal and extrapersonal stimuli (cues)for action

Finally self-regulation models posit that one is motivated to achievean optimal state or system balance In essence an awareness of lack ofbalance will lead to efforts to restore balance (Carver and Scheier 1998Karoly 1980 1993) Drug abuse prevention may demand considerationof alternative actions in order to maintain homeostasis Affect may serveas the main homeostatic mechanism If people feel good or neutral theywill tend to maintain a given course of behavior On the other hand ifthey feel poorly they will want to change their behavior (as in the law ofeffect)

Constituents are those elements that when combined togethercompose a theoretical structure Seven constituents of motivation appearacross the four general theories (Nezami et al 2003) First the idea ofdiscrepancies appears in all theories Motivation exists as a distancebetween what is and what could be and these models assume that peopledesire to reduce such discrepancies Second motivation functions by theestablishment of goals Third motivation exists as energymdasha want ordrive Goals and the accompanying drive to achieve them usually appeartogether Fourth motivation may appear as a series of stages that lead toan end Different goals may operate at different stages Fifth motivationreflects ambivalence about two or more competing goals or behaviorsWorking through ambivalence enhances motivation Sixth motivationarises from different sources usually intrapsychic or environmentalrewards Finally a homeostatic conceptualization of motivation rests onthe idea of maintaining an optimal set point within a regulatory system

Integrations of these four models of motivation could help achievethe prevention of drug abuse One view suggests that due to lifeexperiences people consider goals or directions For example teens maystart to experiment with drugs due to curiosity perceived social pressureor as a means to induce a life change They may subsequently take risksthat injure their relations with others or impair their achievement inschool At some point a discrepancy likely develops between currentcircumstances and their goals For example teens may know that drugabuse is inconsistent with some life goals like school achievementHowever they may value social interaction and physical pleasure whichthey may reach through drug use or other means

Multiple goals may conflict with each other leading to ambivalence(Karoly 1993) Extrinsic and intrinsic sources of input may helpresolve ambivalence For example as the rewards associated with drugabuse diminish teens may experience a desire to decrease their drug

1988 Sussman et al

ORDER REPRINTS

consumption They may prove more likely to adopt a new goal ofdecreased drug use especially if they believe that they could achieve thegoal as self-efficacy theory suggests

Teens may exert energy to reduce discrepancies between currentstates and desired states They may learn new life or social skills whichcan lead them to become involved in rewarding but nondrug-usingactivities (Carroll 1996) In addition they may become involved in newtypes of social networks containing low-risk rather than high-risk peers(Valente et al 2004 Wills et al in press-b) Finally attaining a healthiergoal can create a positive optimal set point and the motivation systemprovides more positive feedback Over time through experience ofdifferent life events youth may alter the set point and begin a new goal-searching process (Sussman and Unger 2004) One may experience atraumatic life event for example and again consider drug use as a meansto return to an optimal set point or repeatedly get into trouble because ofassociating with deviant peers and realize that there is a need to turn todifferent types of associations

Research and theory from several disciplines suggest many motiva-tion strategies for a successful prevention program These motivationstrategies include myth correction stereotyping valuing life andachievement of health goals

Myth Correction

The recovery movement often refers to substance use and abuse as aproblem of perception Another closely related expression drug use mythsdescribes questionable or dysfunctional expectancies or beliefs that serveto justify drug use Myths involve more than expectancies or beliefs aboutpositive or negative outcomes they include inaccurate expectancies orbeliefs about the characteristics (or norms) of drugs and drug use and arelikely to confuse drug effects with drug experiences

Some common myths include inflated expectancies of positiveoutcomes from drug use or underestimates of negative outcomes fromdrug use Teens may believe that substance use will create peer groupacceptance or help them cope with family and school problems when infact the drug use only diverts them from actively coping with these socialand academic issues Thus in the long run drug use makes things worsenot better (Wills and Hirky 1996) Other myths include endorsement ofmisleading beliefs For example many adolescents believe that learningto manage drug intake without getting sick is a positive sign that theirbodies are growing tolerant to the drug rather than signaling the

Motivation Skills and Decision Making 1989

ORDER REPRINTS

beginnings of drug dependence or addiction In addition misperceptionsregarding physical consequences of drug use operate For example usersmistakenly believe that if they are able to regulate subjective effects of adrug they have gained control over use In reality warning systems maybe deteriorating as addiction begins (Glynn et al 1985 Sussman et al1995b) Challenging drug myths undoubtedly helps prevent drug abuse

These challenges can prove especially useful with high-risk popula-tions particularly if social influence programs are less effective in thesegroups Several prevention researchers have adopted a similar taxonomyof drug myths when attempting to prevent drug use Sussman Dent andStacy (1996) examined the internal consistency and discriminant validityof a measure of drug-related myths in 362 continuation (alternative) highschool youth They found good internal consistency and discriminantvalidity for the measure Controlling for its relations with socialdesirability perceived friendsrsquo drug use (a social influence measure)ethnicity and gender the myth measure remained significantly associatedwith four drug use measures Ames Sussman Dent and Stacy (1999)found a myth measure to be a relatively strong psychosocial predictor ofdrug use one-year later Cognitive perceptions obviously play a role indrug abuse prevention (Stein et al 1987) These findings suggest thatcontinued research on drug use myths should prove fruitful forprevention efforts (Sussman et al 1998 2003)

Some cognitive restructuring corrects faulty or self-defeatingcognitive structures (myths) In particular elaborating on the logicalsteps involved in the construction of a drug use myth may help to destroyits impact on behavior For example a common myth suggests thathaving trouble finding onersquos car after getting drunk is a funny event Ifone asks (a) lsquolsquoDid you want to find your carrsquorsquo (b) lsquolsquoWere you too drunk tofind it for a long timersquorsquo and (c) lsquolsquoAnd thatrsquos funnyrsquorsquo the apparent humorin the story may dissipate Further one may delineate the kernel of truthin the myth (not finding onersquos car is an odd event) from the falseaspects of the myth (not finding onersquos car indicates failure of functioningwhich is sad worrisome anxiety provoking not funny)

Stereotyping

Lower risk peers tend to perceive lsquolsquoat riskrsquorsquo others (eg alternativehigh school students) as being more deviant than they actually areUnderstandably youth so-labeled students resent this stereotypeAddressing this stereotype may help prevent drug abuse If lsquolsquoat riskrsquorsquoyouth begin to view themselves as being more deviant than they actually

1990 Sussman et al

ORDER REPRINTS

are the situation could lead to self-fulfilling prophesy as if they weregiving in to the stereotype However lowering the estimates of drug useamong their peers can correct this giving in This version of a prevalence-overestimation reduction lesson which includes a motivational featurehas appeared in successful prevention programs (Sussman et al 2002) Astereotype-oriented lesson may also accomplish a second goal If high-risk youth do not view themselves as being deviant as they assumedothers had judged them possibly reactions against this stereotype mayenergize an effort to avoid drug use as well as portray oneself morefavorably (Hamilton August 20 2000)

Valuing Life and Health Goals

Letrsquos consider the example of older teens Most youth report thatthey plan to graduate from high school and continue their educations orfind a job They do not view hanging out as a desirable option They alsosee that drug use could interfere with achieving their goals A lessonexplaining the negative consequences of drug use particularly oneconsistent with data (Newcomb and Bentler 1988) could reveal howearly involvement with drugs creates symptoms of abuse and dependenceand alters job opportunities marriage and family functioning These lifegoals can seem more valuable as students perceive them as attainableEnhancing the value of life goals can increase motivation for learningadaptive coping (Lau et al 1986) Youth have reported that drug usecould interfere with obtaining desired life goals In theme and componentstudies youth positively evaluated a lesson that taught that drug usecould interfere with obtaining desired goals and that placing animportance on health as a value was consistent with achievement of lifegoals (Sussman 1996) Thus it is important for prevention programs tohelp youth connect the importance of health to obtaining their life goalsand develop a sequenced plan so that they know how to proceed step-by-step (Karoly 1993 Watson and Tharp 2002)

Although modifiable understanding the source of positive life goalsis also important since these may occur earlier in life For instanceNewcomb and Harlow (1986) found that perceived loss of control andmeaninglessness in life mediated the relationship between negative lifeevents and drug use While numerous types of stressful events wereconsidered in this study other studies identify an adverse childhoodfamily environment as a potent precursor to later drug use (Locke andNewcomb in press Palinkas et al 1996) An adverse early homeenvironment a modifiable etiological factor should serve as a focus of

Motivation Skills and Decision Making 1991

ORDER REPRINTS

prevention that addresses child abuse and neglect (see later discussion ofthis topic)

Attitudinal Perspectives

Most youth consider themselves as being moderates They can alsoreliably identify drug use as being a deviant immoderate behaviorPresenting them with the disparity between their self-view as a moderateperson despite their deviant drug use can produce a desired behaviorchange (Sussman 1989 Upshaw and Ostrom 1984) An attitudinalperspective lesson can confront students with the inconsistency betweentheir general self-attitude ratings as moderates vs their more extremespecific behaviors (eg drug use) Adopting a self-perception as amoderate may inoculate youth when social pressures to experiment withdrugs arise A desire for internal consistency a similarity betweenattitudes and behavior may increase motivation to abstain from drugs(Festinger 1957 Heider 1958) Youth received lessons like these quitefavorably in previous work (Salomon et al 1984)

Skills

Direct instruction modeling practice and group reinforcementenhance social learning At least three basic kinds of skills needinstruction self-control communication and resource acquisition

Social Self-control Skills

Good self-control protects against substance use and buffers againstthe impact of risk factors (Bandura 1986 Catalano and Hawkins 1996Weissberg et al 1989 Wills et al 1998) Poor self-control involvesbehavioral affective and cognitive deficits Poor behavioral self-controlis associated with a need to regulate and stabilize mood possiblypreceding uncontrolled behavior or stemming from the consequences ofuncontrolled behavior Poor self-control behavior along with difficultiesin mood stabilization increases risk for substance use and rapidescalation to high levels of use which then can lead to physiologicaldependence (Wills and Stoolmiller 2002)

Self-control strategies cross physiological and personality boundariesbecause self-control also relates to coping motives for substance use a

1992 Sussman et al

ORDER REPRINTS

strong predictor of substance use problems (Wills et al 1999) Self-control includes cognition because developing self-control is the substratefor personality organization including not only behavioral and affectivecontrol but also attitudes values and views of the world as accepting orhostile and social perceptions about substance use as being attractive vsunattractive For example studies find poor self-control correlated withattitudinal tolerance for deviance and more favorable perceptions oftobacco and alcohol users whereas good self-control is related tofavorable perceptions of teens that abstain from drug use (Wills et alin press-a) Self-control approaches can be useful for preventionprograms by improving self and other perceptions academic perfor-mance and the impact or facilitation of negative life events goals that aresalient to teenagers and their parents (Wills and Stoolmiller 2002)

Youth often lack adequate coping skills they tend to lack restraint orplanfulness (Farrell and Danish 1993 Rutter et al 1997) Coping skillsinstruction may help increase self-control (Kendall and Braswell 1982)Coping skills instruction receives little attention in typical social influencesprogramming (Hansen 1992) although this material appears in life skillstraining (Botvin 1993 Botvin et al 1995 Wills 1986) In self-controlprogramming youth learn to assess their self-control particularly in socialcontexts (Sussman et al 2003) They learn the importance of thinkingahead and anticipating problem situations so that they are preparedbeforehand to deal with problems that may arise They also learn theimportance of context (eg not laughing at a funeral) Finally they learnassertiveness and anger management to help them better control theirreactions in social settings (Sambrano May 1999 Sussman et al 2002)

Listening and Communication Skills

Youth genuinely benefit from listening to information with an openmind and asking open-ended questions to keep a conversation goingThey can improve social skills by learning how to ask open-endedquestions establish eye contact appropriately nodding and orientingtheir body toward the other speaker (CPPRG 1999 Eggert and Herting1991 Hawkins et al 1999 Sussman et al 2002 2003) Neverthelesssocial skills training can create problems for nondrug using high-riskteens (Palinkas et al 1996 Sussman et al 1995b Wills et al in press-b)Training in drug refusal may create reactance in some samples (Sussmanet al 1996) Among high-risk youth enhancing assertiveness and datingskills may increase the scope of social entertainment options andinadvertently improve a teenrsquos ability to acquire drugs from new sources

Motivation Skills and Decision Making 1993

ORDER REPRINTS

(Wills et al 1989) Also there are cultural variations on what constitutesgood social skill (Unger et al 2004) There are good arguments forplacing high-risk teens together in activities with well-controlled teens sothat they can model adaptive social skills and problem solvingAdditionally utilizing motivation methods prior to instructing thespecific skill channels canalizes health-directed use of social skillsmastered Overall increasing social competence will have protectiveeffects for high-risk teens (Wills et al 1994) This idea is consistent withthe studies that have shown social withdrawal to increase risk for druguse (Kerr et al 1997) though there may be gender differences in theseeffects (Pulkkinen and Pitkanen 1994) Still it is most wise to includesocial skills training in conjunction with material addressing motivationand decision making Motivations regarding drug use need to beaddressed so behaviors learned are not misdirected

Resource Acquisition

Adults often assume that teens can access community services withlittle effort In fact few teens understand the availability of healthservices or other assistance Simple information including phonenumbers and locations can assist teens immensely (Carroll 1996Sussman et al 2002) Coaching teens on techniques for receivingassistance can prove productive Public assistance for drug use-relatedproblems and other life problems can help tremendously but negotiatingthe bureaucratic difficulties inherent in many of these systems can requireconsiderable skill (Eggert and Herting 1991 Sambrano May 1999Sussman et al 2002) Direct instruction modeling and structuredpractice in resource acquisition skills may help youth to increase theirknowledge and self-efficacy on how to acquire resources and to readilyaccess resources when needed (eg use of the bus system) These skillsmay generalize to comparable tasks later in life

Decision-Making

Prevention programs have employed several decision-making strate-gies For example the protocol from Project Reconnecting Youth(Project RY) is STEPS The acronym stands for Stop Think ofoptions Evaluate options Perform or take action on the chosen optionand then Self-praise for using steps for making healthy choices (Eggertand Herting 1991) The participants help set the agenda and take turns

1994 Sussman et al

ORDER REPRINTS

illustrating it on a flip chart This task helps share the leadership andfocuses the group work and time The lesson STEPS to Drug UseControl follows skills training sessions that cover understandingSTEPS as a decision-making model

Project Towards No Drug Abuse (TND)rsquos decision-making sessioninvolves four steps These steps are

1 Brainstorming (making a list of ideas without judging them)2 Weigh the pros and cons (the benefits and costs of each idea)3 Select the best option4 Follow through (try that option and reevaluate the decision)

(Sussman et al 2002)

These decision-making strategies are similar across different pro-grams except that they include some different emphases For exampleSTEPS includes a self-instruction to begin decision making and self-praise whereas the TND sequence includes more of an emphasis onfollowing through with the decision Generally each program requiresgenerating options evaluating them choosing the best and evaluatingthe outcome in an effort to make the next decision Teens tend to enjoypracticing decision making in bogus problem situations Youth soonlearn to engage in steps like these with considerable skill Training indecision making operates on variables that are intermediate in the causalprocess and thereby strengthen individual profiles of self-controlabilities so that they are more resilient in the face of proximal riskfactors for drug use such as life stresses and peer pressures

Modalities of Programming

Both school and nonschool prevention modalities have a rich andimportant history in substance abuse prevention research (Pentz 1994Pentz et al 2004) Schools provide a captive audience for educationalmaterial Youth spend 25 of their waking lives at school so thisenvironment has considerable potential Furthermore the school contextprovides a rich research history for building new studies and evaluatingtheir efficacy (Sussman et al 1995a) Community programs also offerconsiderable opportunity

Community programs often involve local leaders and organizations(eg coalitions community boards) (Goodman et al 1993 Kaftarianand Hansen 1994) that help mobilize numerous community unitsCommunity units include businesses media the family and governmental

Motivation Skills and Decision Making 1995

ORDER REPRINTS

agencies like the police or recreational departments as well as schoolsystems A network of community units working together to developpromote and implement educational programming could increase youthsrsquobonding to others across a wide variety of social contexts (Hawkins et al1992 Pentz 1994) Community units can provide numerous types ofspecific extra-classroom prevention opportunities (Pentz 1994)

Parent-or-family targeted prevention programs include offering earlychildhood education social support for parents managing crisesparenting skills training parent-child communication skills and resourceacquisition instruction or networking Mass media targeted programsinvolve programs or public service announcements with novel fastand unconventional messages (eg the American Legacy FoundationTRUTH campaign) use of the Internet and interactive CDs (eg videogames) Alternative means to involve youth include involvement in hikingclubs drug-free dances or other after-school events with prosocial adultmentors and with means to involve youth outside of school includingentry into different environments (ie outward bound) (Tobler 1986) Inaddition policy implementation and enforcement may contribute toother prevention programs (Pentz et al 1989) Indeed simultaneousprograms within and outside of schools over long periods might maintainthe positive effects that sometimes dissipate when school programsappear alone (Pentz 1994)

The Difference Between Targeted Prevention and Cessation

Targeted (secondary) prevention attempts to keep persons fromcrossing the invisible line where they funnel into a cycle of addiction andaccumulation of negative consequences Cessation programs (sometimesreferred to as tertiary prevention) take the stance that a behavior hasoccurred with definite and perhaps irreversible negative consequencesThe goal is to stop the behavior permit recovery from the damage learnhow to prevent relapse and learn how to live with permanent changes(eg neurotransmitter function drug use-related injury) It is not clearexactly where indicated prevention ends however and where cessationbegins For example an early version of the Project TND curriculum didnot achieve effects on cigarette smoking possibly because 46 of thesample already smoked cigarettes daily (while not engaging often in someother drug use) In a revised curriculum a smoking cessation componentwas added to the program and then an effect on cigarette smoking wasachieved Cessation material can appear with prevention material to

1996 Sussman et al

ORDER REPRINTS

maximize program effectiveness Careful program development can helpdetermine the best mix (Sussman et al 2002)

Summary of Evidence-based Targeted Drug Abuse Prevention

At present approximately 29 drug-use prevention programs havebeen evaluated favorably for their effects on drug use or other problembehavior (see Table 1) These 29 programs have been identified throughtwo sources Blueprints for Violence Prevention (Elliott 2003) and theSubstance Abuse and Mental Health Services Administrationrsquos(SAMSHA) science-based prevention programsrsquo guide (USDHHS2003) PsycINFO and MEDLINE searches of drug abuse preventionstudies since 1970 supplemented searches through these two guides (seeTable 1) Nine definitions of high-risk were used across these programsEleven programs focused on economic deprivation as the definition Sixprograms focused on delinquent behavior as the identifying characteristicto target Two programs each identified single-parent homes drug use orexposure to drug use family problems alternative high school attendanceor being at risk for dropout at a regular high school as the characteristicsto target subjects Finally one program each identified new immigrantstatus or residential facility placement as the defining characteristic ofbeing at high risk for drug use

Among these programs eight focused on preteens For example theEarly Risers program defined its high-risk youth as those 6ndash10 year-oldsthat suffered economic deprivation and exhibited aggressive or opposi-tional behavior Another five programs focused on a young teen agegroup For example Preventive Intervention defined its high-risk youthas those seventh to eighth graders who exhibited poor school andacademic discipline and reported family problems Another sevenprograms focused on an older teen age group For example ProjectTND defined its high-risk youth as those youth that attended alternativehigh schools Finally nine programs encompassed wide age ranges Forinstance Big Brothers Big Sisters of America defined its high-risk youthas 6ndash18 year-olds that lived in single-parent homes

Of these programs 10 involved multiple often flexible settings ofimplementation Another 13 programs focused on the school settingFour programs focused on the home setting Finally two programsfocused on a community agency setting In general these programsinvolved implementation by highly trained personnel Eighteen of theseprograms involved some motivation aspect generally motivationenhancement but sometimes including extrinsic reinforcement strategies

Motivation Skills and Decision Making 1997

ORDER REPRINTS

Twenty-six of these programs provided skills training Finally 18programs provided instruction in decision making Thus the MSDmodel tends to appear in a majority of these programs however all threecomponents were included together in only nine of these programs

Twenty of these programs involved at least one replication of theprogram and 14 involved three or more replications Further 14 of theseprograms were tested through use of experimental designs and nineinvolved use of only quasi-experimental designs Effects on drug use wereassessed and found in 22 of these programs For example theReconnecting Youth program was implemented to youth at risk fordropout This program involved 90 sessions within a comprehensive highschool class delivered generally over a semester with small studentgroups and a highly trained teacher Instruction included use of groupsupport and providing life skills training (norm setting self-esteem moodmanagement communication skills self-monitoring monitoring goalsschool bonding and social activities) with feedback to parents Programgoals were achieved through use of a quasi-experimental design showingeffects for school performance (18 improvement in grades) drug use(54 decrease in hard drug use) and suicide risk (32 decline inperceived stress) This programrsquos results have been replicated numeroustimes in numerous locations This program involved all three componentsof the MSD model except that motivation was provided through peergroup support not through provision motivation enhancement strate-gies These targeted programs present an optimistic picture for drug-useprevention that is focused on at-risk youth (see Table 1)

Not all targeted prevention programs have been found to beeffective One published program that failed to find positive effects wasProject PALS (Palinkas et al 1996) This project was developed for teengirls who were pregnant or at risk for pregnancy and drug use Theprogram consisted of school-based delivery of 16 sessions once a weekin a class The goal was to decrease drug use The PALS Skills TrainingProgram involved instruction in assertiveness providing and receivingfeedback social conversation handling requests and asking for help andmood management This program was tested against a normativeeducation program (called Facts of Life or FOL) which instructedvalues and decision making sexuality issues and contraception sexuallytransmitted diseases (STDs) drug use risks sexual assault prevalenceand norms material An experimental evaluation with a seven-monthspost-baseline was used The results indicated that the PALS programsubjects reported 29 times greater marijuana use than FOL amongbaseline nonusers No other differences were found It is possible that theprogram was not targeted to the right population that the mix of skills

1998 Sussman et al

ORDER REPRINTS

instructed was not appropriate or that skill training alone (withoutappropriate motivation material) may not be effective in drug useprevention Researchers should examine these possibilities and others tofurther understand program failures as well as program successes

Potential Limitations of Targeted Prevention

Dishion and colleagues (1995) suggest from various findings thatgrouping high-risk youth may lead to increased drug use This outcomecan result if youth come to learn deviant behavior from each other Theycan learn deviant behavior from each other in a program if they haveunstructured or unsupervised time together An essential feature ofseveral targeted programs (eg the RY and TND programs) is building apositive peer culture with group norms that decrease drug involvementand drug-use control problems The RYrsquos findings suggest that a positivepeer group component carefully fostered by a well-trained and competentRY group leader can direct the group toward lower risk behaviorSimilarly classroom management in Project TND involves developmentof positive norms of classroom behavior Further interaction betweenyouth is encouraged but is primarily teacher-directed and highlystructured (Sussman et al 2003) In both RY and Project TND theteacherrsquos role is to actively develop and maintain peer group support inthe class by modeling support positively reinforcing it among groupmembers and negatively reinforcing deviant peer bonds and activities(Eggert and Herting 1991 Vorrath and Brendtro 1985) The teachercreates and structures interactions among youth in prosocial directions(Sussman et al 2003)

Multiple Problem Behaviors of Adolescents

Acknowledging the relationship of drug use to other commonadolescent problems may facilitate identification of effective methods ofreducing drug use Researchers on tobacco alcohol and other drug useantisocial behavior high-risk sexual behavior and depression increas-ingly recognize that these problems are interrelated (McGee andNewcomb 1992) and stem to a large extent from the same environ-mental and biological factors (Biglan et al in press Eggert et al 1995Sussman and Ames 2001 Wills and Cleary 1995) Clearly it is necessaryto have strategies that address the entire range of problems and thecontext that influences those problems Indeed further reductions in

Motivation Skills and Decision Making 1999

ORDER REPRINTS

many problems require that we comprehensively target youth withmultiple problem behaviors

Biglan and colleagues (in press) provide a comprehensive review ofthe relationships among antisocial behavior tobacco alcohol and otherdrug use and high-risk sexual behavior It is clear that the same youngpeople are prone to the development of the entire range of problems In arecent review Moffitt and colleagues (2002) found that antisocialbehavior in early adolescence (rather than late adolescence) is a greaterrisk factor for developing multiple problems These findings point to theimportance of early intervention before youth develop serious problemsMoreover these different problems largely result from the same set ofenvironmental and biological factors

One implication is that disciplines dealing with these problemsother than drug abuse may contribute to dealing with the problem ofdrug use (Newcomb 1996b 1997) In particular research by dev-elopmental psychologists family social workers and sociologists onthe influence of parents on adolescent problem development and oninterventions to alter parenting practices contributes to our understandingof how to prevent or ameliorate drug abuse and other problems Onealso should note that nonsubstance use is not a guarantee for problemimmunity for the entire age range of people whatever their genderethnicity religiosity socioeconomic status (SEC) domicility etc It maybe argued that the most promising programs are those targeting thesemultiple levels of influence Several multidisciplinary programs haveachieved promising results We describe three of these empiricallyevaluated programs tested in various settings

Functional Family Therapy (FFT)FFT is an indicated intervention involving family treatment designed

for delinquent teenagers (also see Table 1) Developed in the early 1970sby Alexander and colleagues (1973) FFT focuses on family commu-nication and the establishment of rules and consequences Several studiesprovide encouraging reports of the programrsquos effectiveness (Alexander etal 1976 Barton et al 1985 Klein et al 1977 Waldron et al 2001) Inthe Waldron et al (2001) study researchers used FFT and anintervention with cognitive behavior therapy on teens referred formarijuana use Each of the interventions produced significant resultson marijuana use by the teens at four months but only the twointerventions combined maintained these results at seven months Theearlier studies found a greater number of results For example in the twoAlexander studies (1973 1976) improvement in family communicationposttreatment led to reduced delinquency Note that all the teens in these

2000 Sussman et al

ORDER REPRINTS

studies had histories of serious antisocial or delinquent behavior Thusachieving positive outcomes even if only short-term should encouragefurther research into the efficacy of FFT

Multisystemic Therapy (MST)As its name suggestsMST targets individual family peer school and

community influences of those youth offenders with serious problems thatmay include violence substance use and severe emotional problems (alsosee Table 1) Numerous researchers have published the results ofrandomized trials of MST (Henggeler et al 1996 1997 1998 Thorntonet al 2000) The most consistent findings across studies are decreased (1)drug use (2) re-arrest (3) self-reported criminal offense and (4) days inout-of-home placements Other consistent findings are improved familyrelations school attendance and psychiatric functioning One cautionarynote the programrsquos effectiveness lowers considerably if not implementedwith fidelity (Hengler et al 1997 1999) In other words all or key lessonsneed to be delivered as written by educators who are well-trained in usingthe strategies employed and youth need to be able to receive all material inan atmosphere conducive to learning the material The programdevelopers have instituted training strategies that address these fidelityissues thus shaping MST to be a very promising program for at-riskyouth

Multidimensional Treatment Foster Care (MTFC)MTFC targets family and peer factors influencing adolescents with a

pattern of repeat criminal offending (see Table 1) (Chamberlain 1994)This intervention includes placement of the youth into a foster homewith a foster parent trained in behavior management who receivessupport from intervention staff After the adolescent has begun torespond to the intervention in the foster home and after the parents havereceived the same training and support as the foster parents did theadolescent returns home Chamberlain and Reid (1998) tested theintervention with 85 boys with felony and other criminal histories andfound substantial benefits of the program Following treatment the boysassigned to MTFC (compared to those receiving community-based groupcare) showed fewer days in detention or lock-up twice as much timeliving with parents fewer misdemeanor and felony arrests and fewer self-reported index crimes felony arrests and general delinquency TheMTFC is a cost-effective alternative to incarceration however staffrequirements are extensive which may influence the ability of some

Motivation Skills and Decision Making 2001

ORDER REPRINTS

groups to apply the program with fidelity However as with each of theprograms described here the results of the randomized trials areencouraging

Future Research Needs in Targeted Prevention

Future research can help discern when and where targeted preventionprogramming will tend to work rather than produce potentiallydeleterious negative group effects or results that are irrelevant for pro-social healthy adaptation as well as what the critical necessary conditionsare for their effective operation within given de facto realities Comparedto the breadth of evaluated universal drug use prevention programs(Tobler et al 2000) relatively few targeted prevention programs havereceived empirical support Yet previous research suggests that universalschool-based drug use prevention programs implemented in junior highschool have relatively less chance of long-term success especially for thoseyouth that began using drugs before the prevention program wasimplemented Of course there are notable exceptions (eg effects lastedfor one and a half years effects lasted for six years) (Chou et al 1998Griffin et al 2003 Skara and Sussman 2003) Almost no research existsregarding maximization of booster programming with high-risk youthMore research on booster programs would help the field

While continuing to engage in this work there will be numerousissues to manage that go well beyond the scope of this article There willbe a need to avoid producing negative labeling effects while providingprogramming for those who are at risk for drug use It is possible thatcessation information needs to be included in the mix with preventionmaterial to provide better targeted-prevention effects There may be aneed to develop a teacher selection instrument to help select out teacherswho can deliver drug abuse prevention programming adequatelyCertainly definition of outcome variables needs continued explorationincluding analysis to ascertain the effects of programming on drug abusevs drug use and identification of the variables that are most closelylinked to change by targeted prevention components

A transdisciplinary approach helps to better understand the lifesituation of high-risk youth as based to some extent on both constitutionaland environmental factors (Fuqua et al 2004 Rutter et al 1997 Wills etal 1996b) From the transactional perspective their situation is in partconstitutional they may have temperamental characteristics that arepartly heritable and that have set the stage at earlier ages for decrements inself-control ability and academic performance that then increase risk for

2002 Sussman et al

ORDER REPRINTS

drug use However their situation is also part environmental based in parton family socialization and in part on the types of peers they have as well asthe type and quality of the physical and cultural environment-at-largeThere are many points at which a potential chain of failures can beinterrupted and the individualrsquos trajectory turned in a better directionProblems are not inevitable from starting level (Tarter and Vanyukov1994) and environmental modifications to support good self-controlability can help to avert an adverse impact from earlier experiences orcurrent difficulties (Brody et al 2002 Novak and Clayton 2001 Patock-Peckham et al 2001 Rutter et al 1997 Wills et al 2002)

The problems and needs of high-risk youth in our nationrsquos highschools demand our attention for designing and rigorously testingtargeted prevention approaches Substantial evidence shows that theseyouth are at greater risk for drug involvement and co-occurring problemssuch as aggression depression and suicidal behaviors as we previouslydiscussed It is hoped that the information presented in this article willstimulate others to join in extending this work including testing othermodels of targeted prevention

GLOSSARY

Universal programs Programs that aim to influence all subjects in acontext

Selective drug-abuse prevention programs Programs that servegroups at greater risk of ATOD usemdashfor example children of alcoholicparents They are at psychosocial risk for drug use and abuse

Indicated drug-abuse prevention programs Programs that attemptto benefit individuals who already show signs of drug involvement orrelated risk factors In indicated prevention programs the primary goal isto stem the progression of ATOD use or reduce drug involvementamong the high-risk youth

Targeted programming Programming that subsumes selective andindicated programming sometimes the other two types of programs thattarget specific groups lsquolsquoat riskrsquorsquo are considered together

ACKNOWLEDGMENTS

This research was supported by grants from the National Institute onDrug Abuse (DA01070 DA07601 DA13814 and DA16094) and by aResearch Scientist Development Award K02 DA00252 from theNational Institute on Drug Abuse

Motivation Skills and Decision Making 2003

ORDER REPRINTS

REFERENCES

Alexander J F Barton C Schiaro R S Parsons B V (1976)

Systems-behavioral intervention with families of delinquents

therapist characteristics family behavior and outcome Journal of

Consulting and Clinical Psychology 44(4)656ndash664Alexander J F Parsons B V (1973) Short-term behavioral interven-

tion with delinquent families impact on family process and

recidivism Journal of Abnormal Psychology 3219ndash225American psychiatric association (APA) (1994) Diagnostic and

Statistical Manual of Mental Disorders 4th edn (DSM-IV)

Washington DC American Psychiatric AssociationAmes S L Sussman S Dent C W (1999) Pro-drug-use myths and

competing constructs in the prediction of substance use among

youth at continuation high schools a one-year prospective study

Personality and Individual Differences 26987ndash1003Bachman S G Wadsworth K N OrsquoMalley P M Johnston L D

Schulenberg J E (1997) Smoking drinking and drug use in young

adulthood Mahwah NJ Lawrence Erlbaum Associates 8ndash25

153ndash190Bandura A (1986) Social Foundations of Thought and Action A Social

Cognitive Theory Englewood Cliffs NJ Prentice HallBarton C Alexander J F Waldron H Turner C W Warburton J

(1985) Generalizing treatment effects of functional family therapy

Three replications The American Journal of Family Therapy

13(3)16ndash26Battin-Pearson S R Newcomb M D Abbott R D Hill K G

Catalano R F Hawkins J D (2000) Predicting early high school

dropout Journal of Educational Psychology 92568ndash582Biglan A Brennan P A Foster S L Holder H D Miller T L

Cunningham P B et al (in press) Helping Adolescents at Risk

Prevention of Multiple Problem Behaviors New York NY Guilford

PressBindra D Stewart J (1996) Motivation Baltimore MD Penguin

BooksBlanton H Gibbons F X Gerrard M Conger K J Smith G E

(1998) The role of family and peers in the development of

prototypes associated with substance use Journal of Family

Psychology 11271ndash288

2004 Sussman et al

ORDER REPRINTS

Botvin G J (1993) School-based drug abuse prevention Long-termfollow-up results In First Annual Meeting of the Society forPrevention Research Kentuck Lexington Society for PreventionResearch

Botvin G J Baker E Dusenbury L Botvin E M Diaz T (1995)Long-term follow-up results of a randomized drug abuse preven-tion trial in a white middle-class population Journal of theAmerican Medical Association 2731106ndash1012

Brody G H Dorsey S Forehand R Armistead L (2002) Uniquecontributions of parenting and classroom processes to the self-control of AfricanndashAmerican children Child Development73274ndash286

Carroll M E (1996) Reducing drug abuse by enriching the environmentwith alternative nondrug reinforcers In Green L Kagel J Heds Advances in Behavioral Economics Norwood NJ NorwoodPublishing Corp 37ndash68

Carver C S Scheier M F (1998) On the Self-Regulation of BehaviorNew York Cambridge University Press

Catalano R F Hawkins J D (1996) The social developmental modela theory of antisocial behavior In Hawkins J D ed Delinquencyand Crime Current Theories New York Cambridge UniversityPress

Centers for Disease Control (CDC) (October 1999) Youth risk BehaviorSurveillancemdashNational Alternative High School Youth RiskBehavior Survey 1998 Morbidity and Mortality Weekly Report48 No SS-7

Chamberlain P (1994) Family connections A treatment foster caremodel for adolescents with delinquency Eugene OR CastaliaPublishing Company

Chamberlain P Reid J B (1998) Comparison of two communityalternatives to incarceration for chronic juvenile offenders Journalof Consulting and Clinical Psychology 66(4)624ndash633

Chassin L A Presson C C Sherman S J (1985) Stepping backwardin order to step forward an acquisition-oriented approach toprimary prevention Journal of Consulting and Clinical Psychology53612ndash622

Chou C-P Montgomery S Pentz M A Rohrbach L A JohnsonC A Flay B R MacKinnon D P (1998) Effects of acommunity-based prevention program on decreasing drug use inhigh-risk adolescentsAmerican Journal of Public Health 88944ndash948

Conducts Problems Prevention Research Group (CPPRG) (1999) Initialimpact of the fast track prevention trial for conduct problems I

Motivation Skills and Decision Making 2005

ORDER REPRINTS

The high-risk sample Journal of Consulting and Clinical Psychology

67631ndash647Conducts Problems Prevention Research Group (CPPRG) (2000)

Merging universal and indicated prevention programs the fast

track model Addictive Behaviors 25913ndash927Council of Philosophical Studies (1981) Psychology and the Philosophy

of Mind in the Philosophy Curriculum San Francisco San Francisco

State UniversityCummings K M Hellmann R Emont S L (1988) Correlates of

participation in a worksite stop smoking program Journal of

Behavioral Medicine 11267ndash277Curry S Wagner E H Gothaus L C (1990) Intrinsic and extrinsic

motivation for smoking cessation Journal of Consulting and

Clinical Psychology 58310ndash316Dent C W Sussman S McCuller W J Stacy A W (2001) Drug

abuse prevention among youth at comprehensive high schools

Preventive Medicine 32514ndash520Dewey J (1886) Psychology New York HarperDishion T J French D C Patterson G R (1995) The development

and ecology of antisocial behavior In Cicchetti D Cohen D

eds Manual of developmental psychopathology New York John

Wiley 421ndash471Eggert L L Herting J R (1991) Preventing teenage drug abuse

exploratory effects of network social support Youth and Society

22482ndash534 [Reprinted National Prevention Evaluation Research

CollectionRockville MD Aspen 1993]Eggert L L Herting J R Thompson E A Nicholas L J Dicker

B G (1994) Preventing adolescent drug abuse and high school

dropout through an intensive school-based social network devel-

opment program American Journal of Health Promotion

8202ndash214Eggert L L Thompson E A Herting J R Nicholas L J (1995)

Reducing suicide potential among high-risk youth tests of a school-

based prevention program Suicide amp Life-Threatening Behavior

25276ndash296Ellickson P L Bell R M (1990) Drug prevention in junior high a

multi-site longitudinal test Science 2471299ndash1305Elliott D S (Series ed) (2003) Blueprints for violence prevention

Boulder CO Institute of Behavioral Science Regents of the

University of Colorado wwwcoloradoeducspvblueprints

2006 Sussman et al

ORDER REPRINTS

Farrell A D Danish S J (1993) Peer drug associations and emotionalrestraint Causes or consequences of adolescent drug use Journal ofConsulting and Clinical Psychology 61327ndash334

Festinger L A (1957) A Theory of Cognitive Dissonance New YorkHarper amp Row

Fuqua J Stokols D Gress J Phillips K Harvey R (2004)Transdisciplinary collaboration as a basis for enhancing the scienceand prevention of substance use and abuse Substance Use ampMisuse

Giuliano J D (1994) A peer education program to promote the use ofconflict resolution skills among at-risk school-age males PublicHealth Reports 109158ndash169

Glynn K Levanthal H Hirschman R (1985) A cognitivedevelopmental approach to smoking prevention In Bell C SBattjes R eds Prevention research Deterring Drug Abuse AmongChildren and Adolescents Rockville MD NIDA ResearchMonograph 63

Glynn T J (1989) Essential elements of school-based smokingprevention programs Journal of School Health 59181ndash188

Goodman R M Burdine J N Meehan E McLeroy K R eds(1993) Community coalitions for health promotion Special issue ofHealth Education Research Theory and Practice 8309ndash453

Goodyear R D Newcomb M D Locke T F (2002) PregnantLatina teenagers psychosocial and developmental determinants ofhow they select and perceive the men who father their childrenJournal of Counseling Psychology 49187ndash201

Gordon R (1987) An operational classification of disease preventionIn Steinberg J A Silverman M M eds Preventing MentalDisorders Rockville MD DHHS 20ndash26

Graham J W Johnson C A Hansen W B Flay B R Gee M(1990) Drug use prevention programs gender and ethnicityevaluation of three seventh-grade project SMART cohortsPreventive Medicine 19305ndash313

Griffin K W Botvin G J Nichols T R Doyal M M (2003)Effectiveness of a universal drug abuse prevention approach foryouth at high risk for substance use initiation Preventive Medicine36(1)1ndash7

Hamilton S (August 20 2000) Views slowly changing on alternativeschools The Sacramento Bee 1ndash3

Hansen W B (1992) School-based substance abuse prevention a reviewof the state of the art in curriculum 1980ndash1990 Health EducationResearch 7403ndash430

Motivation Skills and Decision Making 2007

ORDER REPRINTS

Hansen W B Johnson C A Flay B R Graham J W Sobel J(1988) Affective and social influences approaches to the preventionof multiple substance abuse among seventh grade students resultsfrom project SMART Preventive Medicine 17135ndash154

Hansen W B Graham J W (1991) Preventing alcohol marijuanaand cigarette use among adolescents peer pressure and resistancetraining versus establishing conservative norms PreventiveMedicine 20414ndash430

Hawkins D H Catalano R F Miller J Y (1992) Risk andprotective factors for alcohol and other drug problems inadolescence and early adulthood Implications for substanceabuse prevention Psychological Bulletin 11254ndash105

Hawkins J D Catalano R F Kosterman R Abbott R Hill K G(1999) Preventing adolescent health-risk behaviors by strengthen-ing protection during childhood Archives of Pediatric amp AdolescentMedicine 153226ndash234

Heider F (1958) The Psychology of Interpersonal Relations New YorkWiley

Henggeler S W Pickrel S G Brondino M J Crouch J L (1996)Eliminating (almost) treatment dropout of substance abusing ordependent delinquents through home-based multisystemic therapyAmerican Journal of Psychiatry 153(3)427ndash428

Henggeler S W Melton G B Brondino M J Scherer D GHanley J H (1997) Multisystemic therapy with violent andchronic juvenile offenders and their families the role of treatmentfidelity in successful dissemination Journal of Consulting andClinical Psychology 65(5)821ndash833

Henggeler S W Schoenwald S K Borduin C M Rowland M DCunningham P B (1998) Multisystemic treatment of antisocialbehavior in children and adolescents New York The Guilford Press

Henggeler S W Pickrel S G Brondino M J (1999) Multisystemictreatment of substance-abusing and dependent delinquents out-comes treatment fidelity and transportability Mental HealthServices Residual 1(3)171ndash84

Johnson C A Pentz M A Weber M D Dwyer J H Baer NMacKinnon D P Hansen W B Flay B R (1990) Relativeeffectiveness of comprehensive community programming for drugabuse prevention with high-risk and low-risk adolescents Journalof Consulting and Clinical Psychology 58447ndash456

Kaftarian S J Hansen W B eds (1994) CSAP special issuecommunity partnership program Journal of Community Psychologypages 205

2008 Sussman et al

ORDER REPRINTS

Karoly P (1993) Mechanisms in self-regulation A systems view AnnualReview of Psychology 4423ndash51

Karoly P (1980) Person variables in therapeutic change and develop-ment In Karoly P Steffen J J eds Improving the Long-TermEffects of Psychotherapy New York Gardner Press 195ndash261

Kendall P C Braswell L (1982) Cognitive-behavioral self-controltherapy for children a components analysis Journal of Consultingand Clinical Psychology 50672ndash689

Kerr M Tremblay R E Pagani L Vitaro F (1997) Boysrsquobehavioral inhibition and the risk of later delinquency Archivesof General Psychiatry 54809ndash816

Klein N C Alexander J F Parsons B V (1977) Impact of familysystems intervention on recidivism and sibling delinquency a modelof primary prevention and program evaluation Journal ofConsulting and Clinical Psychology 45(3)469ndash474

Kumpfer K L (1999) Outcomes measures of interventions in the studyof children of substance-abusing parents Pediatrics 1031128ndash1144

Lau R R Hartman K A Ware J E (1986) Health as a valuemethodological and theoretical considerations Health Psychology525ndash43

Lichtenstein E L Glasgow R E (1997) A pragmatic framework forsmoking cessation implications for clinical and public healthprograms Psychology of Addictive Behaviors 11142ndash151

Locke T F Newcomb M D (in press) Childhood maltreatmentparent drug problems polydrug problems and parenting practicesa test of gender differences and four theoretical perspectivesJournal of Family Psychology

McCreary D R Newcomb M D Sadava S W (1999) The male rolealcohol use and alcohol problems a structural modeling examina-tion in adult women and men Journal of Counseling Psychology46109ndash124

McGee L Newcomb M D (1992) General deviance syndromeexpanded hierarchical evaluations at four ages from earlyadolescence to adulthood Journal of Consulting amp ClinicalPsychology 60766ndash776

Miller W R Brown J M (1991) Self-regulation as a conceptual basisfor the prevention of addictive behaviours In Heather N MillerW R Greeley J eds Self-control and the Addictive BehavioursSydney Australia Maxwell Macmillan 3ndash79

Miller W R Leckman A L Delaney H D Tinkcom M (1993)Long-term follow-up of behavioral self-control training forproblem drinkers Journal of Studies on Alcohol 53249ndash261

Motivation Skills and Decision Making 2009

ORDER REPRINTS

Miller W R Rollnick S (1991) Motivational InterviewingPreparing People to Change Addictive Behavior New YorkGuilford Press

Moffitt T E Caspi A Harrington H Milne B J (2002) Males onthe life-course-persistent and adolescence-limited antisocial path-ways follow-up at age 26 years Development and Psychopathology14(1)179ndash207

National Institute on Drug Abuse (NIDA) (1997) Drug abuseprevention What works NIH Publication 97-4110 DHHSNational Institutes of Health National Institute on Drug AbuseOffice of Science Policy and Communications Rockville MD

Newcomb M D (1992a) Substance abuse and control in the UnitedStates ethical and legal issues Social Science and Medicine35471ndash479

Newcomb M D (1992b) Understanding the multidimensional nature ofdrug use and abuse The role of consumption risk factors andprotective factors In Glantz M D Pickens R eds Vulnerabilityto Drug Abuse Washington DC American PsychologicalAssociation 255ndash298

Newcomb M D (1996a) Pseudomaturity among adolescents constructvalidation sex differences and associations in adulthood Journalof Drug Issues 26477ndash504

Newcomb M D (1996b) Adolescence Pathologizing a normal processThe Counseling Psychologist 24482ndash490

Newcomb M D (1997) Psychosocial predictors and consequences ofdrug use a developmental perspective within a prospective studyJournal of Addictive Diseases 1651ndash89

Newcomb M D Bentler P M (1988) Consequences of Adolescent DrugUse Impact on the Lives of Young Adults Beverly Hills CA Sage

Newcomb M D Bentler P M (1989) Substance use and abuse amongchildren and teenagers American Psychologist 44242ndash248

Newcomb M D Harlow L L (1986) Life events and substance useamong adolescents Mediating effects of perceived loss of controland meaninglessness in life Journal of Personality and SocialPsychology 51564ndash577

Newcomb M D Chou C-P Bentler P M Huba G J (1988)Cognitive motivations for drug use among adolescents longitudinaltests of gender differences and predictors of change in drug useJournal of Counseling Psychology 35426ndash438

Newcomb M D Abbott R D Catalano R F Hawkins J DBattin-Pearson S R Hill K (2002) Mediational and deviancetheories of late high school failure Process roles of structural

2010 Sussman et al

ORDER REPRINTS

strains academic competence and general versus specific problem

behaviors Journal of Counseling Psychology 49172ndash186Nezami E Sussman S Pentz M A (2003) Motivation in tobacco use

cessation research Substance Use amp Misuse 3825ndash5Novak S P Clayton R R (2001) The influence of school environment

and self-regulation on transitions between stages of cigarette

smoking Health Psychology 20196ndash207Offord D R (2000) Selection of levels of prevention Addictive

Behaviors 25833ndash842Palinkas L A Atkins C J Miller C Ferreira D (1996) Social skills

training for drug prevention in high-risk female adolescents

Preventive Medicine 25692ndash701Patock-Peckham J A Cheong J-W Balhorn M E Nagoshi C T

(2001) A model of parenting styles self-regulation perceived

drinking control and alcohol use and problems Alcoholism

Experimental and Clinical Research 251284ndash1292Pentz M A (1994) Directions for future research in drug abuse

prevention Preventive Medicine 23646ndash652Pentz M A Dwyer J H MacKinnon D Flay B R Hansen W B

Wang E Y I Johnson C A (1989) A multi-community trial for

primary prevention of adolescent drug abuse effects on drug use

prevalence JAMA 2623259ndash3266Pentz M A Mares D Schinke S Rohrbach L (in press) Political

science public policy and drug abuse prevention Substance Use amp

MisuseProchaska J O DiClemente C C (1982) Transtheoretical therapy

toward a more integrative model of change Psychotherapy Theory

Research and Practice 19275ndash288Pulkkinen L Pitkanen T (1994) A prospective study of the precursors

to problem drinking in young adulthood Journal of Studies on

Alcohol 55578ndash587Rathus S A Nevid J S (1977) Behavior Therapy Strategies for

Solving Problems in Living New York Doubleday and Company

IncResnicow K Botvin G (1993) School-based substance use prevention

programs why do effects decay Preventive Medicine 22484ndash490Rutter M Dunn J Plomin R Simonoff E Pickles A Maughan

B Ormel J Meyer J Eaves L (1997) Integrating nature and

nurture implications of person-environment interactions for

developmental psychopathology Development and Psychopathology

9335ndash364

Motivation Skills and Decision Making 2011

ORDER REPRINTS

Salomon G Stein Y Eisenberg S Klein L (1984) Adolescent

smokers and nonsmokers profiles and their changing structure

Preventive Medicine 13446ndash461Sambrano S (1999) National cross-site evaluation of high risk youth

programs In Interim findings Bulletin Washington DC CSAP

SAMSHA US DHHS May 1ndash16Schinke S P Gilchrist L D (1985) Preventing substance abuse with

children and adolescents Journal of Consulting and Clinical

Psychology 53596ndash602Skara S N Sussman S (2003) A review of 25 long-term adolescent

tobacco and other drug use prevention program evaluations

Preventive MedicineSmith C Lizotte A J Thornberry T P Krohn M D (1995)

Resilient youth identifying factors that prevent high-risk youth

from engaging in delinquency and drug use Delinquency and

Disrepute in the Life Course Greenwich CT John Hagan JAI

press 217ndash247Sommers P V (1972) The Biology of Behavior Australia Pty ltd

Sydney John Wiley amp SonsSt Pierre T L Kaltreider D L Mark M M Aikin K J (1992)

Drug prevention in a community setting a longitudinal study of the

relative effectiveness of a three-year primary prevention program in

boys and girls clubs across the nation American Journal of

Community Psychology 20673ndash706Stein J A Newcomb M D Bentler P M (1987) An eight year study

of multiple influences on drug use and drug use consequences

Journal of Personality and Social Psychology 531094ndash1105Sully J (1884) Outlines of Psychology New York D Appleton amp CoSussman S (1989) Two social influence perspectives of tobacco use

development and prevention Health Education Research Theory

and Practice 4213ndash223Sussman S (1991) Curriculum development in school-based prevention

research Health Education Research Theory and Practice

6339ndash351Sussman S (1996) Development of a school-based drug abuse

prevention curriculum for high risk youth Journal of

Psychoactive Drugs 28169ndash182Sussman S Ames S L (2001) The social psychology of drug abuse

Buckingham GB Open University PressSussman S Unger J (2004) A drug abuse theoretical integration a

transdisciplinary speculation Substance Use amp Misuse

2012 Sussman et al

ORDER REPRINTS

Sussman S Dent C W Burton D Stacy A W Flay B R (1995a)

Developing school-based tobacco use prevention and cessation

programs Thousand Oaks CA Sage Publications IncSussman S Dent C W Simon T R Stacy A W Galaif E R

Moss M A Craig S Johnson C A (1995b) Effectiveness of

social influence substance abuse prevention curricula in compre-

hensive and continuation high schools Drugs and Society 865ndash81Sussman S Dent C W Galaif E R (1997) The correlates of

substance abuse and dependence among adolescents at high risk

for drug abuse Journal of Substance Abuse 9241ndash255Sussman S Dent C W Stacy A W (1996) The relation of pro-drug

use myths with self-reported drug use among youth at continuation

high schools Journal of Applied Social Psychology 26214ndash267Sussman S Dent C W Stacy A Craig S (1998) One-year outcomes

of project towards no drug abuse Preventive Medicine 27632ndash642

(erratum 766)Sussman S Dent C W Stacy S (2002) Project towards no drug

abuse a review of the findings and future directions American

Journal of Health Behavior 26354ndash365Sussman S McCuller W J Dent C W (2003) The associations of

social self-control personality disorders and demographics with

drug use among high risk youth Addictive Behaviors 281159ndash1166Sussman S Rohrbach L Patel R Holiday K (2003) A look at an

interactive classroom-based drug abuse prevention program

Interactive contents and suggestions for research Journal of Drug

Education 33355ndash368Sussman S Sun P McCuller W J Dent C W (2003) Project

towards no drug abuse two year outcomes of a trial that compares

health educator delivery to self-instruction Preventive Medicine

37155ndash162Tarter R E Vanyukov M (1994) Alcoholism a developmental disorder

Journal of Consulting and Clinical Psychology 621096ndash1107Thornton T N Craft C A Dahlberg L L Lynch B S Baer K

(2000) Best Practices of Youth Violence Prevention A Sourcebook

for Community Action Atlanta GA Division of Violence

Prevention Centers for Disease Control and PreventionTobler N S (1986) Meta-analysis of 143 adolescent drug prevention

programs quantitative outcome of program participants compared to

a control or comparison group Journal of Drug Issues 16537ndash567Tobler N S Roona M R Ochshorn P Marshall D G Streke

A V Stackpole K M (2000) School-based adolescent drug

Motivation Skills and Decision Making 2013

ORDER REPRINTS

prevention programs 1998 Meta-analysis The Journal of Primary

Prevention 20275ndash336US Department of Health and Human Services (USDHHS) (2003)

Substance Abuse andMental Health Services Administration Center

for Substance Abuse Prevention Science-based prevention programs and

principles 2002 Rockville MD US DHHS (SMA)03-3764 Also

see httpmodelprogramssamhsagovUnger J Baezconde-Garbanati L Shakib S Palmer P H Nezami

E Mora J (2004) What are the implications of structuralcultural

theory for drug abuse prevention Substance Use amp MisuseUpshaw H S Ostrom T M (1984) Psychological perspective in

attitude research In Eiser J R ed Attitudinal Judgment New

York Springer-Verlag 23ndash42Valente T W Gallaher P Mouttapa M (2004) Using social network

theory to understand and prevent substance use a transdisciplinary

perspective Substance Use amp MisuseVorrath H Brendtro L (1985) Positive peer culture 2nd edn Aldine

ChicagoWaldron H B Slesnick N Brody J L Turner C W Peterson T R

(2001) Treatment outcomes for adolescent substance abuse at 4-

and 7-month assessments Journal of Consulting amp Clinical

Psychology 69(5)802ndash813Watson D L Tharp R G (2002) Self-directed behavior Self-

modification for personal adjustment 8th edn Belmont CA

WadsworthWeissberg R P Caplan M Z Sivo P J (1989) A new conceptual

framework for establishing school-based social competence promo-

tion programs In Bond L A Compas B E eds Primary

Prevention amp Promotion in the Schools Newbury Park CA Sage

255ndash296Wills T A (1986) Stress and coping in early adolescence relationships

to substance use in urban school samples Health Psychology

5503ndash529Wills T A Cleary S D (1995) Stress-coping model for alcohol-

tobacco interactions in adolescence In Fertig J B Allen J P

eds Alcohol and Tobacco From Basic Science to Clinical Practice

Bethesda MD National Institute on Alcohol Abuse and

Alcoholism 107ndash128Wills T A Cleary S D (1999) Peer and adolescent substance use

among 6thndash9th graders Latent growth analyses of influence versus

selection mechanisms Health Psychology 18453ndash463

2014 Sussman et al

ORDER REPRINTS

Wills T A Hirky A E (1996) Coping and substance abuse InZeidner M Endler N S eds Handbook of Coping TheoryResearch and Applications New York Wiley 279ndash302

Wills T A Stoolmiller M (2002) The role of self-control in earlyescalation of substance use a time-varying analysis Journal ofConsulting and Clinical Psychology 70986ndash997

Wills T A Baker E Botvin G J (1989) Dimensions of assertivenessdifferential relationships to substance use in early adolescenceJournal of Consulting and Clinical Psychology 57(4)473ndash478

Wills T A Vaccaro D McNamara G (1994) Novelty seeking risktaking and related constructs as predictors of adolescent substanceuse an application of Cloningerrsquos theory Journal of SubstanceAbuse 61ndash20

Wills T A McNamara G Vaccaro D Hirky A E (1996a)Escalated substance use a longitudinal grouping analysis fromearly to middle adolescence Journal of Abnormal Psychology105166ndash180

Wills T A Pierce J P Evans R I (1996b) Large-scale environmentalrisk factors for substance use American Behavioral Scientist39808ndash822

Wills T A Windle M Cleary S D (1998) Role of temperamentnovelty-seeking and self-control in adolescent substance useJournal of Personality and Social Psychology 74387ndash406

Wills T A Sandy J M Shinar O (1999) Substance use level andproblems in late adolescence a mediational model based on self-control and coping motives Experimental and ClinicalPsychopharmacology 7122ndash134

Wills T A Cleary S D Filer M Shinar O Mariani J Spera K(2001) Temperament and self-control related to early-onsetsubstance use test of a developmental model Prevention Science2145ndash163

Wills T A Sandy J M Yaeger A (2002) Moderators of therelationship between substance use level and problems test of aself-regulation model in adolescence Journal of AbnormalPsychology 1113ndash21

Wills T A Gibbons F X Gerrard M Murry V Brody G (in press-a) Family communication and religiosity related to substance useand sexual behavior in early adolescence Psychology of AddictiveBehaviors

Wills T A Resko J Ainette M Mendoza D (in press-b) The role ofparent and peer support in adolescent substance use a test ofmediated effects Psychology of Addictive Behaviors

Motivation Skills and Decision Making 2015

ORDER REPRINTS

Young P T (1936) Motivation of Behavior New York John Wiley andSons

Zimmerman B J (2000) Attaining self-regulation a social cognitivemodel In Boekaerts M Pintrich P R eds Handbook of Self-Regulation San Diego Academic Press 13ndash39

2016 Sussman et al

Request PermissionOrder Reprints

Reprints of this article can also be ordered at

httpwwwdekkercomservletproductDOI101081JA200034769

Request Permission or Order Reprints Instantly

Interested in copying and sharing this article In most cases US Copyright Law requires that you get permission from the articlersquos rightsholder before using copyrighted content

All information and materials found in this article including but not limited to text trademarks patents logos graphics and images (the Materials) are the copyrighted works and other forms of intellectual property of Marcel Dekker Inc or its licensors All rights not expressly granted are reserved

Get permission to lawfully reproduce and distribute the Materials or order reprints quickly and painlessly Simply click on the Request Permission Order Reprints link below and follow the instructions Visit the US Copyright Office for information on Fair Use limitations of US copyright law Please refer to The Association of American Publishersrsquo (AAP) website for guidelines on Fair Use in the Classroom

The Materials are for your personal use only and cannot be reformatted reposted resold or distributed by electronic means or otherwise without permission from Marcel Dekker Inc Marcel Dekker Inc grants you the limited right to display the Materials only on your personal computer or personal wireless device and to copy and download single copies of such Materials provided that any copyright trademark or other notice appearing on such Materials is also retained by displayed copied or downloaded as part of the Materials and is not removed or obscured and provided you do not edit modify alter or enhance the Materials Please refer to our Website User Agreement for more details

ORDER REPRINTS

Table

1

Continued

Inclusion(ornot)

ofMSD

Components

Nameof

Program

Baseline

GradeAge

Range

Definition

ofRisk

Program

Modalities

Motivation

Skills

Decision

Making

Other

Features

Drug

Effects

Multi-

dim

ensional

Treatm

ent

Foster

Care

(MTFC)

9ndash18

Chronic

conduct

orem

otional

disturbance

crim

inal

behavior

Home-

and

school-based

MTFC

home

placement

case

managem

ent

Positive

reinforcers

Yes

No

Highly

trained

counselors

weekly

parent

groups

family

therapy

community

mentoring

andmonitor-

ing

behavior

modification

Decreasedhard

drugusejail

timeand

arrests

Nurse-Family

Partnership

(NFP)

First-tim

e

mothers

Motherswithno

income

often

teen

mothers

Homevisits

resource

advocacy

No

No

Yes

Highly

trained

counselors

pregnancy

to

2years

old

Decreased

smokingand

alcoholuse

among

mothers

reducedrates

ofchildabuse

Preventive

Intervention

(PI)

7th-8th

Pooracadem

ic

andschool

discipline

family

problems

School-based

skillsand

monitoring

Positive

reinforcers

Yes

No

Increase

child

teacher

parentcom-

munication

role

play

pro-social

alternatives

Lesshard

drug

useless

delinquency

higher

grades

andbetter

attendance

1984 Sussman et al

ORDER REPRINTS

Preventive

Treatm

ent

Program

(PTP)

7ndash9

Disadvantaged

socioeconomic

status(SES)

disruptive

School-based

parentand

childskills

and

monitoring

Positive

reinforcers

Yes

No

17sessionsfor

parent19for

child

separately

parent-

monitoring

andshaping

ofchild

child-

pro-social

skillsand

selfcontrol

Lesslikelihood

ofhaving

beendrunk

ortaken

drugsin

last

12months

less

fighting

andstealing

Project

PATHE

12ndash18

Disadvantaged

socioeconomic

status(SES)

low

achieving

disruptive

School-based

activitiespeer

counseling

schoolpride

jobseeking

Yes

Yes

No

Academ

ic

skillstoo

Decreaseddrug

involvem

ent

school

alienation

discipline

problems

higher

graduation

rates

Project

STATUS

12ndash18

Potential

dropouts

Schoolclim

ate

optionsclass

(socialrules

norm

s)

Accountability

No

Yes

Youth

leadership

staff

development

parent

meetings

community

resources

Lessdrug

involvem

ent

forjunior

highyouth

bettergrades

anddiscipline

(continued

)

Motivation Skills and Decision Making 1985

ORDER REPRINTS

Table

1

Continued

Inclusion(ornot)ofMSD

Components

Nameof

Program

Baseline

GradeAge

Range

Definition

ofRisk

Program

Modalities

Motivation

Skills

Decision

Making

Other

Features

Drug

Effects

Project

STEP

14ndash18

Disadvantaged

socioeconomic

status(SES)

low

achieving

disruptive

Schoolphysical

settinghome

room

teacher

role

Accountability

No

No

Homeroom

teachersact

ascounselors

andadvisors

Lessdrug

involvem

ent

bettergrades

anddiscipline

Project

SUCCESS

14ndash18

Alternativehigh

schoolyouth

School-based

counseling

and

education

SAPmodel

No

Yes

Yes

Highly

trained

counselorsasse-

ssment8-session

classgroup

counseling

parentmeeting

referral

Decreased

problem

behavioruse

ofmarijuana

tobaccoand

alcohol

Project

Towards

NoDrugAbuse

(TND)

14ndash19

Alternativehigh

schoolyouth

School-based

classroom

12

sessions

Yes

Yes

Yes

Trained

teachers

Decreaseduse

ofcigarettes

alcoholmar-

ijuanahard

drugsweapons

carrying

Quantum

Opportunities

Program

(QOP)

9thndash12th

Disadvantaged

socioeconomic

status(SES)

familieson

public

assistance

Schoolhome

and

community

contexts

skillsservice

and

education

Money

Yes

Yes

250education

hours250life

skillshoursjob

preparationcul-

turalenrichment

and250hcom-

munityservice

monetary

incentives

Nodruguse

effectsrepor-

tedincrease

inhighschool

graduation

less

likelyto

becomeateen

parentslightly

less

likelyto

be

arrested

1986 Sussman et al

ORDER REPRINTS

Reconnecting

Youth

(RY)

14ndash18

Atrisk

for

drop-out

School-based

90-session

class

Groupsupport

Yes

Yes

Smallstudent

groups

support

highly

trained

teachera

semester

Decreasedhard

druguse

perceived

stress

improved

grades

Residential

Student

Assistance

Program

(RSAP)

14ndash17

Livingin

residential

facilities

Residential-

based

education

program

assessm

ent

counseling

referral

No

Yes

Yes

Highly

trained

counselors

placedin

residential

facilities

8-session

drug

education

individual

andgroup

counseling

Decreaseduse

ofmarijuana

tobaccoand

alcohol

Strengthening

Families

Program

(SFP)

6ndash12

Childrenof

substance

users

Agency-based

14session

skillstraining

No

Yes

Yes

Highly

trained

counselors

parents

and

childseen

separately

firsthour

together

at

thesecond

hour

Reduces

aggression

increases

family

cohesion

immediate

effectson

druguse

Motivation Skills and Decision Making 1987

ORDER REPRINTS

model of drug abuse prevention We see this intrinsicextrinsic motiva-tion notion as providing intrapersonal and extrapersonal stimuli (cues)for action

Finally self-regulation models posit that one is motivated to achievean optimal state or system balance In essence an awareness of lack ofbalance will lead to efforts to restore balance (Carver and Scheier 1998Karoly 1980 1993) Drug abuse prevention may demand considerationof alternative actions in order to maintain homeostasis Affect may serveas the main homeostatic mechanism If people feel good or neutral theywill tend to maintain a given course of behavior On the other hand ifthey feel poorly they will want to change their behavior (as in the law ofeffect)

Constituents are those elements that when combined togethercompose a theoretical structure Seven constituents of motivation appearacross the four general theories (Nezami et al 2003) First the idea ofdiscrepancies appears in all theories Motivation exists as a distancebetween what is and what could be and these models assume that peopledesire to reduce such discrepancies Second motivation functions by theestablishment of goals Third motivation exists as energymdasha want ordrive Goals and the accompanying drive to achieve them usually appeartogether Fourth motivation may appear as a series of stages that lead toan end Different goals may operate at different stages Fifth motivationreflects ambivalence about two or more competing goals or behaviorsWorking through ambivalence enhances motivation Sixth motivationarises from different sources usually intrapsychic or environmentalrewards Finally a homeostatic conceptualization of motivation rests onthe idea of maintaining an optimal set point within a regulatory system

Integrations of these four models of motivation could help achievethe prevention of drug abuse One view suggests that due to lifeexperiences people consider goals or directions For example teens maystart to experiment with drugs due to curiosity perceived social pressureor as a means to induce a life change They may subsequently take risksthat injure their relations with others or impair their achievement inschool At some point a discrepancy likely develops between currentcircumstances and their goals For example teens may know that drugabuse is inconsistent with some life goals like school achievementHowever they may value social interaction and physical pleasure whichthey may reach through drug use or other means

Multiple goals may conflict with each other leading to ambivalence(Karoly 1993) Extrinsic and intrinsic sources of input may helpresolve ambivalence For example as the rewards associated with drugabuse diminish teens may experience a desire to decrease their drug

1988 Sussman et al

ORDER REPRINTS

consumption They may prove more likely to adopt a new goal ofdecreased drug use especially if they believe that they could achieve thegoal as self-efficacy theory suggests

Teens may exert energy to reduce discrepancies between currentstates and desired states They may learn new life or social skills whichcan lead them to become involved in rewarding but nondrug-usingactivities (Carroll 1996) In addition they may become involved in newtypes of social networks containing low-risk rather than high-risk peers(Valente et al 2004 Wills et al in press-b) Finally attaining a healthiergoal can create a positive optimal set point and the motivation systemprovides more positive feedback Over time through experience ofdifferent life events youth may alter the set point and begin a new goal-searching process (Sussman and Unger 2004) One may experience atraumatic life event for example and again consider drug use as a meansto return to an optimal set point or repeatedly get into trouble because ofassociating with deviant peers and realize that there is a need to turn todifferent types of associations

Research and theory from several disciplines suggest many motiva-tion strategies for a successful prevention program These motivationstrategies include myth correction stereotyping valuing life andachievement of health goals

Myth Correction

The recovery movement often refers to substance use and abuse as aproblem of perception Another closely related expression drug use mythsdescribes questionable or dysfunctional expectancies or beliefs that serveto justify drug use Myths involve more than expectancies or beliefs aboutpositive or negative outcomes they include inaccurate expectancies orbeliefs about the characteristics (or norms) of drugs and drug use and arelikely to confuse drug effects with drug experiences

Some common myths include inflated expectancies of positiveoutcomes from drug use or underestimates of negative outcomes fromdrug use Teens may believe that substance use will create peer groupacceptance or help them cope with family and school problems when infact the drug use only diverts them from actively coping with these socialand academic issues Thus in the long run drug use makes things worsenot better (Wills and Hirky 1996) Other myths include endorsement ofmisleading beliefs For example many adolescents believe that learningto manage drug intake without getting sick is a positive sign that theirbodies are growing tolerant to the drug rather than signaling the

Motivation Skills and Decision Making 1989

ORDER REPRINTS

beginnings of drug dependence or addiction In addition misperceptionsregarding physical consequences of drug use operate For example usersmistakenly believe that if they are able to regulate subjective effects of adrug they have gained control over use In reality warning systems maybe deteriorating as addiction begins (Glynn et al 1985 Sussman et al1995b) Challenging drug myths undoubtedly helps prevent drug abuse

These challenges can prove especially useful with high-risk popula-tions particularly if social influence programs are less effective in thesegroups Several prevention researchers have adopted a similar taxonomyof drug myths when attempting to prevent drug use Sussman Dent andStacy (1996) examined the internal consistency and discriminant validityof a measure of drug-related myths in 362 continuation (alternative) highschool youth They found good internal consistency and discriminantvalidity for the measure Controlling for its relations with socialdesirability perceived friendsrsquo drug use (a social influence measure)ethnicity and gender the myth measure remained significantly associatedwith four drug use measures Ames Sussman Dent and Stacy (1999)found a myth measure to be a relatively strong psychosocial predictor ofdrug use one-year later Cognitive perceptions obviously play a role indrug abuse prevention (Stein et al 1987) These findings suggest thatcontinued research on drug use myths should prove fruitful forprevention efforts (Sussman et al 1998 2003)

Some cognitive restructuring corrects faulty or self-defeatingcognitive structures (myths) In particular elaborating on the logicalsteps involved in the construction of a drug use myth may help to destroyits impact on behavior For example a common myth suggests thathaving trouble finding onersquos car after getting drunk is a funny event Ifone asks (a) lsquolsquoDid you want to find your carrsquorsquo (b) lsquolsquoWere you too drunk tofind it for a long timersquorsquo and (c) lsquolsquoAnd thatrsquos funnyrsquorsquo the apparent humorin the story may dissipate Further one may delineate the kernel of truthin the myth (not finding onersquos car is an odd event) from the falseaspects of the myth (not finding onersquos car indicates failure of functioningwhich is sad worrisome anxiety provoking not funny)

Stereotyping

Lower risk peers tend to perceive lsquolsquoat riskrsquorsquo others (eg alternativehigh school students) as being more deviant than they actually areUnderstandably youth so-labeled students resent this stereotypeAddressing this stereotype may help prevent drug abuse If lsquolsquoat riskrsquorsquoyouth begin to view themselves as being more deviant than they actually

1990 Sussman et al

ORDER REPRINTS

are the situation could lead to self-fulfilling prophesy as if they weregiving in to the stereotype However lowering the estimates of drug useamong their peers can correct this giving in This version of a prevalence-overestimation reduction lesson which includes a motivational featurehas appeared in successful prevention programs (Sussman et al 2002) Astereotype-oriented lesson may also accomplish a second goal If high-risk youth do not view themselves as being deviant as they assumedothers had judged them possibly reactions against this stereotype mayenergize an effort to avoid drug use as well as portray oneself morefavorably (Hamilton August 20 2000)

Valuing Life and Health Goals

Letrsquos consider the example of older teens Most youth report thatthey plan to graduate from high school and continue their educations orfind a job They do not view hanging out as a desirable option They alsosee that drug use could interfere with achieving their goals A lessonexplaining the negative consequences of drug use particularly oneconsistent with data (Newcomb and Bentler 1988) could reveal howearly involvement with drugs creates symptoms of abuse and dependenceand alters job opportunities marriage and family functioning These lifegoals can seem more valuable as students perceive them as attainableEnhancing the value of life goals can increase motivation for learningadaptive coping (Lau et al 1986) Youth have reported that drug usecould interfere with obtaining desired life goals In theme and componentstudies youth positively evaluated a lesson that taught that drug usecould interfere with obtaining desired goals and that placing animportance on health as a value was consistent with achievement of lifegoals (Sussman 1996) Thus it is important for prevention programs tohelp youth connect the importance of health to obtaining their life goalsand develop a sequenced plan so that they know how to proceed step-by-step (Karoly 1993 Watson and Tharp 2002)

Although modifiable understanding the source of positive life goalsis also important since these may occur earlier in life For instanceNewcomb and Harlow (1986) found that perceived loss of control andmeaninglessness in life mediated the relationship between negative lifeevents and drug use While numerous types of stressful events wereconsidered in this study other studies identify an adverse childhoodfamily environment as a potent precursor to later drug use (Locke andNewcomb in press Palinkas et al 1996) An adverse early homeenvironment a modifiable etiological factor should serve as a focus of

Motivation Skills and Decision Making 1991

ORDER REPRINTS

prevention that addresses child abuse and neglect (see later discussion ofthis topic)

Attitudinal Perspectives

Most youth consider themselves as being moderates They can alsoreliably identify drug use as being a deviant immoderate behaviorPresenting them with the disparity between their self-view as a moderateperson despite their deviant drug use can produce a desired behaviorchange (Sussman 1989 Upshaw and Ostrom 1984) An attitudinalperspective lesson can confront students with the inconsistency betweentheir general self-attitude ratings as moderates vs their more extremespecific behaviors (eg drug use) Adopting a self-perception as amoderate may inoculate youth when social pressures to experiment withdrugs arise A desire for internal consistency a similarity betweenattitudes and behavior may increase motivation to abstain from drugs(Festinger 1957 Heider 1958) Youth received lessons like these quitefavorably in previous work (Salomon et al 1984)

Skills

Direct instruction modeling practice and group reinforcementenhance social learning At least three basic kinds of skills needinstruction self-control communication and resource acquisition

Social Self-control Skills

Good self-control protects against substance use and buffers againstthe impact of risk factors (Bandura 1986 Catalano and Hawkins 1996Weissberg et al 1989 Wills et al 1998) Poor self-control involvesbehavioral affective and cognitive deficits Poor behavioral self-controlis associated with a need to regulate and stabilize mood possiblypreceding uncontrolled behavior or stemming from the consequences ofuncontrolled behavior Poor self-control behavior along with difficultiesin mood stabilization increases risk for substance use and rapidescalation to high levels of use which then can lead to physiologicaldependence (Wills and Stoolmiller 2002)

Self-control strategies cross physiological and personality boundariesbecause self-control also relates to coping motives for substance use a

1992 Sussman et al

ORDER REPRINTS

strong predictor of substance use problems (Wills et al 1999) Self-control includes cognition because developing self-control is the substratefor personality organization including not only behavioral and affectivecontrol but also attitudes values and views of the world as accepting orhostile and social perceptions about substance use as being attractive vsunattractive For example studies find poor self-control correlated withattitudinal tolerance for deviance and more favorable perceptions oftobacco and alcohol users whereas good self-control is related tofavorable perceptions of teens that abstain from drug use (Wills et alin press-a) Self-control approaches can be useful for preventionprograms by improving self and other perceptions academic perfor-mance and the impact or facilitation of negative life events goals that aresalient to teenagers and their parents (Wills and Stoolmiller 2002)

Youth often lack adequate coping skills they tend to lack restraint orplanfulness (Farrell and Danish 1993 Rutter et al 1997) Coping skillsinstruction may help increase self-control (Kendall and Braswell 1982)Coping skills instruction receives little attention in typical social influencesprogramming (Hansen 1992) although this material appears in life skillstraining (Botvin 1993 Botvin et al 1995 Wills 1986) In self-controlprogramming youth learn to assess their self-control particularly in socialcontexts (Sussman et al 2003) They learn the importance of thinkingahead and anticipating problem situations so that they are preparedbeforehand to deal with problems that may arise They also learn theimportance of context (eg not laughing at a funeral) Finally they learnassertiveness and anger management to help them better control theirreactions in social settings (Sambrano May 1999 Sussman et al 2002)

Listening and Communication Skills

Youth genuinely benefit from listening to information with an openmind and asking open-ended questions to keep a conversation goingThey can improve social skills by learning how to ask open-endedquestions establish eye contact appropriately nodding and orientingtheir body toward the other speaker (CPPRG 1999 Eggert and Herting1991 Hawkins et al 1999 Sussman et al 2002 2003) Neverthelesssocial skills training can create problems for nondrug using high-riskteens (Palinkas et al 1996 Sussman et al 1995b Wills et al in press-b)Training in drug refusal may create reactance in some samples (Sussmanet al 1996) Among high-risk youth enhancing assertiveness and datingskills may increase the scope of social entertainment options andinadvertently improve a teenrsquos ability to acquire drugs from new sources

Motivation Skills and Decision Making 1993

ORDER REPRINTS

(Wills et al 1989) Also there are cultural variations on what constitutesgood social skill (Unger et al 2004) There are good arguments forplacing high-risk teens together in activities with well-controlled teens sothat they can model adaptive social skills and problem solvingAdditionally utilizing motivation methods prior to instructing thespecific skill channels canalizes health-directed use of social skillsmastered Overall increasing social competence will have protectiveeffects for high-risk teens (Wills et al 1994) This idea is consistent withthe studies that have shown social withdrawal to increase risk for druguse (Kerr et al 1997) though there may be gender differences in theseeffects (Pulkkinen and Pitkanen 1994) Still it is most wise to includesocial skills training in conjunction with material addressing motivationand decision making Motivations regarding drug use need to beaddressed so behaviors learned are not misdirected

Resource Acquisition

Adults often assume that teens can access community services withlittle effort In fact few teens understand the availability of healthservices or other assistance Simple information including phonenumbers and locations can assist teens immensely (Carroll 1996Sussman et al 2002) Coaching teens on techniques for receivingassistance can prove productive Public assistance for drug use-relatedproblems and other life problems can help tremendously but negotiatingthe bureaucratic difficulties inherent in many of these systems can requireconsiderable skill (Eggert and Herting 1991 Sambrano May 1999Sussman et al 2002) Direct instruction modeling and structuredpractice in resource acquisition skills may help youth to increase theirknowledge and self-efficacy on how to acquire resources and to readilyaccess resources when needed (eg use of the bus system) These skillsmay generalize to comparable tasks later in life

Decision-Making

Prevention programs have employed several decision-making strate-gies For example the protocol from Project Reconnecting Youth(Project RY) is STEPS The acronym stands for Stop Think ofoptions Evaluate options Perform or take action on the chosen optionand then Self-praise for using steps for making healthy choices (Eggertand Herting 1991) The participants help set the agenda and take turns

1994 Sussman et al

ORDER REPRINTS

illustrating it on a flip chart This task helps share the leadership andfocuses the group work and time The lesson STEPS to Drug UseControl follows skills training sessions that cover understandingSTEPS as a decision-making model

Project Towards No Drug Abuse (TND)rsquos decision-making sessioninvolves four steps These steps are

1 Brainstorming (making a list of ideas without judging them)2 Weigh the pros and cons (the benefits and costs of each idea)3 Select the best option4 Follow through (try that option and reevaluate the decision)

(Sussman et al 2002)

These decision-making strategies are similar across different pro-grams except that they include some different emphases For exampleSTEPS includes a self-instruction to begin decision making and self-praise whereas the TND sequence includes more of an emphasis onfollowing through with the decision Generally each program requiresgenerating options evaluating them choosing the best and evaluatingthe outcome in an effort to make the next decision Teens tend to enjoypracticing decision making in bogus problem situations Youth soonlearn to engage in steps like these with considerable skill Training indecision making operates on variables that are intermediate in the causalprocess and thereby strengthen individual profiles of self-controlabilities so that they are more resilient in the face of proximal riskfactors for drug use such as life stresses and peer pressures

Modalities of Programming

Both school and nonschool prevention modalities have a rich andimportant history in substance abuse prevention research (Pentz 1994Pentz et al 2004) Schools provide a captive audience for educationalmaterial Youth spend 25 of their waking lives at school so thisenvironment has considerable potential Furthermore the school contextprovides a rich research history for building new studies and evaluatingtheir efficacy (Sussman et al 1995a) Community programs also offerconsiderable opportunity

Community programs often involve local leaders and organizations(eg coalitions community boards) (Goodman et al 1993 Kaftarianand Hansen 1994) that help mobilize numerous community unitsCommunity units include businesses media the family and governmental

Motivation Skills and Decision Making 1995

ORDER REPRINTS

agencies like the police or recreational departments as well as schoolsystems A network of community units working together to developpromote and implement educational programming could increase youthsrsquobonding to others across a wide variety of social contexts (Hawkins et al1992 Pentz 1994) Community units can provide numerous types ofspecific extra-classroom prevention opportunities (Pentz 1994)

Parent-or-family targeted prevention programs include offering earlychildhood education social support for parents managing crisesparenting skills training parent-child communication skills and resourceacquisition instruction or networking Mass media targeted programsinvolve programs or public service announcements with novel fastand unconventional messages (eg the American Legacy FoundationTRUTH campaign) use of the Internet and interactive CDs (eg videogames) Alternative means to involve youth include involvement in hikingclubs drug-free dances or other after-school events with prosocial adultmentors and with means to involve youth outside of school includingentry into different environments (ie outward bound) (Tobler 1986) Inaddition policy implementation and enforcement may contribute toother prevention programs (Pentz et al 1989) Indeed simultaneousprograms within and outside of schools over long periods might maintainthe positive effects that sometimes dissipate when school programsappear alone (Pentz 1994)

The Difference Between Targeted Prevention and Cessation

Targeted (secondary) prevention attempts to keep persons fromcrossing the invisible line where they funnel into a cycle of addiction andaccumulation of negative consequences Cessation programs (sometimesreferred to as tertiary prevention) take the stance that a behavior hasoccurred with definite and perhaps irreversible negative consequencesThe goal is to stop the behavior permit recovery from the damage learnhow to prevent relapse and learn how to live with permanent changes(eg neurotransmitter function drug use-related injury) It is not clearexactly where indicated prevention ends however and where cessationbegins For example an early version of the Project TND curriculum didnot achieve effects on cigarette smoking possibly because 46 of thesample already smoked cigarettes daily (while not engaging often in someother drug use) In a revised curriculum a smoking cessation componentwas added to the program and then an effect on cigarette smoking wasachieved Cessation material can appear with prevention material to

1996 Sussman et al

ORDER REPRINTS

maximize program effectiveness Careful program development can helpdetermine the best mix (Sussman et al 2002)

Summary of Evidence-based Targeted Drug Abuse Prevention

At present approximately 29 drug-use prevention programs havebeen evaluated favorably for their effects on drug use or other problembehavior (see Table 1) These 29 programs have been identified throughtwo sources Blueprints for Violence Prevention (Elliott 2003) and theSubstance Abuse and Mental Health Services Administrationrsquos(SAMSHA) science-based prevention programsrsquo guide (USDHHS2003) PsycINFO and MEDLINE searches of drug abuse preventionstudies since 1970 supplemented searches through these two guides (seeTable 1) Nine definitions of high-risk were used across these programsEleven programs focused on economic deprivation as the definition Sixprograms focused on delinquent behavior as the identifying characteristicto target Two programs each identified single-parent homes drug use orexposure to drug use family problems alternative high school attendanceor being at risk for dropout at a regular high school as the characteristicsto target subjects Finally one program each identified new immigrantstatus or residential facility placement as the defining characteristic ofbeing at high risk for drug use

Among these programs eight focused on preteens For example theEarly Risers program defined its high-risk youth as those 6ndash10 year-oldsthat suffered economic deprivation and exhibited aggressive or opposi-tional behavior Another five programs focused on a young teen agegroup For example Preventive Intervention defined its high-risk youthas those seventh to eighth graders who exhibited poor school andacademic discipline and reported family problems Another sevenprograms focused on an older teen age group For example ProjectTND defined its high-risk youth as those youth that attended alternativehigh schools Finally nine programs encompassed wide age ranges Forinstance Big Brothers Big Sisters of America defined its high-risk youthas 6ndash18 year-olds that lived in single-parent homes

Of these programs 10 involved multiple often flexible settings ofimplementation Another 13 programs focused on the school settingFour programs focused on the home setting Finally two programsfocused on a community agency setting In general these programsinvolved implementation by highly trained personnel Eighteen of theseprograms involved some motivation aspect generally motivationenhancement but sometimes including extrinsic reinforcement strategies

Motivation Skills and Decision Making 1997

ORDER REPRINTS

Twenty-six of these programs provided skills training Finally 18programs provided instruction in decision making Thus the MSDmodel tends to appear in a majority of these programs however all threecomponents were included together in only nine of these programs

Twenty of these programs involved at least one replication of theprogram and 14 involved three or more replications Further 14 of theseprograms were tested through use of experimental designs and nineinvolved use of only quasi-experimental designs Effects on drug use wereassessed and found in 22 of these programs For example theReconnecting Youth program was implemented to youth at risk fordropout This program involved 90 sessions within a comprehensive highschool class delivered generally over a semester with small studentgroups and a highly trained teacher Instruction included use of groupsupport and providing life skills training (norm setting self-esteem moodmanagement communication skills self-monitoring monitoring goalsschool bonding and social activities) with feedback to parents Programgoals were achieved through use of a quasi-experimental design showingeffects for school performance (18 improvement in grades) drug use(54 decrease in hard drug use) and suicide risk (32 decline inperceived stress) This programrsquos results have been replicated numeroustimes in numerous locations This program involved all three componentsof the MSD model except that motivation was provided through peergroup support not through provision motivation enhancement strate-gies These targeted programs present an optimistic picture for drug-useprevention that is focused on at-risk youth (see Table 1)

Not all targeted prevention programs have been found to beeffective One published program that failed to find positive effects wasProject PALS (Palinkas et al 1996) This project was developed for teengirls who were pregnant or at risk for pregnancy and drug use Theprogram consisted of school-based delivery of 16 sessions once a weekin a class The goal was to decrease drug use The PALS Skills TrainingProgram involved instruction in assertiveness providing and receivingfeedback social conversation handling requests and asking for help andmood management This program was tested against a normativeeducation program (called Facts of Life or FOL) which instructedvalues and decision making sexuality issues and contraception sexuallytransmitted diseases (STDs) drug use risks sexual assault prevalenceand norms material An experimental evaluation with a seven-monthspost-baseline was used The results indicated that the PALS programsubjects reported 29 times greater marijuana use than FOL amongbaseline nonusers No other differences were found It is possible that theprogram was not targeted to the right population that the mix of skills

1998 Sussman et al

ORDER REPRINTS

instructed was not appropriate or that skill training alone (withoutappropriate motivation material) may not be effective in drug useprevention Researchers should examine these possibilities and others tofurther understand program failures as well as program successes

Potential Limitations of Targeted Prevention

Dishion and colleagues (1995) suggest from various findings thatgrouping high-risk youth may lead to increased drug use This outcomecan result if youth come to learn deviant behavior from each other Theycan learn deviant behavior from each other in a program if they haveunstructured or unsupervised time together An essential feature ofseveral targeted programs (eg the RY and TND programs) is building apositive peer culture with group norms that decrease drug involvementand drug-use control problems The RYrsquos findings suggest that a positivepeer group component carefully fostered by a well-trained and competentRY group leader can direct the group toward lower risk behaviorSimilarly classroom management in Project TND involves developmentof positive norms of classroom behavior Further interaction betweenyouth is encouraged but is primarily teacher-directed and highlystructured (Sussman et al 2003) In both RY and Project TND theteacherrsquos role is to actively develop and maintain peer group support inthe class by modeling support positively reinforcing it among groupmembers and negatively reinforcing deviant peer bonds and activities(Eggert and Herting 1991 Vorrath and Brendtro 1985) The teachercreates and structures interactions among youth in prosocial directions(Sussman et al 2003)

Multiple Problem Behaviors of Adolescents

Acknowledging the relationship of drug use to other commonadolescent problems may facilitate identification of effective methods ofreducing drug use Researchers on tobacco alcohol and other drug useantisocial behavior high-risk sexual behavior and depression increas-ingly recognize that these problems are interrelated (McGee andNewcomb 1992) and stem to a large extent from the same environ-mental and biological factors (Biglan et al in press Eggert et al 1995Sussman and Ames 2001 Wills and Cleary 1995) Clearly it is necessaryto have strategies that address the entire range of problems and thecontext that influences those problems Indeed further reductions in

Motivation Skills and Decision Making 1999

ORDER REPRINTS

many problems require that we comprehensively target youth withmultiple problem behaviors

Biglan and colleagues (in press) provide a comprehensive review ofthe relationships among antisocial behavior tobacco alcohol and otherdrug use and high-risk sexual behavior It is clear that the same youngpeople are prone to the development of the entire range of problems In arecent review Moffitt and colleagues (2002) found that antisocialbehavior in early adolescence (rather than late adolescence) is a greaterrisk factor for developing multiple problems These findings point to theimportance of early intervention before youth develop serious problemsMoreover these different problems largely result from the same set ofenvironmental and biological factors

One implication is that disciplines dealing with these problemsother than drug abuse may contribute to dealing with the problem ofdrug use (Newcomb 1996b 1997) In particular research by dev-elopmental psychologists family social workers and sociologists onthe influence of parents on adolescent problem development and oninterventions to alter parenting practices contributes to our understandingof how to prevent or ameliorate drug abuse and other problems Onealso should note that nonsubstance use is not a guarantee for problemimmunity for the entire age range of people whatever their genderethnicity religiosity socioeconomic status (SEC) domicility etc It maybe argued that the most promising programs are those targeting thesemultiple levels of influence Several multidisciplinary programs haveachieved promising results We describe three of these empiricallyevaluated programs tested in various settings

Functional Family Therapy (FFT)FFT is an indicated intervention involving family treatment designed

for delinquent teenagers (also see Table 1) Developed in the early 1970sby Alexander and colleagues (1973) FFT focuses on family commu-nication and the establishment of rules and consequences Several studiesprovide encouraging reports of the programrsquos effectiveness (Alexander etal 1976 Barton et al 1985 Klein et al 1977 Waldron et al 2001) Inthe Waldron et al (2001) study researchers used FFT and anintervention with cognitive behavior therapy on teens referred formarijuana use Each of the interventions produced significant resultson marijuana use by the teens at four months but only the twointerventions combined maintained these results at seven months Theearlier studies found a greater number of results For example in the twoAlexander studies (1973 1976) improvement in family communicationposttreatment led to reduced delinquency Note that all the teens in these

2000 Sussman et al

ORDER REPRINTS

studies had histories of serious antisocial or delinquent behavior Thusachieving positive outcomes even if only short-term should encouragefurther research into the efficacy of FFT

Multisystemic Therapy (MST)As its name suggestsMST targets individual family peer school and

community influences of those youth offenders with serious problems thatmay include violence substance use and severe emotional problems (alsosee Table 1) Numerous researchers have published the results ofrandomized trials of MST (Henggeler et al 1996 1997 1998 Thorntonet al 2000) The most consistent findings across studies are decreased (1)drug use (2) re-arrest (3) self-reported criminal offense and (4) days inout-of-home placements Other consistent findings are improved familyrelations school attendance and psychiatric functioning One cautionarynote the programrsquos effectiveness lowers considerably if not implementedwith fidelity (Hengler et al 1997 1999) In other words all or key lessonsneed to be delivered as written by educators who are well-trained in usingthe strategies employed and youth need to be able to receive all material inan atmosphere conducive to learning the material The programdevelopers have instituted training strategies that address these fidelityissues thus shaping MST to be a very promising program for at-riskyouth

Multidimensional Treatment Foster Care (MTFC)MTFC targets family and peer factors influencing adolescents with a

pattern of repeat criminal offending (see Table 1) (Chamberlain 1994)This intervention includes placement of the youth into a foster homewith a foster parent trained in behavior management who receivessupport from intervention staff After the adolescent has begun torespond to the intervention in the foster home and after the parents havereceived the same training and support as the foster parents did theadolescent returns home Chamberlain and Reid (1998) tested theintervention with 85 boys with felony and other criminal histories andfound substantial benefits of the program Following treatment the boysassigned to MTFC (compared to those receiving community-based groupcare) showed fewer days in detention or lock-up twice as much timeliving with parents fewer misdemeanor and felony arrests and fewer self-reported index crimes felony arrests and general delinquency TheMTFC is a cost-effective alternative to incarceration however staffrequirements are extensive which may influence the ability of some

Motivation Skills and Decision Making 2001

ORDER REPRINTS

groups to apply the program with fidelity However as with each of theprograms described here the results of the randomized trials areencouraging

Future Research Needs in Targeted Prevention

Future research can help discern when and where targeted preventionprogramming will tend to work rather than produce potentiallydeleterious negative group effects or results that are irrelevant for pro-social healthy adaptation as well as what the critical necessary conditionsare for their effective operation within given de facto realities Comparedto the breadth of evaluated universal drug use prevention programs(Tobler et al 2000) relatively few targeted prevention programs havereceived empirical support Yet previous research suggests that universalschool-based drug use prevention programs implemented in junior highschool have relatively less chance of long-term success especially for thoseyouth that began using drugs before the prevention program wasimplemented Of course there are notable exceptions (eg effects lastedfor one and a half years effects lasted for six years) (Chou et al 1998Griffin et al 2003 Skara and Sussman 2003) Almost no research existsregarding maximization of booster programming with high-risk youthMore research on booster programs would help the field

While continuing to engage in this work there will be numerousissues to manage that go well beyond the scope of this article There willbe a need to avoid producing negative labeling effects while providingprogramming for those who are at risk for drug use It is possible thatcessation information needs to be included in the mix with preventionmaterial to provide better targeted-prevention effects There may be aneed to develop a teacher selection instrument to help select out teacherswho can deliver drug abuse prevention programming adequatelyCertainly definition of outcome variables needs continued explorationincluding analysis to ascertain the effects of programming on drug abusevs drug use and identification of the variables that are most closelylinked to change by targeted prevention components

A transdisciplinary approach helps to better understand the lifesituation of high-risk youth as based to some extent on both constitutionaland environmental factors (Fuqua et al 2004 Rutter et al 1997 Wills etal 1996b) From the transactional perspective their situation is in partconstitutional they may have temperamental characteristics that arepartly heritable and that have set the stage at earlier ages for decrements inself-control ability and academic performance that then increase risk for

2002 Sussman et al

ORDER REPRINTS

drug use However their situation is also part environmental based in parton family socialization and in part on the types of peers they have as well asthe type and quality of the physical and cultural environment-at-largeThere are many points at which a potential chain of failures can beinterrupted and the individualrsquos trajectory turned in a better directionProblems are not inevitable from starting level (Tarter and Vanyukov1994) and environmental modifications to support good self-controlability can help to avert an adverse impact from earlier experiences orcurrent difficulties (Brody et al 2002 Novak and Clayton 2001 Patock-Peckham et al 2001 Rutter et al 1997 Wills et al 2002)

The problems and needs of high-risk youth in our nationrsquos highschools demand our attention for designing and rigorously testingtargeted prevention approaches Substantial evidence shows that theseyouth are at greater risk for drug involvement and co-occurring problemssuch as aggression depression and suicidal behaviors as we previouslydiscussed It is hoped that the information presented in this article willstimulate others to join in extending this work including testing othermodels of targeted prevention

GLOSSARY

Universal programs Programs that aim to influence all subjects in acontext

Selective drug-abuse prevention programs Programs that servegroups at greater risk of ATOD usemdashfor example children of alcoholicparents They are at psychosocial risk for drug use and abuse

Indicated drug-abuse prevention programs Programs that attemptto benefit individuals who already show signs of drug involvement orrelated risk factors In indicated prevention programs the primary goal isto stem the progression of ATOD use or reduce drug involvementamong the high-risk youth

Targeted programming Programming that subsumes selective andindicated programming sometimes the other two types of programs thattarget specific groups lsquolsquoat riskrsquorsquo are considered together

ACKNOWLEDGMENTS

This research was supported by grants from the National Institute onDrug Abuse (DA01070 DA07601 DA13814 and DA16094) and by aResearch Scientist Development Award K02 DA00252 from theNational Institute on Drug Abuse

Motivation Skills and Decision Making 2003

ORDER REPRINTS

REFERENCES

Alexander J F Barton C Schiaro R S Parsons B V (1976)

Systems-behavioral intervention with families of delinquents

therapist characteristics family behavior and outcome Journal of

Consulting and Clinical Psychology 44(4)656ndash664Alexander J F Parsons B V (1973) Short-term behavioral interven-

tion with delinquent families impact on family process and

recidivism Journal of Abnormal Psychology 3219ndash225American psychiatric association (APA) (1994) Diagnostic and

Statistical Manual of Mental Disorders 4th edn (DSM-IV)

Washington DC American Psychiatric AssociationAmes S L Sussman S Dent C W (1999) Pro-drug-use myths and

competing constructs in the prediction of substance use among

youth at continuation high schools a one-year prospective study

Personality and Individual Differences 26987ndash1003Bachman S G Wadsworth K N OrsquoMalley P M Johnston L D

Schulenberg J E (1997) Smoking drinking and drug use in young

adulthood Mahwah NJ Lawrence Erlbaum Associates 8ndash25

153ndash190Bandura A (1986) Social Foundations of Thought and Action A Social

Cognitive Theory Englewood Cliffs NJ Prentice HallBarton C Alexander J F Waldron H Turner C W Warburton J

(1985) Generalizing treatment effects of functional family therapy

Three replications The American Journal of Family Therapy

13(3)16ndash26Battin-Pearson S R Newcomb M D Abbott R D Hill K G

Catalano R F Hawkins J D (2000) Predicting early high school

dropout Journal of Educational Psychology 92568ndash582Biglan A Brennan P A Foster S L Holder H D Miller T L

Cunningham P B et al (in press) Helping Adolescents at Risk

Prevention of Multiple Problem Behaviors New York NY Guilford

PressBindra D Stewart J (1996) Motivation Baltimore MD Penguin

BooksBlanton H Gibbons F X Gerrard M Conger K J Smith G E

(1998) The role of family and peers in the development of

prototypes associated with substance use Journal of Family

Psychology 11271ndash288

2004 Sussman et al

ORDER REPRINTS

Botvin G J (1993) School-based drug abuse prevention Long-termfollow-up results In First Annual Meeting of the Society forPrevention Research Kentuck Lexington Society for PreventionResearch

Botvin G J Baker E Dusenbury L Botvin E M Diaz T (1995)Long-term follow-up results of a randomized drug abuse preven-tion trial in a white middle-class population Journal of theAmerican Medical Association 2731106ndash1012

Brody G H Dorsey S Forehand R Armistead L (2002) Uniquecontributions of parenting and classroom processes to the self-control of AfricanndashAmerican children Child Development73274ndash286

Carroll M E (1996) Reducing drug abuse by enriching the environmentwith alternative nondrug reinforcers In Green L Kagel J Heds Advances in Behavioral Economics Norwood NJ NorwoodPublishing Corp 37ndash68

Carver C S Scheier M F (1998) On the Self-Regulation of BehaviorNew York Cambridge University Press

Catalano R F Hawkins J D (1996) The social developmental modela theory of antisocial behavior In Hawkins J D ed Delinquencyand Crime Current Theories New York Cambridge UniversityPress

Centers for Disease Control (CDC) (October 1999) Youth risk BehaviorSurveillancemdashNational Alternative High School Youth RiskBehavior Survey 1998 Morbidity and Mortality Weekly Report48 No SS-7

Chamberlain P (1994) Family connections A treatment foster caremodel for adolescents with delinquency Eugene OR CastaliaPublishing Company

Chamberlain P Reid J B (1998) Comparison of two communityalternatives to incarceration for chronic juvenile offenders Journalof Consulting and Clinical Psychology 66(4)624ndash633

Chassin L A Presson C C Sherman S J (1985) Stepping backwardin order to step forward an acquisition-oriented approach toprimary prevention Journal of Consulting and Clinical Psychology53612ndash622

Chou C-P Montgomery S Pentz M A Rohrbach L A JohnsonC A Flay B R MacKinnon D P (1998) Effects of acommunity-based prevention program on decreasing drug use inhigh-risk adolescentsAmerican Journal of Public Health 88944ndash948

Conducts Problems Prevention Research Group (CPPRG) (1999) Initialimpact of the fast track prevention trial for conduct problems I

Motivation Skills and Decision Making 2005

ORDER REPRINTS

The high-risk sample Journal of Consulting and Clinical Psychology

67631ndash647Conducts Problems Prevention Research Group (CPPRG) (2000)

Merging universal and indicated prevention programs the fast

track model Addictive Behaviors 25913ndash927Council of Philosophical Studies (1981) Psychology and the Philosophy

of Mind in the Philosophy Curriculum San Francisco San Francisco

State UniversityCummings K M Hellmann R Emont S L (1988) Correlates of

participation in a worksite stop smoking program Journal of

Behavioral Medicine 11267ndash277Curry S Wagner E H Gothaus L C (1990) Intrinsic and extrinsic

motivation for smoking cessation Journal of Consulting and

Clinical Psychology 58310ndash316Dent C W Sussman S McCuller W J Stacy A W (2001) Drug

abuse prevention among youth at comprehensive high schools

Preventive Medicine 32514ndash520Dewey J (1886) Psychology New York HarperDishion T J French D C Patterson G R (1995) The development

and ecology of antisocial behavior In Cicchetti D Cohen D

eds Manual of developmental psychopathology New York John

Wiley 421ndash471Eggert L L Herting J R (1991) Preventing teenage drug abuse

exploratory effects of network social support Youth and Society

22482ndash534 [Reprinted National Prevention Evaluation Research

CollectionRockville MD Aspen 1993]Eggert L L Herting J R Thompson E A Nicholas L J Dicker

B G (1994) Preventing adolescent drug abuse and high school

dropout through an intensive school-based social network devel-

opment program American Journal of Health Promotion

8202ndash214Eggert L L Thompson E A Herting J R Nicholas L J (1995)

Reducing suicide potential among high-risk youth tests of a school-

based prevention program Suicide amp Life-Threatening Behavior

25276ndash296Ellickson P L Bell R M (1990) Drug prevention in junior high a

multi-site longitudinal test Science 2471299ndash1305Elliott D S (Series ed) (2003) Blueprints for violence prevention

Boulder CO Institute of Behavioral Science Regents of the

University of Colorado wwwcoloradoeducspvblueprints

2006 Sussman et al

ORDER REPRINTS

Farrell A D Danish S J (1993) Peer drug associations and emotionalrestraint Causes or consequences of adolescent drug use Journal ofConsulting and Clinical Psychology 61327ndash334

Festinger L A (1957) A Theory of Cognitive Dissonance New YorkHarper amp Row

Fuqua J Stokols D Gress J Phillips K Harvey R (2004)Transdisciplinary collaboration as a basis for enhancing the scienceand prevention of substance use and abuse Substance Use ampMisuse

Giuliano J D (1994) A peer education program to promote the use ofconflict resolution skills among at-risk school-age males PublicHealth Reports 109158ndash169

Glynn K Levanthal H Hirschman R (1985) A cognitivedevelopmental approach to smoking prevention In Bell C SBattjes R eds Prevention research Deterring Drug Abuse AmongChildren and Adolescents Rockville MD NIDA ResearchMonograph 63

Glynn T J (1989) Essential elements of school-based smokingprevention programs Journal of School Health 59181ndash188

Goodman R M Burdine J N Meehan E McLeroy K R eds(1993) Community coalitions for health promotion Special issue ofHealth Education Research Theory and Practice 8309ndash453

Goodyear R D Newcomb M D Locke T F (2002) PregnantLatina teenagers psychosocial and developmental determinants ofhow they select and perceive the men who father their childrenJournal of Counseling Psychology 49187ndash201

Gordon R (1987) An operational classification of disease preventionIn Steinberg J A Silverman M M eds Preventing MentalDisorders Rockville MD DHHS 20ndash26

Graham J W Johnson C A Hansen W B Flay B R Gee M(1990) Drug use prevention programs gender and ethnicityevaluation of three seventh-grade project SMART cohortsPreventive Medicine 19305ndash313

Griffin K W Botvin G J Nichols T R Doyal M M (2003)Effectiveness of a universal drug abuse prevention approach foryouth at high risk for substance use initiation Preventive Medicine36(1)1ndash7

Hamilton S (August 20 2000) Views slowly changing on alternativeschools The Sacramento Bee 1ndash3

Hansen W B (1992) School-based substance abuse prevention a reviewof the state of the art in curriculum 1980ndash1990 Health EducationResearch 7403ndash430

Motivation Skills and Decision Making 2007

ORDER REPRINTS

Hansen W B Johnson C A Flay B R Graham J W Sobel J(1988) Affective and social influences approaches to the preventionof multiple substance abuse among seventh grade students resultsfrom project SMART Preventive Medicine 17135ndash154

Hansen W B Graham J W (1991) Preventing alcohol marijuanaand cigarette use among adolescents peer pressure and resistancetraining versus establishing conservative norms PreventiveMedicine 20414ndash430

Hawkins D H Catalano R F Miller J Y (1992) Risk andprotective factors for alcohol and other drug problems inadolescence and early adulthood Implications for substanceabuse prevention Psychological Bulletin 11254ndash105

Hawkins J D Catalano R F Kosterman R Abbott R Hill K G(1999) Preventing adolescent health-risk behaviors by strengthen-ing protection during childhood Archives of Pediatric amp AdolescentMedicine 153226ndash234

Heider F (1958) The Psychology of Interpersonal Relations New YorkWiley

Henggeler S W Pickrel S G Brondino M J Crouch J L (1996)Eliminating (almost) treatment dropout of substance abusing ordependent delinquents through home-based multisystemic therapyAmerican Journal of Psychiatry 153(3)427ndash428

Henggeler S W Melton G B Brondino M J Scherer D GHanley J H (1997) Multisystemic therapy with violent andchronic juvenile offenders and their families the role of treatmentfidelity in successful dissemination Journal of Consulting andClinical Psychology 65(5)821ndash833

Henggeler S W Schoenwald S K Borduin C M Rowland M DCunningham P B (1998) Multisystemic treatment of antisocialbehavior in children and adolescents New York The Guilford Press

Henggeler S W Pickrel S G Brondino M J (1999) Multisystemictreatment of substance-abusing and dependent delinquents out-comes treatment fidelity and transportability Mental HealthServices Residual 1(3)171ndash84

Johnson C A Pentz M A Weber M D Dwyer J H Baer NMacKinnon D P Hansen W B Flay B R (1990) Relativeeffectiveness of comprehensive community programming for drugabuse prevention with high-risk and low-risk adolescents Journalof Consulting and Clinical Psychology 58447ndash456

Kaftarian S J Hansen W B eds (1994) CSAP special issuecommunity partnership program Journal of Community Psychologypages 205

2008 Sussman et al

ORDER REPRINTS

Karoly P (1993) Mechanisms in self-regulation A systems view AnnualReview of Psychology 4423ndash51

Karoly P (1980) Person variables in therapeutic change and develop-ment In Karoly P Steffen J J eds Improving the Long-TermEffects of Psychotherapy New York Gardner Press 195ndash261

Kendall P C Braswell L (1982) Cognitive-behavioral self-controltherapy for children a components analysis Journal of Consultingand Clinical Psychology 50672ndash689

Kerr M Tremblay R E Pagani L Vitaro F (1997) Boysrsquobehavioral inhibition and the risk of later delinquency Archivesof General Psychiatry 54809ndash816

Klein N C Alexander J F Parsons B V (1977) Impact of familysystems intervention on recidivism and sibling delinquency a modelof primary prevention and program evaluation Journal ofConsulting and Clinical Psychology 45(3)469ndash474

Kumpfer K L (1999) Outcomes measures of interventions in the studyof children of substance-abusing parents Pediatrics 1031128ndash1144

Lau R R Hartman K A Ware J E (1986) Health as a valuemethodological and theoretical considerations Health Psychology525ndash43

Lichtenstein E L Glasgow R E (1997) A pragmatic framework forsmoking cessation implications for clinical and public healthprograms Psychology of Addictive Behaviors 11142ndash151

Locke T F Newcomb M D (in press) Childhood maltreatmentparent drug problems polydrug problems and parenting practicesa test of gender differences and four theoretical perspectivesJournal of Family Psychology

McCreary D R Newcomb M D Sadava S W (1999) The male rolealcohol use and alcohol problems a structural modeling examina-tion in adult women and men Journal of Counseling Psychology46109ndash124

McGee L Newcomb M D (1992) General deviance syndromeexpanded hierarchical evaluations at four ages from earlyadolescence to adulthood Journal of Consulting amp ClinicalPsychology 60766ndash776

Miller W R Brown J M (1991) Self-regulation as a conceptual basisfor the prevention of addictive behaviours In Heather N MillerW R Greeley J eds Self-control and the Addictive BehavioursSydney Australia Maxwell Macmillan 3ndash79

Miller W R Leckman A L Delaney H D Tinkcom M (1993)Long-term follow-up of behavioral self-control training forproblem drinkers Journal of Studies on Alcohol 53249ndash261

Motivation Skills and Decision Making 2009

ORDER REPRINTS

Miller W R Rollnick S (1991) Motivational InterviewingPreparing People to Change Addictive Behavior New YorkGuilford Press

Moffitt T E Caspi A Harrington H Milne B J (2002) Males onthe life-course-persistent and adolescence-limited antisocial path-ways follow-up at age 26 years Development and Psychopathology14(1)179ndash207

National Institute on Drug Abuse (NIDA) (1997) Drug abuseprevention What works NIH Publication 97-4110 DHHSNational Institutes of Health National Institute on Drug AbuseOffice of Science Policy and Communications Rockville MD

Newcomb M D (1992a) Substance abuse and control in the UnitedStates ethical and legal issues Social Science and Medicine35471ndash479

Newcomb M D (1992b) Understanding the multidimensional nature ofdrug use and abuse The role of consumption risk factors andprotective factors In Glantz M D Pickens R eds Vulnerabilityto Drug Abuse Washington DC American PsychologicalAssociation 255ndash298

Newcomb M D (1996a) Pseudomaturity among adolescents constructvalidation sex differences and associations in adulthood Journalof Drug Issues 26477ndash504

Newcomb M D (1996b) Adolescence Pathologizing a normal processThe Counseling Psychologist 24482ndash490

Newcomb M D (1997) Psychosocial predictors and consequences ofdrug use a developmental perspective within a prospective studyJournal of Addictive Diseases 1651ndash89

Newcomb M D Bentler P M (1988) Consequences of Adolescent DrugUse Impact on the Lives of Young Adults Beverly Hills CA Sage

Newcomb M D Bentler P M (1989) Substance use and abuse amongchildren and teenagers American Psychologist 44242ndash248

Newcomb M D Harlow L L (1986) Life events and substance useamong adolescents Mediating effects of perceived loss of controland meaninglessness in life Journal of Personality and SocialPsychology 51564ndash577

Newcomb M D Chou C-P Bentler P M Huba G J (1988)Cognitive motivations for drug use among adolescents longitudinaltests of gender differences and predictors of change in drug useJournal of Counseling Psychology 35426ndash438

Newcomb M D Abbott R D Catalano R F Hawkins J DBattin-Pearson S R Hill K (2002) Mediational and deviancetheories of late high school failure Process roles of structural

2010 Sussman et al

ORDER REPRINTS

strains academic competence and general versus specific problem

behaviors Journal of Counseling Psychology 49172ndash186Nezami E Sussman S Pentz M A (2003) Motivation in tobacco use

cessation research Substance Use amp Misuse 3825ndash5Novak S P Clayton R R (2001) The influence of school environment

and self-regulation on transitions between stages of cigarette

smoking Health Psychology 20196ndash207Offord D R (2000) Selection of levels of prevention Addictive

Behaviors 25833ndash842Palinkas L A Atkins C J Miller C Ferreira D (1996) Social skills

training for drug prevention in high-risk female adolescents

Preventive Medicine 25692ndash701Patock-Peckham J A Cheong J-W Balhorn M E Nagoshi C T

(2001) A model of parenting styles self-regulation perceived

drinking control and alcohol use and problems Alcoholism

Experimental and Clinical Research 251284ndash1292Pentz M A (1994) Directions for future research in drug abuse

prevention Preventive Medicine 23646ndash652Pentz M A Dwyer J H MacKinnon D Flay B R Hansen W B

Wang E Y I Johnson C A (1989) A multi-community trial for

primary prevention of adolescent drug abuse effects on drug use

prevalence JAMA 2623259ndash3266Pentz M A Mares D Schinke S Rohrbach L (in press) Political

science public policy and drug abuse prevention Substance Use amp

MisuseProchaska J O DiClemente C C (1982) Transtheoretical therapy

toward a more integrative model of change Psychotherapy Theory

Research and Practice 19275ndash288Pulkkinen L Pitkanen T (1994) A prospective study of the precursors

to problem drinking in young adulthood Journal of Studies on

Alcohol 55578ndash587Rathus S A Nevid J S (1977) Behavior Therapy Strategies for

Solving Problems in Living New York Doubleday and Company

IncResnicow K Botvin G (1993) School-based substance use prevention

programs why do effects decay Preventive Medicine 22484ndash490Rutter M Dunn J Plomin R Simonoff E Pickles A Maughan

B Ormel J Meyer J Eaves L (1997) Integrating nature and

nurture implications of person-environment interactions for

developmental psychopathology Development and Psychopathology

9335ndash364

Motivation Skills and Decision Making 2011

ORDER REPRINTS

Salomon G Stein Y Eisenberg S Klein L (1984) Adolescent

smokers and nonsmokers profiles and their changing structure

Preventive Medicine 13446ndash461Sambrano S (1999) National cross-site evaluation of high risk youth

programs In Interim findings Bulletin Washington DC CSAP

SAMSHA US DHHS May 1ndash16Schinke S P Gilchrist L D (1985) Preventing substance abuse with

children and adolescents Journal of Consulting and Clinical

Psychology 53596ndash602Skara S N Sussman S (2003) A review of 25 long-term adolescent

tobacco and other drug use prevention program evaluations

Preventive MedicineSmith C Lizotte A J Thornberry T P Krohn M D (1995)

Resilient youth identifying factors that prevent high-risk youth

from engaging in delinquency and drug use Delinquency and

Disrepute in the Life Course Greenwich CT John Hagan JAI

press 217ndash247Sommers P V (1972) The Biology of Behavior Australia Pty ltd

Sydney John Wiley amp SonsSt Pierre T L Kaltreider D L Mark M M Aikin K J (1992)

Drug prevention in a community setting a longitudinal study of the

relative effectiveness of a three-year primary prevention program in

boys and girls clubs across the nation American Journal of

Community Psychology 20673ndash706Stein J A Newcomb M D Bentler P M (1987) An eight year study

of multiple influences on drug use and drug use consequences

Journal of Personality and Social Psychology 531094ndash1105Sully J (1884) Outlines of Psychology New York D Appleton amp CoSussman S (1989) Two social influence perspectives of tobacco use

development and prevention Health Education Research Theory

and Practice 4213ndash223Sussman S (1991) Curriculum development in school-based prevention

research Health Education Research Theory and Practice

6339ndash351Sussman S (1996) Development of a school-based drug abuse

prevention curriculum for high risk youth Journal of

Psychoactive Drugs 28169ndash182Sussman S Ames S L (2001) The social psychology of drug abuse

Buckingham GB Open University PressSussman S Unger J (2004) A drug abuse theoretical integration a

transdisciplinary speculation Substance Use amp Misuse

2012 Sussman et al

ORDER REPRINTS

Sussman S Dent C W Burton D Stacy A W Flay B R (1995a)

Developing school-based tobacco use prevention and cessation

programs Thousand Oaks CA Sage Publications IncSussman S Dent C W Simon T R Stacy A W Galaif E R

Moss M A Craig S Johnson C A (1995b) Effectiveness of

social influence substance abuse prevention curricula in compre-

hensive and continuation high schools Drugs and Society 865ndash81Sussman S Dent C W Galaif E R (1997) The correlates of

substance abuse and dependence among adolescents at high risk

for drug abuse Journal of Substance Abuse 9241ndash255Sussman S Dent C W Stacy A W (1996) The relation of pro-drug

use myths with self-reported drug use among youth at continuation

high schools Journal of Applied Social Psychology 26214ndash267Sussman S Dent C W Stacy A Craig S (1998) One-year outcomes

of project towards no drug abuse Preventive Medicine 27632ndash642

(erratum 766)Sussman S Dent C W Stacy S (2002) Project towards no drug

abuse a review of the findings and future directions American

Journal of Health Behavior 26354ndash365Sussman S McCuller W J Dent C W (2003) The associations of

social self-control personality disorders and demographics with

drug use among high risk youth Addictive Behaviors 281159ndash1166Sussman S Rohrbach L Patel R Holiday K (2003) A look at an

interactive classroom-based drug abuse prevention program

Interactive contents and suggestions for research Journal of Drug

Education 33355ndash368Sussman S Sun P McCuller W J Dent C W (2003) Project

towards no drug abuse two year outcomes of a trial that compares

health educator delivery to self-instruction Preventive Medicine

37155ndash162Tarter R E Vanyukov M (1994) Alcoholism a developmental disorder

Journal of Consulting and Clinical Psychology 621096ndash1107Thornton T N Craft C A Dahlberg L L Lynch B S Baer K

(2000) Best Practices of Youth Violence Prevention A Sourcebook

for Community Action Atlanta GA Division of Violence

Prevention Centers for Disease Control and PreventionTobler N S (1986) Meta-analysis of 143 adolescent drug prevention

programs quantitative outcome of program participants compared to

a control or comparison group Journal of Drug Issues 16537ndash567Tobler N S Roona M R Ochshorn P Marshall D G Streke

A V Stackpole K M (2000) School-based adolescent drug

Motivation Skills and Decision Making 2013

ORDER REPRINTS

prevention programs 1998 Meta-analysis The Journal of Primary

Prevention 20275ndash336US Department of Health and Human Services (USDHHS) (2003)

Substance Abuse andMental Health Services Administration Center

for Substance Abuse Prevention Science-based prevention programs and

principles 2002 Rockville MD US DHHS (SMA)03-3764 Also

see httpmodelprogramssamhsagovUnger J Baezconde-Garbanati L Shakib S Palmer P H Nezami

E Mora J (2004) What are the implications of structuralcultural

theory for drug abuse prevention Substance Use amp MisuseUpshaw H S Ostrom T M (1984) Psychological perspective in

attitude research In Eiser J R ed Attitudinal Judgment New

York Springer-Verlag 23ndash42Valente T W Gallaher P Mouttapa M (2004) Using social network

theory to understand and prevent substance use a transdisciplinary

perspective Substance Use amp MisuseVorrath H Brendtro L (1985) Positive peer culture 2nd edn Aldine

ChicagoWaldron H B Slesnick N Brody J L Turner C W Peterson T R

(2001) Treatment outcomes for adolescent substance abuse at 4-

and 7-month assessments Journal of Consulting amp Clinical

Psychology 69(5)802ndash813Watson D L Tharp R G (2002) Self-directed behavior Self-

modification for personal adjustment 8th edn Belmont CA

WadsworthWeissberg R P Caplan M Z Sivo P J (1989) A new conceptual

framework for establishing school-based social competence promo-

tion programs In Bond L A Compas B E eds Primary

Prevention amp Promotion in the Schools Newbury Park CA Sage

255ndash296Wills T A (1986) Stress and coping in early adolescence relationships

to substance use in urban school samples Health Psychology

5503ndash529Wills T A Cleary S D (1995) Stress-coping model for alcohol-

tobacco interactions in adolescence In Fertig J B Allen J P

eds Alcohol and Tobacco From Basic Science to Clinical Practice

Bethesda MD National Institute on Alcohol Abuse and

Alcoholism 107ndash128Wills T A Cleary S D (1999) Peer and adolescent substance use

among 6thndash9th graders Latent growth analyses of influence versus

selection mechanisms Health Psychology 18453ndash463

2014 Sussman et al

ORDER REPRINTS

Wills T A Hirky A E (1996) Coping and substance abuse InZeidner M Endler N S eds Handbook of Coping TheoryResearch and Applications New York Wiley 279ndash302

Wills T A Stoolmiller M (2002) The role of self-control in earlyescalation of substance use a time-varying analysis Journal ofConsulting and Clinical Psychology 70986ndash997

Wills T A Baker E Botvin G J (1989) Dimensions of assertivenessdifferential relationships to substance use in early adolescenceJournal of Consulting and Clinical Psychology 57(4)473ndash478

Wills T A Vaccaro D McNamara G (1994) Novelty seeking risktaking and related constructs as predictors of adolescent substanceuse an application of Cloningerrsquos theory Journal of SubstanceAbuse 61ndash20

Wills T A McNamara G Vaccaro D Hirky A E (1996a)Escalated substance use a longitudinal grouping analysis fromearly to middle adolescence Journal of Abnormal Psychology105166ndash180

Wills T A Pierce J P Evans R I (1996b) Large-scale environmentalrisk factors for substance use American Behavioral Scientist39808ndash822

Wills T A Windle M Cleary S D (1998) Role of temperamentnovelty-seeking and self-control in adolescent substance useJournal of Personality and Social Psychology 74387ndash406

Wills T A Sandy J M Shinar O (1999) Substance use level andproblems in late adolescence a mediational model based on self-control and coping motives Experimental and ClinicalPsychopharmacology 7122ndash134

Wills T A Cleary S D Filer M Shinar O Mariani J Spera K(2001) Temperament and self-control related to early-onsetsubstance use test of a developmental model Prevention Science2145ndash163

Wills T A Sandy J M Yaeger A (2002) Moderators of therelationship between substance use level and problems test of aself-regulation model in adolescence Journal of AbnormalPsychology 1113ndash21

Wills T A Gibbons F X Gerrard M Murry V Brody G (in press-a) Family communication and religiosity related to substance useand sexual behavior in early adolescence Psychology of AddictiveBehaviors

Wills T A Resko J Ainette M Mendoza D (in press-b) The role ofparent and peer support in adolescent substance use a test ofmediated effects Psychology of Addictive Behaviors

Motivation Skills and Decision Making 2015

ORDER REPRINTS

Young P T (1936) Motivation of Behavior New York John Wiley andSons

Zimmerman B J (2000) Attaining self-regulation a social cognitivemodel In Boekaerts M Pintrich P R eds Handbook of Self-Regulation San Diego Academic Press 13ndash39

2016 Sussman et al

Request PermissionOrder Reprints

Reprints of this article can also be ordered at

httpwwwdekkercomservletproductDOI101081JA200034769

Request Permission or Order Reprints Instantly

Interested in copying and sharing this article In most cases US Copyright Law requires that you get permission from the articlersquos rightsholder before using copyrighted content

All information and materials found in this article including but not limited to text trademarks patents logos graphics and images (the Materials) are the copyrighted works and other forms of intellectual property of Marcel Dekker Inc or its licensors All rights not expressly granted are reserved

Get permission to lawfully reproduce and distribute the Materials or order reprints quickly and painlessly Simply click on the Request Permission Order Reprints link below and follow the instructions Visit the US Copyright Office for information on Fair Use limitations of US copyright law Please refer to The Association of American Publishersrsquo (AAP) website for guidelines on Fair Use in the Classroom

The Materials are for your personal use only and cannot be reformatted reposted resold or distributed by electronic means or otherwise without permission from Marcel Dekker Inc Marcel Dekker Inc grants you the limited right to display the Materials only on your personal computer or personal wireless device and to copy and download single copies of such Materials provided that any copyright trademark or other notice appearing on such Materials is also retained by displayed copied or downloaded as part of the Materials and is not removed or obscured and provided you do not edit modify alter or enhance the Materials Please refer to our Website User Agreement for more details

ORDER REPRINTS

Preventive

Treatm

ent

Program

(PTP)

7ndash9

Disadvantaged

socioeconomic

status(SES)

disruptive

School-based

parentand

childskills

and

monitoring

Positive

reinforcers

Yes

No

17sessionsfor

parent19for

child

separately

parent-

monitoring

andshaping

ofchild

child-

pro-social

skillsand

selfcontrol

Lesslikelihood

ofhaving

beendrunk

ortaken

drugsin

last

12months

less

fighting

andstealing

Project

PATHE

12ndash18

Disadvantaged

socioeconomic

status(SES)

low

achieving

disruptive

School-based

activitiespeer

counseling

schoolpride

jobseeking

Yes

Yes

No

Academ

ic

skillstoo

Decreaseddrug

involvem

ent

school

alienation

discipline

problems

higher

graduation

rates

Project

STATUS

12ndash18

Potential

dropouts

Schoolclim

ate

optionsclass

(socialrules

norm

s)

Accountability

No

Yes

Youth

leadership

staff

development

parent

meetings

community

resources

Lessdrug

involvem

ent

forjunior

highyouth

bettergrades

anddiscipline

(continued

)

Motivation Skills and Decision Making 1985

ORDER REPRINTS

Table

1

Continued

Inclusion(ornot)ofMSD

Components

Nameof

Program

Baseline

GradeAge

Range

Definition

ofRisk

Program

Modalities

Motivation

Skills

Decision

Making

Other

Features

Drug

Effects

Project

STEP

14ndash18

Disadvantaged

socioeconomic

status(SES)

low

achieving

disruptive

Schoolphysical

settinghome

room

teacher

role

Accountability

No

No

Homeroom

teachersact

ascounselors

andadvisors

Lessdrug

involvem

ent

bettergrades

anddiscipline

Project

SUCCESS

14ndash18

Alternativehigh

schoolyouth

School-based

counseling

and

education

SAPmodel

No

Yes

Yes

Highly

trained

counselorsasse-

ssment8-session

classgroup

counseling

parentmeeting

referral

Decreased

problem

behavioruse

ofmarijuana

tobaccoand

alcohol

Project

Towards

NoDrugAbuse

(TND)

14ndash19

Alternativehigh

schoolyouth

School-based

classroom

12

sessions

Yes

Yes

Yes

Trained

teachers

Decreaseduse

ofcigarettes

alcoholmar-

ijuanahard

drugsweapons

carrying

Quantum

Opportunities

Program

(QOP)

9thndash12th

Disadvantaged

socioeconomic

status(SES)

familieson

public

assistance

Schoolhome

and

community

contexts

skillsservice

and

education

Money

Yes

Yes

250education

hours250life

skillshoursjob

preparationcul-

turalenrichment

and250hcom-

munityservice

monetary

incentives

Nodruguse

effectsrepor-

tedincrease

inhighschool

graduation

less

likelyto

becomeateen

parentslightly

less

likelyto

be

arrested

1986 Sussman et al

ORDER REPRINTS

Reconnecting

Youth

(RY)

14ndash18

Atrisk

for

drop-out

School-based

90-session

class

Groupsupport

Yes

Yes

Smallstudent

groups

support

highly

trained

teachera

semester

Decreasedhard

druguse

perceived

stress

improved

grades

Residential

Student

Assistance

Program

(RSAP)

14ndash17

Livingin

residential

facilities

Residential-

based

education

program

assessm

ent

counseling

referral

No

Yes

Yes

Highly

trained

counselors

placedin

residential

facilities

8-session

drug

education

individual

andgroup

counseling

Decreaseduse

ofmarijuana

tobaccoand

alcohol

Strengthening

Families

Program

(SFP)

6ndash12

Childrenof

substance

users

Agency-based

14session

skillstraining

No

Yes

Yes

Highly

trained

counselors

parents

and

childseen

separately

firsthour

together

at

thesecond

hour

Reduces

aggression

increases

family

cohesion

immediate

effectson

druguse

Motivation Skills and Decision Making 1987

ORDER REPRINTS

model of drug abuse prevention We see this intrinsicextrinsic motiva-tion notion as providing intrapersonal and extrapersonal stimuli (cues)for action

Finally self-regulation models posit that one is motivated to achievean optimal state or system balance In essence an awareness of lack ofbalance will lead to efforts to restore balance (Carver and Scheier 1998Karoly 1980 1993) Drug abuse prevention may demand considerationof alternative actions in order to maintain homeostasis Affect may serveas the main homeostatic mechanism If people feel good or neutral theywill tend to maintain a given course of behavior On the other hand ifthey feel poorly they will want to change their behavior (as in the law ofeffect)

Constituents are those elements that when combined togethercompose a theoretical structure Seven constituents of motivation appearacross the four general theories (Nezami et al 2003) First the idea ofdiscrepancies appears in all theories Motivation exists as a distancebetween what is and what could be and these models assume that peopledesire to reduce such discrepancies Second motivation functions by theestablishment of goals Third motivation exists as energymdasha want ordrive Goals and the accompanying drive to achieve them usually appeartogether Fourth motivation may appear as a series of stages that lead toan end Different goals may operate at different stages Fifth motivationreflects ambivalence about two or more competing goals or behaviorsWorking through ambivalence enhances motivation Sixth motivationarises from different sources usually intrapsychic or environmentalrewards Finally a homeostatic conceptualization of motivation rests onthe idea of maintaining an optimal set point within a regulatory system

Integrations of these four models of motivation could help achievethe prevention of drug abuse One view suggests that due to lifeexperiences people consider goals or directions For example teens maystart to experiment with drugs due to curiosity perceived social pressureor as a means to induce a life change They may subsequently take risksthat injure their relations with others or impair their achievement inschool At some point a discrepancy likely develops between currentcircumstances and their goals For example teens may know that drugabuse is inconsistent with some life goals like school achievementHowever they may value social interaction and physical pleasure whichthey may reach through drug use or other means

Multiple goals may conflict with each other leading to ambivalence(Karoly 1993) Extrinsic and intrinsic sources of input may helpresolve ambivalence For example as the rewards associated with drugabuse diminish teens may experience a desire to decrease their drug

1988 Sussman et al

ORDER REPRINTS

consumption They may prove more likely to adopt a new goal ofdecreased drug use especially if they believe that they could achieve thegoal as self-efficacy theory suggests

Teens may exert energy to reduce discrepancies between currentstates and desired states They may learn new life or social skills whichcan lead them to become involved in rewarding but nondrug-usingactivities (Carroll 1996) In addition they may become involved in newtypes of social networks containing low-risk rather than high-risk peers(Valente et al 2004 Wills et al in press-b) Finally attaining a healthiergoal can create a positive optimal set point and the motivation systemprovides more positive feedback Over time through experience ofdifferent life events youth may alter the set point and begin a new goal-searching process (Sussman and Unger 2004) One may experience atraumatic life event for example and again consider drug use as a meansto return to an optimal set point or repeatedly get into trouble because ofassociating with deviant peers and realize that there is a need to turn todifferent types of associations

Research and theory from several disciplines suggest many motiva-tion strategies for a successful prevention program These motivationstrategies include myth correction stereotyping valuing life andachievement of health goals

Myth Correction

The recovery movement often refers to substance use and abuse as aproblem of perception Another closely related expression drug use mythsdescribes questionable or dysfunctional expectancies or beliefs that serveto justify drug use Myths involve more than expectancies or beliefs aboutpositive or negative outcomes they include inaccurate expectancies orbeliefs about the characteristics (or norms) of drugs and drug use and arelikely to confuse drug effects with drug experiences

Some common myths include inflated expectancies of positiveoutcomes from drug use or underestimates of negative outcomes fromdrug use Teens may believe that substance use will create peer groupacceptance or help them cope with family and school problems when infact the drug use only diverts them from actively coping with these socialand academic issues Thus in the long run drug use makes things worsenot better (Wills and Hirky 1996) Other myths include endorsement ofmisleading beliefs For example many adolescents believe that learningto manage drug intake without getting sick is a positive sign that theirbodies are growing tolerant to the drug rather than signaling the

Motivation Skills and Decision Making 1989

ORDER REPRINTS

beginnings of drug dependence or addiction In addition misperceptionsregarding physical consequences of drug use operate For example usersmistakenly believe that if they are able to regulate subjective effects of adrug they have gained control over use In reality warning systems maybe deteriorating as addiction begins (Glynn et al 1985 Sussman et al1995b) Challenging drug myths undoubtedly helps prevent drug abuse

These challenges can prove especially useful with high-risk popula-tions particularly if social influence programs are less effective in thesegroups Several prevention researchers have adopted a similar taxonomyof drug myths when attempting to prevent drug use Sussman Dent andStacy (1996) examined the internal consistency and discriminant validityof a measure of drug-related myths in 362 continuation (alternative) highschool youth They found good internal consistency and discriminantvalidity for the measure Controlling for its relations with socialdesirability perceived friendsrsquo drug use (a social influence measure)ethnicity and gender the myth measure remained significantly associatedwith four drug use measures Ames Sussman Dent and Stacy (1999)found a myth measure to be a relatively strong psychosocial predictor ofdrug use one-year later Cognitive perceptions obviously play a role indrug abuse prevention (Stein et al 1987) These findings suggest thatcontinued research on drug use myths should prove fruitful forprevention efforts (Sussman et al 1998 2003)

Some cognitive restructuring corrects faulty or self-defeatingcognitive structures (myths) In particular elaborating on the logicalsteps involved in the construction of a drug use myth may help to destroyits impact on behavior For example a common myth suggests thathaving trouble finding onersquos car after getting drunk is a funny event Ifone asks (a) lsquolsquoDid you want to find your carrsquorsquo (b) lsquolsquoWere you too drunk tofind it for a long timersquorsquo and (c) lsquolsquoAnd thatrsquos funnyrsquorsquo the apparent humorin the story may dissipate Further one may delineate the kernel of truthin the myth (not finding onersquos car is an odd event) from the falseaspects of the myth (not finding onersquos car indicates failure of functioningwhich is sad worrisome anxiety provoking not funny)

Stereotyping

Lower risk peers tend to perceive lsquolsquoat riskrsquorsquo others (eg alternativehigh school students) as being more deviant than they actually areUnderstandably youth so-labeled students resent this stereotypeAddressing this stereotype may help prevent drug abuse If lsquolsquoat riskrsquorsquoyouth begin to view themselves as being more deviant than they actually

1990 Sussman et al

ORDER REPRINTS

are the situation could lead to self-fulfilling prophesy as if they weregiving in to the stereotype However lowering the estimates of drug useamong their peers can correct this giving in This version of a prevalence-overestimation reduction lesson which includes a motivational featurehas appeared in successful prevention programs (Sussman et al 2002) Astereotype-oriented lesson may also accomplish a second goal If high-risk youth do not view themselves as being deviant as they assumedothers had judged them possibly reactions against this stereotype mayenergize an effort to avoid drug use as well as portray oneself morefavorably (Hamilton August 20 2000)

Valuing Life and Health Goals

Letrsquos consider the example of older teens Most youth report thatthey plan to graduate from high school and continue their educations orfind a job They do not view hanging out as a desirable option They alsosee that drug use could interfere with achieving their goals A lessonexplaining the negative consequences of drug use particularly oneconsistent with data (Newcomb and Bentler 1988) could reveal howearly involvement with drugs creates symptoms of abuse and dependenceand alters job opportunities marriage and family functioning These lifegoals can seem more valuable as students perceive them as attainableEnhancing the value of life goals can increase motivation for learningadaptive coping (Lau et al 1986) Youth have reported that drug usecould interfere with obtaining desired life goals In theme and componentstudies youth positively evaluated a lesson that taught that drug usecould interfere with obtaining desired goals and that placing animportance on health as a value was consistent with achievement of lifegoals (Sussman 1996) Thus it is important for prevention programs tohelp youth connect the importance of health to obtaining their life goalsand develop a sequenced plan so that they know how to proceed step-by-step (Karoly 1993 Watson and Tharp 2002)

Although modifiable understanding the source of positive life goalsis also important since these may occur earlier in life For instanceNewcomb and Harlow (1986) found that perceived loss of control andmeaninglessness in life mediated the relationship between negative lifeevents and drug use While numerous types of stressful events wereconsidered in this study other studies identify an adverse childhoodfamily environment as a potent precursor to later drug use (Locke andNewcomb in press Palinkas et al 1996) An adverse early homeenvironment a modifiable etiological factor should serve as a focus of

Motivation Skills and Decision Making 1991

ORDER REPRINTS

prevention that addresses child abuse and neglect (see later discussion ofthis topic)

Attitudinal Perspectives

Most youth consider themselves as being moderates They can alsoreliably identify drug use as being a deviant immoderate behaviorPresenting them with the disparity between their self-view as a moderateperson despite their deviant drug use can produce a desired behaviorchange (Sussman 1989 Upshaw and Ostrom 1984) An attitudinalperspective lesson can confront students with the inconsistency betweentheir general self-attitude ratings as moderates vs their more extremespecific behaviors (eg drug use) Adopting a self-perception as amoderate may inoculate youth when social pressures to experiment withdrugs arise A desire for internal consistency a similarity betweenattitudes and behavior may increase motivation to abstain from drugs(Festinger 1957 Heider 1958) Youth received lessons like these quitefavorably in previous work (Salomon et al 1984)

Skills

Direct instruction modeling practice and group reinforcementenhance social learning At least three basic kinds of skills needinstruction self-control communication and resource acquisition

Social Self-control Skills

Good self-control protects against substance use and buffers againstthe impact of risk factors (Bandura 1986 Catalano and Hawkins 1996Weissberg et al 1989 Wills et al 1998) Poor self-control involvesbehavioral affective and cognitive deficits Poor behavioral self-controlis associated with a need to regulate and stabilize mood possiblypreceding uncontrolled behavior or stemming from the consequences ofuncontrolled behavior Poor self-control behavior along with difficultiesin mood stabilization increases risk for substance use and rapidescalation to high levels of use which then can lead to physiologicaldependence (Wills and Stoolmiller 2002)

Self-control strategies cross physiological and personality boundariesbecause self-control also relates to coping motives for substance use a

1992 Sussman et al

ORDER REPRINTS

strong predictor of substance use problems (Wills et al 1999) Self-control includes cognition because developing self-control is the substratefor personality organization including not only behavioral and affectivecontrol but also attitudes values and views of the world as accepting orhostile and social perceptions about substance use as being attractive vsunattractive For example studies find poor self-control correlated withattitudinal tolerance for deviance and more favorable perceptions oftobacco and alcohol users whereas good self-control is related tofavorable perceptions of teens that abstain from drug use (Wills et alin press-a) Self-control approaches can be useful for preventionprograms by improving self and other perceptions academic perfor-mance and the impact or facilitation of negative life events goals that aresalient to teenagers and their parents (Wills and Stoolmiller 2002)

Youth often lack adequate coping skills they tend to lack restraint orplanfulness (Farrell and Danish 1993 Rutter et al 1997) Coping skillsinstruction may help increase self-control (Kendall and Braswell 1982)Coping skills instruction receives little attention in typical social influencesprogramming (Hansen 1992) although this material appears in life skillstraining (Botvin 1993 Botvin et al 1995 Wills 1986) In self-controlprogramming youth learn to assess their self-control particularly in socialcontexts (Sussman et al 2003) They learn the importance of thinkingahead and anticipating problem situations so that they are preparedbeforehand to deal with problems that may arise They also learn theimportance of context (eg not laughing at a funeral) Finally they learnassertiveness and anger management to help them better control theirreactions in social settings (Sambrano May 1999 Sussman et al 2002)

Listening and Communication Skills

Youth genuinely benefit from listening to information with an openmind and asking open-ended questions to keep a conversation goingThey can improve social skills by learning how to ask open-endedquestions establish eye contact appropriately nodding and orientingtheir body toward the other speaker (CPPRG 1999 Eggert and Herting1991 Hawkins et al 1999 Sussman et al 2002 2003) Neverthelesssocial skills training can create problems for nondrug using high-riskteens (Palinkas et al 1996 Sussman et al 1995b Wills et al in press-b)Training in drug refusal may create reactance in some samples (Sussmanet al 1996) Among high-risk youth enhancing assertiveness and datingskills may increase the scope of social entertainment options andinadvertently improve a teenrsquos ability to acquire drugs from new sources

Motivation Skills and Decision Making 1993

ORDER REPRINTS

(Wills et al 1989) Also there are cultural variations on what constitutesgood social skill (Unger et al 2004) There are good arguments forplacing high-risk teens together in activities with well-controlled teens sothat they can model adaptive social skills and problem solvingAdditionally utilizing motivation methods prior to instructing thespecific skill channels canalizes health-directed use of social skillsmastered Overall increasing social competence will have protectiveeffects for high-risk teens (Wills et al 1994) This idea is consistent withthe studies that have shown social withdrawal to increase risk for druguse (Kerr et al 1997) though there may be gender differences in theseeffects (Pulkkinen and Pitkanen 1994) Still it is most wise to includesocial skills training in conjunction with material addressing motivationand decision making Motivations regarding drug use need to beaddressed so behaviors learned are not misdirected

Resource Acquisition

Adults often assume that teens can access community services withlittle effort In fact few teens understand the availability of healthservices or other assistance Simple information including phonenumbers and locations can assist teens immensely (Carroll 1996Sussman et al 2002) Coaching teens on techniques for receivingassistance can prove productive Public assistance for drug use-relatedproblems and other life problems can help tremendously but negotiatingthe bureaucratic difficulties inherent in many of these systems can requireconsiderable skill (Eggert and Herting 1991 Sambrano May 1999Sussman et al 2002) Direct instruction modeling and structuredpractice in resource acquisition skills may help youth to increase theirknowledge and self-efficacy on how to acquire resources and to readilyaccess resources when needed (eg use of the bus system) These skillsmay generalize to comparable tasks later in life

Decision-Making

Prevention programs have employed several decision-making strate-gies For example the protocol from Project Reconnecting Youth(Project RY) is STEPS The acronym stands for Stop Think ofoptions Evaluate options Perform or take action on the chosen optionand then Self-praise for using steps for making healthy choices (Eggertand Herting 1991) The participants help set the agenda and take turns

1994 Sussman et al

ORDER REPRINTS

illustrating it on a flip chart This task helps share the leadership andfocuses the group work and time The lesson STEPS to Drug UseControl follows skills training sessions that cover understandingSTEPS as a decision-making model

Project Towards No Drug Abuse (TND)rsquos decision-making sessioninvolves four steps These steps are

1 Brainstorming (making a list of ideas without judging them)2 Weigh the pros and cons (the benefits and costs of each idea)3 Select the best option4 Follow through (try that option and reevaluate the decision)

(Sussman et al 2002)

These decision-making strategies are similar across different pro-grams except that they include some different emphases For exampleSTEPS includes a self-instruction to begin decision making and self-praise whereas the TND sequence includes more of an emphasis onfollowing through with the decision Generally each program requiresgenerating options evaluating them choosing the best and evaluatingthe outcome in an effort to make the next decision Teens tend to enjoypracticing decision making in bogus problem situations Youth soonlearn to engage in steps like these with considerable skill Training indecision making operates on variables that are intermediate in the causalprocess and thereby strengthen individual profiles of self-controlabilities so that they are more resilient in the face of proximal riskfactors for drug use such as life stresses and peer pressures

Modalities of Programming

Both school and nonschool prevention modalities have a rich andimportant history in substance abuse prevention research (Pentz 1994Pentz et al 2004) Schools provide a captive audience for educationalmaterial Youth spend 25 of their waking lives at school so thisenvironment has considerable potential Furthermore the school contextprovides a rich research history for building new studies and evaluatingtheir efficacy (Sussman et al 1995a) Community programs also offerconsiderable opportunity

Community programs often involve local leaders and organizations(eg coalitions community boards) (Goodman et al 1993 Kaftarianand Hansen 1994) that help mobilize numerous community unitsCommunity units include businesses media the family and governmental

Motivation Skills and Decision Making 1995

ORDER REPRINTS

agencies like the police or recreational departments as well as schoolsystems A network of community units working together to developpromote and implement educational programming could increase youthsrsquobonding to others across a wide variety of social contexts (Hawkins et al1992 Pentz 1994) Community units can provide numerous types ofspecific extra-classroom prevention opportunities (Pentz 1994)

Parent-or-family targeted prevention programs include offering earlychildhood education social support for parents managing crisesparenting skills training parent-child communication skills and resourceacquisition instruction or networking Mass media targeted programsinvolve programs or public service announcements with novel fastand unconventional messages (eg the American Legacy FoundationTRUTH campaign) use of the Internet and interactive CDs (eg videogames) Alternative means to involve youth include involvement in hikingclubs drug-free dances or other after-school events with prosocial adultmentors and with means to involve youth outside of school includingentry into different environments (ie outward bound) (Tobler 1986) Inaddition policy implementation and enforcement may contribute toother prevention programs (Pentz et al 1989) Indeed simultaneousprograms within and outside of schools over long periods might maintainthe positive effects that sometimes dissipate when school programsappear alone (Pentz 1994)

The Difference Between Targeted Prevention and Cessation

Targeted (secondary) prevention attempts to keep persons fromcrossing the invisible line where they funnel into a cycle of addiction andaccumulation of negative consequences Cessation programs (sometimesreferred to as tertiary prevention) take the stance that a behavior hasoccurred with definite and perhaps irreversible negative consequencesThe goal is to stop the behavior permit recovery from the damage learnhow to prevent relapse and learn how to live with permanent changes(eg neurotransmitter function drug use-related injury) It is not clearexactly where indicated prevention ends however and where cessationbegins For example an early version of the Project TND curriculum didnot achieve effects on cigarette smoking possibly because 46 of thesample already smoked cigarettes daily (while not engaging often in someother drug use) In a revised curriculum a smoking cessation componentwas added to the program and then an effect on cigarette smoking wasachieved Cessation material can appear with prevention material to

1996 Sussman et al

ORDER REPRINTS

maximize program effectiveness Careful program development can helpdetermine the best mix (Sussman et al 2002)

Summary of Evidence-based Targeted Drug Abuse Prevention

At present approximately 29 drug-use prevention programs havebeen evaluated favorably for their effects on drug use or other problembehavior (see Table 1) These 29 programs have been identified throughtwo sources Blueprints for Violence Prevention (Elliott 2003) and theSubstance Abuse and Mental Health Services Administrationrsquos(SAMSHA) science-based prevention programsrsquo guide (USDHHS2003) PsycINFO and MEDLINE searches of drug abuse preventionstudies since 1970 supplemented searches through these two guides (seeTable 1) Nine definitions of high-risk were used across these programsEleven programs focused on economic deprivation as the definition Sixprograms focused on delinquent behavior as the identifying characteristicto target Two programs each identified single-parent homes drug use orexposure to drug use family problems alternative high school attendanceor being at risk for dropout at a regular high school as the characteristicsto target subjects Finally one program each identified new immigrantstatus or residential facility placement as the defining characteristic ofbeing at high risk for drug use

Among these programs eight focused on preteens For example theEarly Risers program defined its high-risk youth as those 6ndash10 year-oldsthat suffered economic deprivation and exhibited aggressive or opposi-tional behavior Another five programs focused on a young teen agegroup For example Preventive Intervention defined its high-risk youthas those seventh to eighth graders who exhibited poor school andacademic discipline and reported family problems Another sevenprograms focused on an older teen age group For example ProjectTND defined its high-risk youth as those youth that attended alternativehigh schools Finally nine programs encompassed wide age ranges Forinstance Big Brothers Big Sisters of America defined its high-risk youthas 6ndash18 year-olds that lived in single-parent homes

Of these programs 10 involved multiple often flexible settings ofimplementation Another 13 programs focused on the school settingFour programs focused on the home setting Finally two programsfocused on a community agency setting In general these programsinvolved implementation by highly trained personnel Eighteen of theseprograms involved some motivation aspect generally motivationenhancement but sometimes including extrinsic reinforcement strategies

Motivation Skills and Decision Making 1997

ORDER REPRINTS

Twenty-six of these programs provided skills training Finally 18programs provided instruction in decision making Thus the MSDmodel tends to appear in a majority of these programs however all threecomponents were included together in only nine of these programs

Twenty of these programs involved at least one replication of theprogram and 14 involved three or more replications Further 14 of theseprograms were tested through use of experimental designs and nineinvolved use of only quasi-experimental designs Effects on drug use wereassessed and found in 22 of these programs For example theReconnecting Youth program was implemented to youth at risk fordropout This program involved 90 sessions within a comprehensive highschool class delivered generally over a semester with small studentgroups and a highly trained teacher Instruction included use of groupsupport and providing life skills training (norm setting self-esteem moodmanagement communication skills self-monitoring monitoring goalsschool bonding and social activities) with feedback to parents Programgoals were achieved through use of a quasi-experimental design showingeffects for school performance (18 improvement in grades) drug use(54 decrease in hard drug use) and suicide risk (32 decline inperceived stress) This programrsquos results have been replicated numeroustimes in numerous locations This program involved all three componentsof the MSD model except that motivation was provided through peergroup support not through provision motivation enhancement strate-gies These targeted programs present an optimistic picture for drug-useprevention that is focused on at-risk youth (see Table 1)

Not all targeted prevention programs have been found to beeffective One published program that failed to find positive effects wasProject PALS (Palinkas et al 1996) This project was developed for teengirls who were pregnant or at risk for pregnancy and drug use Theprogram consisted of school-based delivery of 16 sessions once a weekin a class The goal was to decrease drug use The PALS Skills TrainingProgram involved instruction in assertiveness providing and receivingfeedback social conversation handling requests and asking for help andmood management This program was tested against a normativeeducation program (called Facts of Life or FOL) which instructedvalues and decision making sexuality issues and contraception sexuallytransmitted diseases (STDs) drug use risks sexual assault prevalenceand norms material An experimental evaluation with a seven-monthspost-baseline was used The results indicated that the PALS programsubjects reported 29 times greater marijuana use than FOL amongbaseline nonusers No other differences were found It is possible that theprogram was not targeted to the right population that the mix of skills

1998 Sussman et al

ORDER REPRINTS

instructed was not appropriate or that skill training alone (withoutappropriate motivation material) may not be effective in drug useprevention Researchers should examine these possibilities and others tofurther understand program failures as well as program successes

Potential Limitations of Targeted Prevention

Dishion and colleagues (1995) suggest from various findings thatgrouping high-risk youth may lead to increased drug use This outcomecan result if youth come to learn deviant behavior from each other Theycan learn deviant behavior from each other in a program if they haveunstructured or unsupervised time together An essential feature ofseveral targeted programs (eg the RY and TND programs) is building apositive peer culture with group norms that decrease drug involvementand drug-use control problems The RYrsquos findings suggest that a positivepeer group component carefully fostered by a well-trained and competentRY group leader can direct the group toward lower risk behaviorSimilarly classroom management in Project TND involves developmentof positive norms of classroom behavior Further interaction betweenyouth is encouraged but is primarily teacher-directed and highlystructured (Sussman et al 2003) In both RY and Project TND theteacherrsquos role is to actively develop and maintain peer group support inthe class by modeling support positively reinforcing it among groupmembers and negatively reinforcing deviant peer bonds and activities(Eggert and Herting 1991 Vorrath and Brendtro 1985) The teachercreates and structures interactions among youth in prosocial directions(Sussman et al 2003)

Multiple Problem Behaviors of Adolescents

Acknowledging the relationship of drug use to other commonadolescent problems may facilitate identification of effective methods ofreducing drug use Researchers on tobacco alcohol and other drug useantisocial behavior high-risk sexual behavior and depression increas-ingly recognize that these problems are interrelated (McGee andNewcomb 1992) and stem to a large extent from the same environ-mental and biological factors (Biglan et al in press Eggert et al 1995Sussman and Ames 2001 Wills and Cleary 1995) Clearly it is necessaryto have strategies that address the entire range of problems and thecontext that influences those problems Indeed further reductions in

Motivation Skills and Decision Making 1999

ORDER REPRINTS

many problems require that we comprehensively target youth withmultiple problem behaviors

Biglan and colleagues (in press) provide a comprehensive review ofthe relationships among antisocial behavior tobacco alcohol and otherdrug use and high-risk sexual behavior It is clear that the same youngpeople are prone to the development of the entire range of problems In arecent review Moffitt and colleagues (2002) found that antisocialbehavior in early adolescence (rather than late adolescence) is a greaterrisk factor for developing multiple problems These findings point to theimportance of early intervention before youth develop serious problemsMoreover these different problems largely result from the same set ofenvironmental and biological factors

One implication is that disciplines dealing with these problemsother than drug abuse may contribute to dealing with the problem ofdrug use (Newcomb 1996b 1997) In particular research by dev-elopmental psychologists family social workers and sociologists onthe influence of parents on adolescent problem development and oninterventions to alter parenting practices contributes to our understandingof how to prevent or ameliorate drug abuse and other problems Onealso should note that nonsubstance use is not a guarantee for problemimmunity for the entire age range of people whatever their genderethnicity religiosity socioeconomic status (SEC) domicility etc It maybe argued that the most promising programs are those targeting thesemultiple levels of influence Several multidisciplinary programs haveachieved promising results We describe three of these empiricallyevaluated programs tested in various settings

Functional Family Therapy (FFT)FFT is an indicated intervention involving family treatment designed

for delinquent teenagers (also see Table 1) Developed in the early 1970sby Alexander and colleagues (1973) FFT focuses on family commu-nication and the establishment of rules and consequences Several studiesprovide encouraging reports of the programrsquos effectiveness (Alexander etal 1976 Barton et al 1985 Klein et al 1977 Waldron et al 2001) Inthe Waldron et al (2001) study researchers used FFT and anintervention with cognitive behavior therapy on teens referred formarijuana use Each of the interventions produced significant resultson marijuana use by the teens at four months but only the twointerventions combined maintained these results at seven months Theearlier studies found a greater number of results For example in the twoAlexander studies (1973 1976) improvement in family communicationposttreatment led to reduced delinquency Note that all the teens in these

2000 Sussman et al

ORDER REPRINTS

studies had histories of serious antisocial or delinquent behavior Thusachieving positive outcomes even if only short-term should encouragefurther research into the efficacy of FFT

Multisystemic Therapy (MST)As its name suggestsMST targets individual family peer school and

community influences of those youth offenders with serious problems thatmay include violence substance use and severe emotional problems (alsosee Table 1) Numerous researchers have published the results ofrandomized trials of MST (Henggeler et al 1996 1997 1998 Thorntonet al 2000) The most consistent findings across studies are decreased (1)drug use (2) re-arrest (3) self-reported criminal offense and (4) days inout-of-home placements Other consistent findings are improved familyrelations school attendance and psychiatric functioning One cautionarynote the programrsquos effectiveness lowers considerably if not implementedwith fidelity (Hengler et al 1997 1999) In other words all or key lessonsneed to be delivered as written by educators who are well-trained in usingthe strategies employed and youth need to be able to receive all material inan atmosphere conducive to learning the material The programdevelopers have instituted training strategies that address these fidelityissues thus shaping MST to be a very promising program for at-riskyouth

Multidimensional Treatment Foster Care (MTFC)MTFC targets family and peer factors influencing adolescents with a

pattern of repeat criminal offending (see Table 1) (Chamberlain 1994)This intervention includes placement of the youth into a foster homewith a foster parent trained in behavior management who receivessupport from intervention staff After the adolescent has begun torespond to the intervention in the foster home and after the parents havereceived the same training and support as the foster parents did theadolescent returns home Chamberlain and Reid (1998) tested theintervention with 85 boys with felony and other criminal histories andfound substantial benefits of the program Following treatment the boysassigned to MTFC (compared to those receiving community-based groupcare) showed fewer days in detention or lock-up twice as much timeliving with parents fewer misdemeanor and felony arrests and fewer self-reported index crimes felony arrests and general delinquency TheMTFC is a cost-effective alternative to incarceration however staffrequirements are extensive which may influence the ability of some

Motivation Skills and Decision Making 2001

ORDER REPRINTS

groups to apply the program with fidelity However as with each of theprograms described here the results of the randomized trials areencouraging

Future Research Needs in Targeted Prevention

Future research can help discern when and where targeted preventionprogramming will tend to work rather than produce potentiallydeleterious negative group effects or results that are irrelevant for pro-social healthy adaptation as well as what the critical necessary conditionsare for their effective operation within given de facto realities Comparedto the breadth of evaluated universal drug use prevention programs(Tobler et al 2000) relatively few targeted prevention programs havereceived empirical support Yet previous research suggests that universalschool-based drug use prevention programs implemented in junior highschool have relatively less chance of long-term success especially for thoseyouth that began using drugs before the prevention program wasimplemented Of course there are notable exceptions (eg effects lastedfor one and a half years effects lasted for six years) (Chou et al 1998Griffin et al 2003 Skara and Sussman 2003) Almost no research existsregarding maximization of booster programming with high-risk youthMore research on booster programs would help the field

While continuing to engage in this work there will be numerousissues to manage that go well beyond the scope of this article There willbe a need to avoid producing negative labeling effects while providingprogramming for those who are at risk for drug use It is possible thatcessation information needs to be included in the mix with preventionmaterial to provide better targeted-prevention effects There may be aneed to develop a teacher selection instrument to help select out teacherswho can deliver drug abuse prevention programming adequatelyCertainly definition of outcome variables needs continued explorationincluding analysis to ascertain the effects of programming on drug abusevs drug use and identification of the variables that are most closelylinked to change by targeted prevention components

A transdisciplinary approach helps to better understand the lifesituation of high-risk youth as based to some extent on both constitutionaland environmental factors (Fuqua et al 2004 Rutter et al 1997 Wills etal 1996b) From the transactional perspective their situation is in partconstitutional they may have temperamental characteristics that arepartly heritable and that have set the stage at earlier ages for decrements inself-control ability and academic performance that then increase risk for

2002 Sussman et al

ORDER REPRINTS

drug use However their situation is also part environmental based in parton family socialization and in part on the types of peers they have as well asthe type and quality of the physical and cultural environment-at-largeThere are many points at which a potential chain of failures can beinterrupted and the individualrsquos trajectory turned in a better directionProblems are not inevitable from starting level (Tarter and Vanyukov1994) and environmental modifications to support good self-controlability can help to avert an adverse impact from earlier experiences orcurrent difficulties (Brody et al 2002 Novak and Clayton 2001 Patock-Peckham et al 2001 Rutter et al 1997 Wills et al 2002)

The problems and needs of high-risk youth in our nationrsquos highschools demand our attention for designing and rigorously testingtargeted prevention approaches Substantial evidence shows that theseyouth are at greater risk for drug involvement and co-occurring problemssuch as aggression depression and suicidal behaviors as we previouslydiscussed It is hoped that the information presented in this article willstimulate others to join in extending this work including testing othermodels of targeted prevention

GLOSSARY

Universal programs Programs that aim to influence all subjects in acontext

Selective drug-abuse prevention programs Programs that servegroups at greater risk of ATOD usemdashfor example children of alcoholicparents They are at psychosocial risk for drug use and abuse

Indicated drug-abuse prevention programs Programs that attemptto benefit individuals who already show signs of drug involvement orrelated risk factors In indicated prevention programs the primary goal isto stem the progression of ATOD use or reduce drug involvementamong the high-risk youth

Targeted programming Programming that subsumes selective andindicated programming sometimes the other two types of programs thattarget specific groups lsquolsquoat riskrsquorsquo are considered together

ACKNOWLEDGMENTS

This research was supported by grants from the National Institute onDrug Abuse (DA01070 DA07601 DA13814 and DA16094) and by aResearch Scientist Development Award K02 DA00252 from theNational Institute on Drug Abuse

Motivation Skills and Decision Making 2003

ORDER REPRINTS

REFERENCES

Alexander J F Barton C Schiaro R S Parsons B V (1976)

Systems-behavioral intervention with families of delinquents

therapist characteristics family behavior and outcome Journal of

Consulting and Clinical Psychology 44(4)656ndash664Alexander J F Parsons B V (1973) Short-term behavioral interven-

tion with delinquent families impact on family process and

recidivism Journal of Abnormal Psychology 3219ndash225American psychiatric association (APA) (1994) Diagnostic and

Statistical Manual of Mental Disorders 4th edn (DSM-IV)

Washington DC American Psychiatric AssociationAmes S L Sussman S Dent C W (1999) Pro-drug-use myths and

competing constructs in the prediction of substance use among

youth at continuation high schools a one-year prospective study

Personality and Individual Differences 26987ndash1003Bachman S G Wadsworth K N OrsquoMalley P M Johnston L D

Schulenberg J E (1997) Smoking drinking and drug use in young

adulthood Mahwah NJ Lawrence Erlbaum Associates 8ndash25

153ndash190Bandura A (1986) Social Foundations of Thought and Action A Social

Cognitive Theory Englewood Cliffs NJ Prentice HallBarton C Alexander J F Waldron H Turner C W Warburton J

(1985) Generalizing treatment effects of functional family therapy

Three replications The American Journal of Family Therapy

13(3)16ndash26Battin-Pearson S R Newcomb M D Abbott R D Hill K G

Catalano R F Hawkins J D (2000) Predicting early high school

dropout Journal of Educational Psychology 92568ndash582Biglan A Brennan P A Foster S L Holder H D Miller T L

Cunningham P B et al (in press) Helping Adolescents at Risk

Prevention of Multiple Problem Behaviors New York NY Guilford

PressBindra D Stewart J (1996) Motivation Baltimore MD Penguin

BooksBlanton H Gibbons F X Gerrard M Conger K J Smith G E

(1998) The role of family and peers in the development of

prototypes associated with substance use Journal of Family

Psychology 11271ndash288

2004 Sussman et al

ORDER REPRINTS

Botvin G J (1993) School-based drug abuse prevention Long-termfollow-up results In First Annual Meeting of the Society forPrevention Research Kentuck Lexington Society for PreventionResearch

Botvin G J Baker E Dusenbury L Botvin E M Diaz T (1995)Long-term follow-up results of a randomized drug abuse preven-tion trial in a white middle-class population Journal of theAmerican Medical Association 2731106ndash1012

Brody G H Dorsey S Forehand R Armistead L (2002) Uniquecontributions of parenting and classroom processes to the self-control of AfricanndashAmerican children Child Development73274ndash286

Carroll M E (1996) Reducing drug abuse by enriching the environmentwith alternative nondrug reinforcers In Green L Kagel J Heds Advances in Behavioral Economics Norwood NJ NorwoodPublishing Corp 37ndash68

Carver C S Scheier M F (1998) On the Self-Regulation of BehaviorNew York Cambridge University Press

Catalano R F Hawkins J D (1996) The social developmental modela theory of antisocial behavior In Hawkins J D ed Delinquencyand Crime Current Theories New York Cambridge UniversityPress

Centers for Disease Control (CDC) (October 1999) Youth risk BehaviorSurveillancemdashNational Alternative High School Youth RiskBehavior Survey 1998 Morbidity and Mortality Weekly Report48 No SS-7

Chamberlain P (1994) Family connections A treatment foster caremodel for adolescents with delinquency Eugene OR CastaliaPublishing Company

Chamberlain P Reid J B (1998) Comparison of two communityalternatives to incarceration for chronic juvenile offenders Journalof Consulting and Clinical Psychology 66(4)624ndash633

Chassin L A Presson C C Sherman S J (1985) Stepping backwardin order to step forward an acquisition-oriented approach toprimary prevention Journal of Consulting and Clinical Psychology53612ndash622

Chou C-P Montgomery S Pentz M A Rohrbach L A JohnsonC A Flay B R MacKinnon D P (1998) Effects of acommunity-based prevention program on decreasing drug use inhigh-risk adolescentsAmerican Journal of Public Health 88944ndash948

Conducts Problems Prevention Research Group (CPPRG) (1999) Initialimpact of the fast track prevention trial for conduct problems I

Motivation Skills and Decision Making 2005

ORDER REPRINTS

The high-risk sample Journal of Consulting and Clinical Psychology

67631ndash647Conducts Problems Prevention Research Group (CPPRG) (2000)

Merging universal and indicated prevention programs the fast

track model Addictive Behaviors 25913ndash927Council of Philosophical Studies (1981) Psychology and the Philosophy

of Mind in the Philosophy Curriculum San Francisco San Francisco

State UniversityCummings K M Hellmann R Emont S L (1988) Correlates of

participation in a worksite stop smoking program Journal of

Behavioral Medicine 11267ndash277Curry S Wagner E H Gothaus L C (1990) Intrinsic and extrinsic

motivation for smoking cessation Journal of Consulting and

Clinical Psychology 58310ndash316Dent C W Sussman S McCuller W J Stacy A W (2001) Drug

abuse prevention among youth at comprehensive high schools

Preventive Medicine 32514ndash520Dewey J (1886) Psychology New York HarperDishion T J French D C Patterson G R (1995) The development

and ecology of antisocial behavior In Cicchetti D Cohen D

eds Manual of developmental psychopathology New York John

Wiley 421ndash471Eggert L L Herting J R (1991) Preventing teenage drug abuse

exploratory effects of network social support Youth and Society

22482ndash534 [Reprinted National Prevention Evaluation Research

CollectionRockville MD Aspen 1993]Eggert L L Herting J R Thompson E A Nicholas L J Dicker

B G (1994) Preventing adolescent drug abuse and high school

dropout through an intensive school-based social network devel-

opment program American Journal of Health Promotion

8202ndash214Eggert L L Thompson E A Herting J R Nicholas L J (1995)

Reducing suicide potential among high-risk youth tests of a school-

based prevention program Suicide amp Life-Threatening Behavior

25276ndash296Ellickson P L Bell R M (1990) Drug prevention in junior high a

multi-site longitudinal test Science 2471299ndash1305Elliott D S (Series ed) (2003) Blueprints for violence prevention

Boulder CO Institute of Behavioral Science Regents of the

University of Colorado wwwcoloradoeducspvblueprints

2006 Sussman et al

ORDER REPRINTS

Farrell A D Danish S J (1993) Peer drug associations and emotionalrestraint Causes or consequences of adolescent drug use Journal ofConsulting and Clinical Psychology 61327ndash334

Festinger L A (1957) A Theory of Cognitive Dissonance New YorkHarper amp Row

Fuqua J Stokols D Gress J Phillips K Harvey R (2004)Transdisciplinary collaboration as a basis for enhancing the scienceand prevention of substance use and abuse Substance Use ampMisuse

Giuliano J D (1994) A peer education program to promote the use ofconflict resolution skills among at-risk school-age males PublicHealth Reports 109158ndash169

Glynn K Levanthal H Hirschman R (1985) A cognitivedevelopmental approach to smoking prevention In Bell C SBattjes R eds Prevention research Deterring Drug Abuse AmongChildren and Adolescents Rockville MD NIDA ResearchMonograph 63

Glynn T J (1989) Essential elements of school-based smokingprevention programs Journal of School Health 59181ndash188

Goodman R M Burdine J N Meehan E McLeroy K R eds(1993) Community coalitions for health promotion Special issue ofHealth Education Research Theory and Practice 8309ndash453

Goodyear R D Newcomb M D Locke T F (2002) PregnantLatina teenagers psychosocial and developmental determinants ofhow they select and perceive the men who father their childrenJournal of Counseling Psychology 49187ndash201

Gordon R (1987) An operational classification of disease preventionIn Steinberg J A Silverman M M eds Preventing MentalDisorders Rockville MD DHHS 20ndash26

Graham J W Johnson C A Hansen W B Flay B R Gee M(1990) Drug use prevention programs gender and ethnicityevaluation of three seventh-grade project SMART cohortsPreventive Medicine 19305ndash313

Griffin K W Botvin G J Nichols T R Doyal M M (2003)Effectiveness of a universal drug abuse prevention approach foryouth at high risk for substance use initiation Preventive Medicine36(1)1ndash7

Hamilton S (August 20 2000) Views slowly changing on alternativeschools The Sacramento Bee 1ndash3

Hansen W B (1992) School-based substance abuse prevention a reviewof the state of the art in curriculum 1980ndash1990 Health EducationResearch 7403ndash430

Motivation Skills and Decision Making 2007

ORDER REPRINTS

Hansen W B Johnson C A Flay B R Graham J W Sobel J(1988) Affective and social influences approaches to the preventionof multiple substance abuse among seventh grade students resultsfrom project SMART Preventive Medicine 17135ndash154

Hansen W B Graham J W (1991) Preventing alcohol marijuanaand cigarette use among adolescents peer pressure and resistancetraining versus establishing conservative norms PreventiveMedicine 20414ndash430

Hawkins D H Catalano R F Miller J Y (1992) Risk andprotective factors for alcohol and other drug problems inadolescence and early adulthood Implications for substanceabuse prevention Psychological Bulletin 11254ndash105

Hawkins J D Catalano R F Kosterman R Abbott R Hill K G(1999) Preventing adolescent health-risk behaviors by strengthen-ing protection during childhood Archives of Pediatric amp AdolescentMedicine 153226ndash234

Heider F (1958) The Psychology of Interpersonal Relations New YorkWiley

Henggeler S W Pickrel S G Brondino M J Crouch J L (1996)Eliminating (almost) treatment dropout of substance abusing ordependent delinquents through home-based multisystemic therapyAmerican Journal of Psychiatry 153(3)427ndash428

Henggeler S W Melton G B Brondino M J Scherer D GHanley J H (1997) Multisystemic therapy with violent andchronic juvenile offenders and their families the role of treatmentfidelity in successful dissemination Journal of Consulting andClinical Psychology 65(5)821ndash833

Henggeler S W Schoenwald S K Borduin C M Rowland M DCunningham P B (1998) Multisystemic treatment of antisocialbehavior in children and adolescents New York The Guilford Press

Henggeler S W Pickrel S G Brondino M J (1999) Multisystemictreatment of substance-abusing and dependent delinquents out-comes treatment fidelity and transportability Mental HealthServices Residual 1(3)171ndash84

Johnson C A Pentz M A Weber M D Dwyer J H Baer NMacKinnon D P Hansen W B Flay B R (1990) Relativeeffectiveness of comprehensive community programming for drugabuse prevention with high-risk and low-risk adolescents Journalof Consulting and Clinical Psychology 58447ndash456

Kaftarian S J Hansen W B eds (1994) CSAP special issuecommunity partnership program Journal of Community Psychologypages 205

2008 Sussman et al

ORDER REPRINTS

Karoly P (1993) Mechanisms in self-regulation A systems view AnnualReview of Psychology 4423ndash51

Karoly P (1980) Person variables in therapeutic change and develop-ment In Karoly P Steffen J J eds Improving the Long-TermEffects of Psychotherapy New York Gardner Press 195ndash261

Kendall P C Braswell L (1982) Cognitive-behavioral self-controltherapy for children a components analysis Journal of Consultingand Clinical Psychology 50672ndash689

Kerr M Tremblay R E Pagani L Vitaro F (1997) Boysrsquobehavioral inhibition and the risk of later delinquency Archivesof General Psychiatry 54809ndash816

Klein N C Alexander J F Parsons B V (1977) Impact of familysystems intervention on recidivism and sibling delinquency a modelof primary prevention and program evaluation Journal ofConsulting and Clinical Psychology 45(3)469ndash474

Kumpfer K L (1999) Outcomes measures of interventions in the studyof children of substance-abusing parents Pediatrics 1031128ndash1144

Lau R R Hartman K A Ware J E (1986) Health as a valuemethodological and theoretical considerations Health Psychology525ndash43

Lichtenstein E L Glasgow R E (1997) A pragmatic framework forsmoking cessation implications for clinical and public healthprograms Psychology of Addictive Behaviors 11142ndash151

Locke T F Newcomb M D (in press) Childhood maltreatmentparent drug problems polydrug problems and parenting practicesa test of gender differences and four theoretical perspectivesJournal of Family Psychology

McCreary D R Newcomb M D Sadava S W (1999) The male rolealcohol use and alcohol problems a structural modeling examina-tion in adult women and men Journal of Counseling Psychology46109ndash124

McGee L Newcomb M D (1992) General deviance syndromeexpanded hierarchical evaluations at four ages from earlyadolescence to adulthood Journal of Consulting amp ClinicalPsychology 60766ndash776

Miller W R Brown J M (1991) Self-regulation as a conceptual basisfor the prevention of addictive behaviours In Heather N MillerW R Greeley J eds Self-control and the Addictive BehavioursSydney Australia Maxwell Macmillan 3ndash79

Miller W R Leckman A L Delaney H D Tinkcom M (1993)Long-term follow-up of behavioral self-control training forproblem drinkers Journal of Studies on Alcohol 53249ndash261

Motivation Skills and Decision Making 2009

ORDER REPRINTS

Miller W R Rollnick S (1991) Motivational InterviewingPreparing People to Change Addictive Behavior New YorkGuilford Press

Moffitt T E Caspi A Harrington H Milne B J (2002) Males onthe life-course-persistent and adolescence-limited antisocial path-ways follow-up at age 26 years Development and Psychopathology14(1)179ndash207

National Institute on Drug Abuse (NIDA) (1997) Drug abuseprevention What works NIH Publication 97-4110 DHHSNational Institutes of Health National Institute on Drug AbuseOffice of Science Policy and Communications Rockville MD

Newcomb M D (1992a) Substance abuse and control in the UnitedStates ethical and legal issues Social Science and Medicine35471ndash479

Newcomb M D (1992b) Understanding the multidimensional nature ofdrug use and abuse The role of consumption risk factors andprotective factors In Glantz M D Pickens R eds Vulnerabilityto Drug Abuse Washington DC American PsychologicalAssociation 255ndash298

Newcomb M D (1996a) Pseudomaturity among adolescents constructvalidation sex differences and associations in adulthood Journalof Drug Issues 26477ndash504

Newcomb M D (1996b) Adolescence Pathologizing a normal processThe Counseling Psychologist 24482ndash490

Newcomb M D (1997) Psychosocial predictors and consequences ofdrug use a developmental perspective within a prospective studyJournal of Addictive Diseases 1651ndash89

Newcomb M D Bentler P M (1988) Consequences of Adolescent DrugUse Impact on the Lives of Young Adults Beverly Hills CA Sage

Newcomb M D Bentler P M (1989) Substance use and abuse amongchildren and teenagers American Psychologist 44242ndash248

Newcomb M D Harlow L L (1986) Life events and substance useamong adolescents Mediating effects of perceived loss of controland meaninglessness in life Journal of Personality and SocialPsychology 51564ndash577

Newcomb M D Chou C-P Bentler P M Huba G J (1988)Cognitive motivations for drug use among adolescents longitudinaltests of gender differences and predictors of change in drug useJournal of Counseling Psychology 35426ndash438

Newcomb M D Abbott R D Catalano R F Hawkins J DBattin-Pearson S R Hill K (2002) Mediational and deviancetheories of late high school failure Process roles of structural

2010 Sussman et al

ORDER REPRINTS

strains academic competence and general versus specific problem

behaviors Journal of Counseling Psychology 49172ndash186Nezami E Sussman S Pentz M A (2003) Motivation in tobacco use

cessation research Substance Use amp Misuse 3825ndash5Novak S P Clayton R R (2001) The influence of school environment

and self-regulation on transitions between stages of cigarette

smoking Health Psychology 20196ndash207Offord D R (2000) Selection of levels of prevention Addictive

Behaviors 25833ndash842Palinkas L A Atkins C J Miller C Ferreira D (1996) Social skills

training for drug prevention in high-risk female adolescents

Preventive Medicine 25692ndash701Patock-Peckham J A Cheong J-W Balhorn M E Nagoshi C T

(2001) A model of parenting styles self-regulation perceived

drinking control and alcohol use and problems Alcoholism

Experimental and Clinical Research 251284ndash1292Pentz M A (1994) Directions for future research in drug abuse

prevention Preventive Medicine 23646ndash652Pentz M A Dwyer J H MacKinnon D Flay B R Hansen W B

Wang E Y I Johnson C A (1989) A multi-community trial for

primary prevention of adolescent drug abuse effects on drug use

prevalence JAMA 2623259ndash3266Pentz M A Mares D Schinke S Rohrbach L (in press) Political

science public policy and drug abuse prevention Substance Use amp

MisuseProchaska J O DiClemente C C (1982) Transtheoretical therapy

toward a more integrative model of change Psychotherapy Theory

Research and Practice 19275ndash288Pulkkinen L Pitkanen T (1994) A prospective study of the precursors

to problem drinking in young adulthood Journal of Studies on

Alcohol 55578ndash587Rathus S A Nevid J S (1977) Behavior Therapy Strategies for

Solving Problems in Living New York Doubleday and Company

IncResnicow K Botvin G (1993) School-based substance use prevention

programs why do effects decay Preventive Medicine 22484ndash490Rutter M Dunn J Plomin R Simonoff E Pickles A Maughan

B Ormel J Meyer J Eaves L (1997) Integrating nature and

nurture implications of person-environment interactions for

developmental psychopathology Development and Psychopathology

9335ndash364

Motivation Skills and Decision Making 2011

ORDER REPRINTS

Salomon G Stein Y Eisenberg S Klein L (1984) Adolescent

smokers and nonsmokers profiles and their changing structure

Preventive Medicine 13446ndash461Sambrano S (1999) National cross-site evaluation of high risk youth

programs In Interim findings Bulletin Washington DC CSAP

SAMSHA US DHHS May 1ndash16Schinke S P Gilchrist L D (1985) Preventing substance abuse with

children and adolescents Journal of Consulting and Clinical

Psychology 53596ndash602Skara S N Sussman S (2003) A review of 25 long-term adolescent

tobacco and other drug use prevention program evaluations

Preventive MedicineSmith C Lizotte A J Thornberry T P Krohn M D (1995)

Resilient youth identifying factors that prevent high-risk youth

from engaging in delinquency and drug use Delinquency and

Disrepute in the Life Course Greenwich CT John Hagan JAI

press 217ndash247Sommers P V (1972) The Biology of Behavior Australia Pty ltd

Sydney John Wiley amp SonsSt Pierre T L Kaltreider D L Mark M M Aikin K J (1992)

Drug prevention in a community setting a longitudinal study of the

relative effectiveness of a three-year primary prevention program in

boys and girls clubs across the nation American Journal of

Community Psychology 20673ndash706Stein J A Newcomb M D Bentler P M (1987) An eight year study

of multiple influences on drug use and drug use consequences

Journal of Personality and Social Psychology 531094ndash1105Sully J (1884) Outlines of Psychology New York D Appleton amp CoSussman S (1989) Two social influence perspectives of tobacco use

development and prevention Health Education Research Theory

and Practice 4213ndash223Sussman S (1991) Curriculum development in school-based prevention

research Health Education Research Theory and Practice

6339ndash351Sussman S (1996) Development of a school-based drug abuse

prevention curriculum for high risk youth Journal of

Psychoactive Drugs 28169ndash182Sussman S Ames S L (2001) The social psychology of drug abuse

Buckingham GB Open University PressSussman S Unger J (2004) A drug abuse theoretical integration a

transdisciplinary speculation Substance Use amp Misuse

2012 Sussman et al

ORDER REPRINTS

Sussman S Dent C W Burton D Stacy A W Flay B R (1995a)

Developing school-based tobacco use prevention and cessation

programs Thousand Oaks CA Sage Publications IncSussman S Dent C W Simon T R Stacy A W Galaif E R

Moss M A Craig S Johnson C A (1995b) Effectiveness of

social influence substance abuse prevention curricula in compre-

hensive and continuation high schools Drugs and Society 865ndash81Sussman S Dent C W Galaif E R (1997) The correlates of

substance abuse and dependence among adolescents at high risk

for drug abuse Journal of Substance Abuse 9241ndash255Sussman S Dent C W Stacy A W (1996) The relation of pro-drug

use myths with self-reported drug use among youth at continuation

high schools Journal of Applied Social Psychology 26214ndash267Sussman S Dent C W Stacy A Craig S (1998) One-year outcomes

of project towards no drug abuse Preventive Medicine 27632ndash642

(erratum 766)Sussman S Dent C W Stacy S (2002) Project towards no drug

abuse a review of the findings and future directions American

Journal of Health Behavior 26354ndash365Sussman S McCuller W J Dent C W (2003) The associations of

social self-control personality disorders and demographics with

drug use among high risk youth Addictive Behaviors 281159ndash1166Sussman S Rohrbach L Patel R Holiday K (2003) A look at an

interactive classroom-based drug abuse prevention program

Interactive contents and suggestions for research Journal of Drug

Education 33355ndash368Sussman S Sun P McCuller W J Dent C W (2003) Project

towards no drug abuse two year outcomes of a trial that compares

health educator delivery to self-instruction Preventive Medicine

37155ndash162Tarter R E Vanyukov M (1994) Alcoholism a developmental disorder

Journal of Consulting and Clinical Psychology 621096ndash1107Thornton T N Craft C A Dahlberg L L Lynch B S Baer K

(2000) Best Practices of Youth Violence Prevention A Sourcebook

for Community Action Atlanta GA Division of Violence

Prevention Centers for Disease Control and PreventionTobler N S (1986) Meta-analysis of 143 adolescent drug prevention

programs quantitative outcome of program participants compared to

a control or comparison group Journal of Drug Issues 16537ndash567Tobler N S Roona M R Ochshorn P Marshall D G Streke

A V Stackpole K M (2000) School-based adolescent drug

Motivation Skills and Decision Making 2013

ORDER REPRINTS

prevention programs 1998 Meta-analysis The Journal of Primary

Prevention 20275ndash336US Department of Health and Human Services (USDHHS) (2003)

Substance Abuse andMental Health Services Administration Center

for Substance Abuse Prevention Science-based prevention programs and

principles 2002 Rockville MD US DHHS (SMA)03-3764 Also

see httpmodelprogramssamhsagovUnger J Baezconde-Garbanati L Shakib S Palmer P H Nezami

E Mora J (2004) What are the implications of structuralcultural

theory for drug abuse prevention Substance Use amp MisuseUpshaw H S Ostrom T M (1984) Psychological perspective in

attitude research In Eiser J R ed Attitudinal Judgment New

York Springer-Verlag 23ndash42Valente T W Gallaher P Mouttapa M (2004) Using social network

theory to understand and prevent substance use a transdisciplinary

perspective Substance Use amp MisuseVorrath H Brendtro L (1985) Positive peer culture 2nd edn Aldine

ChicagoWaldron H B Slesnick N Brody J L Turner C W Peterson T R

(2001) Treatment outcomes for adolescent substance abuse at 4-

and 7-month assessments Journal of Consulting amp Clinical

Psychology 69(5)802ndash813Watson D L Tharp R G (2002) Self-directed behavior Self-

modification for personal adjustment 8th edn Belmont CA

WadsworthWeissberg R P Caplan M Z Sivo P J (1989) A new conceptual

framework for establishing school-based social competence promo-

tion programs In Bond L A Compas B E eds Primary

Prevention amp Promotion in the Schools Newbury Park CA Sage

255ndash296Wills T A (1986) Stress and coping in early adolescence relationships

to substance use in urban school samples Health Psychology

5503ndash529Wills T A Cleary S D (1995) Stress-coping model for alcohol-

tobacco interactions in adolescence In Fertig J B Allen J P

eds Alcohol and Tobacco From Basic Science to Clinical Practice

Bethesda MD National Institute on Alcohol Abuse and

Alcoholism 107ndash128Wills T A Cleary S D (1999) Peer and adolescent substance use

among 6thndash9th graders Latent growth analyses of influence versus

selection mechanisms Health Psychology 18453ndash463

2014 Sussman et al

ORDER REPRINTS

Wills T A Hirky A E (1996) Coping and substance abuse InZeidner M Endler N S eds Handbook of Coping TheoryResearch and Applications New York Wiley 279ndash302

Wills T A Stoolmiller M (2002) The role of self-control in earlyescalation of substance use a time-varying analysis Journal ofConsulting and Clinical Psychology 70986ndash997

Wills T A Baker E Botvin G J (1989) Dimensions of assertivenessdifferential relationships to substance use in early adolescenceJournal of Consulting and Clinical Psychology 57(4)473ndash478

Wills T A Vaccaro D McNamara G (1994) Novelty seeking risktaking and related constructs as predictors of adolescent substanceuse an application of Cloningerrsquos theory Journal of SubstanceAbuse 61ndash20

Wills T A McNamara G Vaccaro D Hirky A E (1996a)Escalated substance use a longitudinal grouping analysis fromearly to middle adolescence Journal of Abnormal Psychology105166ndash180

Wills T A Pierce J P Evans R I (1996b) Large-scale environmentalrisk factors for substance use American Behavioral Scientist39808ndash822

Wills T A Windle M Cleary S D (1998) Role of temperamentnovelty-seeking and self-control in adolescent substance useJournal of Personality and Social Psychology 74387ndash406

Wills T A Sandy J M Shinar O (1999) Substance use level andproblems in late adolescence a mediational model based on self-control and coping motives Experimental and ClinicalPsychopharmacology 7122ndash134

Wills T A Cleary S D Filer M Shinar O Mariani J Spera K(2001) Temperament and self-control related to early-onsetsubstance use test of a developmental model Prevention Science2145ndash163

Wills T A Sandy J M Yaeger A (2002) Moderators of therelationship between substance use level and problems test of aself-regulation model in adolescence Journal of AbnormalPsychology 1113ndash21

Wills T A Gibbons F X Gerrard M Murry V Brody G (in press-a) Family communication and religiosity related to substance useand sexual behavior in early adolescence Psychology of AddictiveBehaviors

Wills T A Resko J Ainette M Mendoza D (in press-b) The role ofparent and peer support in adolescent substance use a test ofmediated effects Psychology of Addictive Behaviors

Motivation Skills and Decision Making 2015

ORDER REPRINTS

Young P T (1936) Motivation of Behavior New York John Wiley andSons

Zimmerman B J (2000) Attaining self-regulation a social cognitivemodel In Boekaerts M Pintrich P R eds Handbook of Self-Regulation San Diego Academic Press 13ndash39

2016 Sussman et al

Request PermissionOrder Reprints

Reprints of this article can also be ordered at

httpwwwdekkercomservletproductDOI101081JA200034769

Request Permission or Order Reprints Instantly

Interested in copying and sharing this article In most cases US Copyright Law requires that you get permission from the articlersquos rightsholder before using copyrighted content

All information and materials found in this article including but not limited to text trademarks patents logos graphics and images (the Materials) are the copyrighted works and other forms of intellectual property of Marcel Dekker Inc or its licensors All rights not expressly granted are reserved

Get permission to lawfully reproduce and distribute the Materials or order reprints quickly and painlessly Simply click on the Request Permission Order Reprints link below and follow the instructions Visit the US Copyright Office for information on Fair Use limitations of US copyright law Please refer to The Association of American Publishersrsquo (AAP) website for guidelines on Fair Use in the Classroom

The Materials are for your personal use only and cannot be reformatted reposted resold or distributed by electronic means or otherwise without permission from Marcel Dekker Inc Marcel Dekker Inc grants you the limited right to display the Materials only on your personal computer or personal wireless device and to copy and download single copies of such Materials provided that any copyright trademark or other notice appearing on such Materials is also retained by displayed copied or downloaded as part of the Materials and is not removed or obscured and provided you do not edit modify alter or enhance the Materials Please refer to our Website User Agreement for more details

ORDER REPRINTS

Table

1

Continued

Inclusion(ornot)ofMSD

Components

Nameof

Program

Baseline

GradeAge

Range

Definition

ofRisk

Program

Modalities

Motivation

Skills

Decision

Making

Other

Features

Drug

Effects

Project

STEP

14ndash18

Disadvantaged

socioeconomic

status(SES)

low

achieving

disruptive

Schoolphysical

settinghome

room

teacher

role

Accountability

No

No

Homeroom

teachersact

ascounselors

andadvisors

Lessdrug

involvem

ent

bettergrades

anddiscipline

Project

SUCCESS

14ndash18

Alternativehigh

schoolyouth

School-based

counseling

and

education

SAPmodel

No

Yes

Yes

Highly

trained

counselorsasse-

ssment8-session

classgroup

counseling

parentmeeting

referral

Decreased

problem

behavioruse

ofmarijuana

tobaccoand

alcohol

Project

Towards

NoDrugAbuse

(TND)

14ndash19

Alternativehigh

schoolyouth

School-based

classroom

12

sessions

Yes

Yes

Yes

Trained

teachers

Decreaseduse

ofcigarettes

alcoholmar-

ijuanahard

drugsweapons

carrying

Quantum

Opportunities

Program

(QOP)

9thndash12th

Disadvantaged

socioeconomic

status(SES)

familieson

public

assistance

Schoolhome

and

community

contexts

skillsservice

and

education

Money

Yes

Yes

250education

hours250life

skillshoursjob

preparationcul-

turalenrichment

and250hcom-

munityservice

monetary

incentives

Nodruguse

effectsrepor-

tedincrease

inhighschool

graduation

less

likelyto

becomeateen

parentslightly

less

likelyto

be

arrested

1986 Sussman et al

ORDER REPRINTS

Reconnecting

Youth

(RY)

14ndash18

Atrisk

for

drop-out

School-based

90-session

class

Groupsupport

Yes

Yes

Smallstudent

groups

support

highly

trained

teachera

semester

Decreasedhard

druguse

perceived

stress

improved

grades

Residential

Student

Assistance

Program

(RSAP)

14ndash17

Livingin

residential

facilities

Residential-

based

education

program

assessm

ent

counseling

referral

No

Yes

Yes

Highly

trained

counselors

placedin

residential

facilities

8-session

drug

education

individual

andgroup

counseling

Decreaseduse

ofmarijuana

tobaccoand

alcohol

Strengthening

Families

Program

(SFP)

6ndash12

Childrenof

substance

users

Agency-based

14session

skillstraining

No

Yes

Yes

Highly

trained

counselors

parents

and

childseen

separately

firsthour

together

at

thesecond

hour

Reduces

aggression

increases

family

cohesion

immediate

effectson

druguse

Motivation Skills and Decision Making 1987

ORDER REPRINTS

model of drug abuse prevention We see this intrinsicextrinsic motiva-tion notion as providing intrapersonal and extrapersonal stimuli (cues)for action

Finally self-regulation models posit that one is motivated to achievean optimal state or system balance In essence an awareness of lack ofbalance will lead to efforts to restore balance (Carver and Scheier 1998Karoly 1980 1993) Drug abuse prevention may demand considerationof alternative actions in order to maintain homeostasis Affect may serveas the main homeostatic mechanism If people feel good or neutral theywill tend to maintain a given course of behavior On the other hand ifthey feel poorly they will want to change their behavior (as in the law ofeffect)

Constituents are those elements that when combined togethercompose a theoretical structure Seven constituents of motivation appearacross the four general theories (Nezami et al 2003) First the idea ofdiscrepancies appears in all theories Motivation exists as a distancebetween what is and what could be and these models assume that peopledesire to reduce such discrepancies Second motivation functions by theestablishment of goals Third motivation exists as energymdasha want ordrive Goals and the accompanying drive to achieve them usually appeartogether Fourth motivation may appear as a series of stages that lead toan end Different goals may operate at different stages Fifth motivationreflects ambivalence about two or more competing goals or behaviorsWorking through ambivalence enhances motivation Sixth motivationarises from different sources usually intrapsychic or environmentalrewards Finally a homeostatic conceptualization of motivation rests onthe idea of maintaining an optimal set point within a regulatory system

Integrations of these four models of motivation could help achievethe prevention of drug abuse One view suggests that due to lifeexperiences people consider goals or directions For example teens maystart to experiment with drugs due to curiosity perceived social pressureor as a means to induce a life change They may subsequently take risksthat injure their relations with others or impair their achievement inschool At some point a discrepancy likely develops between currentcircumstances and their goals For example teens may know that drugabuse is inconsistent with some life goals like school achievementHowever they may value social interaction and physical pleasure whichthey may reach through drug use or other means

Multiple goals may conflict with each other leading to ambivalence(Karoly 1993) Extrinsic and intrinsic sources of input may helpresolve ambivalence For example as the rewards associated with drugabuse diminish teens may experience a desire to decrease their drug

1988 Sussman et al

ORDER REPRINTS

consumption They may prove more likely to adopt a new goal ofdecreased drug use especially if they believe that they could achieve thegoal as self-efficacy theory suggests

Teens may exert energy to reduce discrepancies between currentstates and desired states They may learn new life or social skills whichcan lead them to become involved in rewarding but nondrug-usingactivities (Carroll 1996) In addition they may become involved in newtypes of social networks containing low-risk rather than high-risk peers(Valente et al 2004 Wills et al in press-b) Finally attaining a healthiergoal can create a positive optimal set point and the motivation systemprovides more positive feedback Over time through experience ofdifferent life events youth may alter the set point and begin a new goal-searching process (Sussman and Unger 2004) One may experience atraumatic life event for example and again consider drug use as a meansto return to an optimal set point or repeatedly get into trouble because ofassociating with deviant peers and realize that there is a need to turn todifferent types of associations

Research and theory from several disciplines suggest many motiva-tion strategies for a successful prevention program These motivationstrategies include myth correction stereotyping valuing life andachievement of health goals

Myth Correction

The recovery movement often refers to substance use and abuse as aproblem of perception Another closely related expression drug use mythsdescribes questionable or dysfunctional expectancies or beliefs that serveto justify drug use Myths involve more than expectancies or beliefs aboutpositive or negative outcomes they include inaccurate expectancies orbeliefs about the characteristics (or norms) of drugs and drug use and arelikely to confuse drug effects with drug experiences

Some common myths include inflated expectancies of positiveoutcomes from drug use or underestimates of negative outcomes fromdrug use Teens may believe that substance use will create peer groupacceptance or help them cope with family and school problems when infact the drug use only diverts them from actively coping with these socialand academic issues Thus in the long run drug use makes things worsenot better (Wills and Hirky 1996) Other myths include endorsement ofmisleading beliefs For example many adolescents believe that learningto manage drug intake without getting sick is a positive sign that theirbodies are growing tolerant to the drug rather than signaling the

Motivation Skills and Decision Making 1989

ORDER REPRINTS

beginnings of drug dependence or addiction In addition misperceptionsregarding physical consequences of drug use operate For example usersmistakenly believe that if they are able to regulate subjective effects of adrug they have gained control over use In reality warning systems maybe deteriorating as addiction begins (Glynn et al 1985 Sussman et al1995b) Challenging drug myths undoubtedly helps prevent drug abuse

These challenges can prove especially useful with high-risk popula-tions particularly if social influence programs are less effective in thesegroups Several prevention researchers have adopted a similar taxonomyof drug myths when attempting to prevent drug use Sussman Dent andStacy (1996) examined the internal consistency and discriminant validityof a measure of drug-related myths in 362 continuation (alternative) highschool youth They found good internal consistency and discriminantvalidity for the measure Controlling for its relations with socialdesirability perceived friendsrsquo drug use (a social influence measure)ethnicity and gender the myth measure remained significantly associatedwith four drug use measures Ames Sussman Dent and Stacy (1999)found a myth measure to be a relatively strong psychosocial predictor ofdrug use one-year later Cognitive perceptions obviously play a role indrug abuse prevention (Stein et al 1987) These findings suggest thatcontinued research on drug use myths should prove fruitful forprevention efforts (Sussman et al 1998 2003)

Some cognitive restructuring corrects faulty or self-defeatingcognitive structures (myths) In particular elaborating on the logicalsteps involved in the construction of a drug use myth may help to destroyits impact on behavior For example a common myth suggests thathaving trouble finding onersquos car after getting drunk is a funny event Ifone asks (a) lsquolsquoDid you want to find your carrsquorsquo (b) lsquolsquoWere you too drunk tofind it for a long timersquorsquo and (c) lsquolsquoAnd thatrsquos funnyrsquorsquo the apparent humorin the story may dissipate Further one may delineate the kernel of truthin the myth (not finding onersquos car is an odd event) from the falseaspects of the myth (not finding onersquos car indicates failure of functioningwhich is sad worrisome anxiety provoking not funny)

Stereotyping

Lower risk peers tend to perceive lsquolsquoat riskrsquorsquo others (eg alternativehigh school students) as being more deviant than they actually areUnderstandably youth so-labeled students resent this stereotypeAddressing this stereotype may help prevent drug abuse If lsquolsquoat riskrsquorsquoyouth begin to view themselves as being more deviant than they actually

1990 Sussman et al

ORDER REPRINTS

are the situation could lead to self-fulfilling prophesy as if they weregiving in to the stereotype However lowering the estimates of drug useamong their peers can correct this giving in This version of a prevalence-overestimation reduction lesson which includes a motivational featurehas appeared in successful prevention programs (Sussman et al 2002) Astereotype-oriented lesson may also accomplish a second goal If high-risk youth do not view themselves as being deviant as they assumedothers had judged them possibly reactions against this stereotype mayenergize an effort to avoid drug use as well as portray oneself morefavorably (Hamilton August 20 2000)

Valuing Life and Health Goals

Letrsquos consider the example of older teens Most youth report thatthey plan to graduate from high school and continue their educations orfind a job They do not view hanging out as a desirable option They alsosee that drug use could interfere with achieving their goals A lessonexplaining the negative consequences of drug use particularly oneconsistent with data (Newcomb and Bentler 1988) could reveal howearly involvement with drugs creates symptoms of abuse and dependenceand alters job opportunities marriage and family functioning These lifegoals can seem more valuable as students perceive them as attainableEnhancing the value of life goals can increase motivation for learningadaptive coping (Lau et al 1986) Youth have reported that drug usecould interfere with obtaining desired life goals In theme and componentstudies youth positively evaluated a lesson that taught that drug usecould interfere with obtaining desired goals and that placing animportance on health as a value was consistent with achievement of lifegoals (Sussman 1996) Thus it is important for prevention programs tohelp youth connect the importance of health to obtaining their life goalsand develop a sequenced plan so that they know how to proceed step-by-step (Karoly 1993 Watson and Tharp 2002)

Although modifiable understanding the source of positive life goalsis also important since these may occur earlier in life For instanceNewcomb and Harlow (1986) found that perceived loss of control andmeaninglessness in life mediated the relationship between negative lifeevents and drug use While numerous types of stressful events wereconsidered in this study other studies identify an adverse childhoodfamily environment as a potent precursor to later drug use (Locke andNewcomb in press Palinkas et al 1996) An adverse early homeenvironment a modifiable etiological factor should serve as a focus of

Motivation Skills and Decision Making 1991

ORDER REPRINTS

prevention that addresses child abuse and neglect (see later discussion ofthis topic)

Attitudinal Perspectives

Most youth consider themselves as being moderates They can alsoreliably identify drug use as being a deviant immoderate behaviorPresenting them with the disparity between their self-view as a moderateperson despite their deviant drug use can produce a desired behaviorchange (Sussman 1989 Upshaw and Ostrom 1984) An attitudinalperspective lesson can confront students with the inconsistency betweentheir general self-attitude ratings as moderates vs their more extremespecific behaviors (eg drug use) Adopting a self-perception as amoderate may inoculate youth when social pressures to experiment withdrugs arise A desire for internal consistency a similarity betweenattitudes and behavior may increase motivation to abstain from drugs(Festinger 1957 Heider 1958) Youth received lessons like these quitefavorably in previous work (Salomon et al 1984)

Skills

Direct instruction modeling practice and group reinforcementenhance social learning At least three basic kinds of skills needinstruction self-control communication and resource acquisition

Social Self-control Skills

Good self-control protects against substance use and buffers againstthe impact of risk factors (Bandura 1986 Catalano and Hawkins 1996Weissberg et al 1989 Wills et al 1998) Poor self-control involvesbehavioral affective and cognitive deficits Poor behavioral self-controlis associated with a need to regulate and stabilize mood possiblypreceding uncontrolled behavior or stemming from the consequences ofuncontrolled behavior Poor self-control behavior along with difficultiesin mood stabilization increases risk for substance use and rapidescalation to high levels of use which then can lead to physiologicaldependence (Wills and Stoolmiller 2002)

Self-control strategies cross physiological and personality boundariesbecause self-control also relates to coping motives for substance use a

1992 Sussman et al

ORDER REPRINTS

strong predictor of substance use problems (Wills et al 1999) Self-control includes cognition because developing self-control is the substratefor personality organization including not only behavioral and affectivecontrol but also attitudes values and views of the world as accepting orhostile and social perceptions about substance use as being attractive vsunattractive For example studies find poor self-control correlated withattitudinal tolerance for deviance and more favorable perceptions oftobacco and alcohol users whereas good self-control is related tofavorable perceptions of teens that abstain from drug use (Wills et alin press-a) Self-control approaches can be useful for preventionprograms by improving self and other perceptions academic perfor-mance and the impact or facilitation of negative life events goals that aresalient to teenagers and their parents (Wills and Stoolmiller 2002)

Youth often lack adequate coping skills they tend to lack restraint orplanfulness (Farrell and Danish 1993 Rutter et al 1997) Coping skillsinstruction may help increase self-control (Kendall and Braswell 1982)Coping skills instruction receives little attention in typical social influencesprogramming (Hansen 1992) although this material appears in life skillstraining (Botvin 1993 Botvin et al 1995 Wills 1986) In self-controlprogramming youth learn to assess their self-control particularly in socialcontexts (Sussman et al 2003) They learn the importance of thinkingahead and anticipating problem situations so that they are preparedbeforehand to deal with problems that may arise They also learn theimportance of context (eg not laughing at a funeral) Finally they learnassertiveness and anger management to help them better control theirreactions in social settings (Sambrano May 1999 Sussman et al 2002)

Listening and Communication Skills

Youth genuinely benefit from listening to information with an openmind and asking open-ended questions to keep a conversation goingThey can improve social skills by learning how to ask open-endedquestions establish eye contact appropriately nodding and orientingtheir body toward the other speaker (CPPRG 1999 Eggert and Herting1991 Hawkins et al 1999 Sussman et al 2002 2003) Neverthelesssocial skills training can create problems for nondrug using high-riskteens (Palinkas et al 1996 Sussman et al 1995b Wills et al in press-b)Training in drug refusal may create reactance in some samples (Sussmanet al 1996) Among high-risk youth enhancing assertiveness and datingskills may increase the scope of social entertainment options andinadvertently improve a teenrsquos ability to acquire drugs from new sources

Motivation Skills and Decision Making 1993

ORDER REPRINTS

(Wills et al 1989) Also there are cultural variations on what constitutesgood social skill (Unger et al 2004) There are good arguments forplacing high-risk teens together in activities with well-controlled teens sothat they can model adaptive social skills and problem solvingAdditionally utilizing motivation methods prior to instructing thespecific skill channels canalizes health-directed use of social skillsmastered Overall increasing social competence will have protectiveeffects for high-risk teens (Wills et al 1994) This idea is consistent withthe studies that have shown social withdrawal to increase risk for druguse (Kerr et al 1997) though there may be gender differences in theseeffects (Pulkkinen and Pitkanen 1994) Still it is most wise to includesocial skills training in conjunction with material addressing motivationand decision making Motivations regarding drug use need to beaddressed so behaviors learned are not misdirected

Resource Acquisition

Adults often assume that teens can access community services withlittle effort In fact few teens understand the availability of healthservices or other assistance Simple information including phonenumbers and locations can assist teens immensely (Carroll 1996Sussman et al 2002) Coaching teens on techniques for receivingassistance can prove productive Public assistance for drug use-relatedproblems and other life problems can help tremendously but negotiatingthe bureaucratic difficulties inherent in many of these systems can requireconsiderable skill (Eggert and Herting 1991 Sambrano May 1999Sussman et al 2002) Direct instruction modeling and structuredpractice in resource acquisition skills may help youth to increase theirknowledge and self-efficacy on how to acquire resources and to readilyaccess resources when needed (eg use of the bus system) These skillsmay generalize to comparable tasks later in life

Decision-Making

Prevention programs have employed several decision-making strate-gies For example the protocol from Project Reconnecting Youth(Project RY) is STEPS The acronym stands for Stop Think ofoptions Evaluate options Perform or take action on the chosen optionand then Self-praise for using steps for making healthy choices (Eggertand Herting 1991) The participants help set the agenda and take turns

1994 Sussman et al

ORDER REPRINTS

illustrating it on a flip chart This task helps share the leadership andfocuses the group work and time The lesson STEPS to Drug UseControl follows skills training sessions that cover understandingSTEPS as a decision-making model

Project Towards No Drug Abuse (TND)rsquos decision-making sessioninvolves four steps These steps are

1 Brainstorming (making a list of ideas without judging them)2 Weigh the pros and cons (the benefits and costs of each idea)3 Select the best option4 Follow through (try that option and reevaluate the decision)

(Sussman et al 2002)

These decision-making strategies are similar across different pro-grams except that they include some different emphases For exampleSTEPS includes a self-instruction to begin decision making and self-praise whereas the TND sequence includes more of an emphasis onfollowing through with the decision Generally each program requiresgenerating options evaluating them choosing the best and evaluatingthe outcome in an effort to make the next decision Teens tend to enjoypracticing decision making in bogus problem situations Youth soonlearn to engage in steps like these with considerable skill Training indecision making operates on variables that are intermediate in the causalprocess and thereby strengthen individual profiles of self-controlabilities so that they are more resilient in the face of proximal riskfactors for drug use such as life stresses and peer pressures

Modalities of Programming

Both school and nonschool prevention modalities have a rich andimportant history in substance abuse prevention research (Pentz 1994Pentz et al 2004) Schools provide a captive audience for educationalmaterial Youth spend 25 of their waking lives at school so thisenvironment has considerable potential Furthermore the school contextprovides a rich research history for building new studies and evaluatingtheir efficacy (Sussman et al 1995a) Community programs also offerconsiderable opportunity

Community programs often involve local leaders and organizations(eg coalitions community boards) (Goodman et al 1993 Kaftarianand Hansen 1994) that help mobilize numerous community unitsCommunity units include businesses media the family and governmental

Motivation Skills and Decision Making 1995

ORDER REPRINTS

agencies like the police or recreational departments as well as schoolsystems A network of community units working together to developpromote and implement educational programming could increase youthsrsquobonding to others across a wide variety of social contexts (Hawkins et al1992 Pentz 1994) Community units can provide numerous types ofspecific extra-classroom prevention opportunities (Pentz 1994)

Parent-or-family targeted prevention programs include offering earlychildhood education social support for parents managing crisesparenting skills training parent-child communication skills and resourceacquisition instruction or networking Mass media targeted programsinvolve programs or public service announcements with novel fastand unconventional messages (eg the American Legacy FoundationTRUTH campaign) use of the Internet and interactive CDs (eg videogames) Alternative means to involve youth include involvement in hikingclubs drug-free dances or other after-school events with prosocial adultmentors and with means to involve youth outside of school includingentry into different environments (ie outward bound) (Tobler 1986) Inaddition policy implementation and enforcement may contribute toother prevention programs (Pentz et al 1989) Indeed simultaneousprograms within and outside of schools over long periods might maintainthe positive effects that sometimes dissipate when school programsappear alone (Pentz 1994)

The Difference Between Targeted Prevention and Cessation

Targeted (secondary) prevention attempts to keep persons fromcrossing the invisible line where they funnel into a cycle of addiction andaccumulation of negative consequences Cessation programs (sometimesreferred to as tertiary prevention) take the stance that a behavior hasoccurred with definite and perhaps irreversible negative consequencesThe goal is to stop the behavior permit recovery from the damage learnhow to prevent relapse and learn how to live with permanent changes(eg neurotransmitter function drug use-related injury) It is not clearexactly where indicated prevention ends however and where cessationbegins For example an early version of the Project TND curriculum didnot achieve effects on cigarette smoking possibly because 46 of thesample already smoked cigarettes daily (while not engaging often in someother drug use) In a revised curriculum a smoking cessation componentwas added to the program and then an effect on cigarette smoking wasachieved Cessation material can appear with prevention material to

1996 Sussman et al

ORDER REPRINTS

maximize program effectiveness Careful program development can helpdetermine the best mix (Sussman et al 2002)

Summary of Evidence-based Targeted Drug Abuse Prevention

At present approximately 29 drug-use prevention programs havebeen evaluated favorably for their effects on drug use or other problembehavior (see Table 1) These 29 programs have been identified throughtwo sources Blueprints for Violence Prevention (Elliott 2003) and theSubstance Abuse and Mental Health Services Administrationrsquos(SAMSHA) science-based prevention programsrsquo guide (USDHHS2003) PsycINFO and MEDLINE searches of drug abuse preventionstudies since 1970 supplemented searches through these two guides (seeTable 1) Nine definitions of high-risk were used across these programsEleven programs focused on economic deprivation as the definition Sixprograms focused on delinquent behavior as the identifying characteristicto target Two programs each identified single-parent homes drug use orexposure to drug use family problems alternative high school attendanceor being at risk for dropout at a regular high school as the characteristicsto target subjects Finally one program each identified new immigrantstatus or residential facility placement as the defining characteristic ofbeing at high risk for drug use

Among these programs eight focused on preteens For example theEarly Risers program defined its high-risk youth as those 6ndash10 year-oldsthat suffered economic deprivation and exhibited aggressive or opposi-tional behavior Another five programs focused on a young teen agegroup For example Preventive Intervention defined its high-risk youthas those seventh to eighth graders who exhibited poor school andacademic discipline and reported family problems Another sevenprograms focused on an older teen age group For example ProjectTND defined its high-risk youth as those youth that attended alternativehigh schools Finally nine programs encompassed wide age ranges Forinstance Big Brothers Big Sisters of America defined its high-risk youthas 6ndash18 year-olds that lived in single-parent homes

Of these programs 10 involved multiple often flexible settings ofimplementation Another 13 programs focused on the school settingFour programs focused on the home setting Finally two programsfocused on a community agency setting In general these programsinvolved implementation by highly trained personnel Eighteen of theseprograms involved some motivation aspect generally motivationenhancement but sometimes including extrinsic reinforcement strategies

Motivation Skills and Decision Making 1997

ORDER REPRINTS

Twenty-six of these programs provided skills training Finally 18programs provided instruction in decision making Thus the MSDmodel tends to appear in a majority of these programs however all threecomponents were included together in only nine of these programs

Twenty of these programs involved at least one replication of theprogram and 14 involved three or more replications Further 14 of theseprograms were tested through use of experimental designs and nineinvolved use of only quasi-experimental designs Effects on drug use wereassessed and found in 22 of these programs For example theReconnecting Youth program was implemented to youth at risk fordropout This program involved 90 sessions within a comprehensive highschool class delivered generally over a semester with small studentgroups and a highly trained teacher Instruction included use of groupsupport and providing life skills training (norm setting self-esteem moodmanagement communication skills self-monitoring monitoring goalsschool bonding and social activities) with feedback to parents Programgoals were achieved through use of a quasi-experimental design showingeffects for school performance (18 improvement in grades) drug use(54 decrease in hard drug use) and suicide risk (32 decline inperceived stress) This programrsquos results have been replicated numeroustimes in numerous locations This program involved all three componentsof the MSD model except that motivation was provided through peergroup support not through provision motivation enhancement strate-gies These targeted programs present an optimistic picture for drug-useprevention that is focused on at-risk youth (see Table 1)

Not all targeted prevention programs have been found to beeffective One published program that failed to find positive effects wasProject PALS (Palinkas et al 1996) This project was developed for teengirls who were pregnant or at risk for pregnancy and drug use Theprogram consisted of school-based delivery of 16 sessions once a weekin a class The goal was to decrease drug use The PALS Skills TrainingProgram involved instruction in assertiveness providing and receivingfeedback social conversation handling requests and asking for help andmood management This program was tested against a normativeeducation program (called Facts of Life or FOL) which instructedvalues and decision making sexuality issues and contraception sexuallytransmitted diseases (STDs) drug use risks sexual assault prevalenceand norms material An experimental evaluation with a seven-monthspost-baseline was used The results indicated that the PALS programsubjects reported 29 times greater marijuana use than FOL amongbaseline nonusers No other differences were found It is possible that theprogram was not targeted to the right population that the mix of skills

1998 Sussman et al

ORDER REPRINTS

instructed was not appropriate or that skill training alone (withoutappropriate motivation material) may not be effective in drug useprevention Researchers should examine these possibilities and others tofurther understand program failures as well as program successes

Potential Limitations of Targeted Prevention

Dishion and colleagues (1995) suggest from various findings thatgrouping high-risk youth may lead to increased drug use This outcomecan result if youth come to learn deviant behavior from each other Theycan learn deviant behavior from each other in a program if they haveunstructured or unsupervised time together An essential feature ofseveral targeted programs (eg the RY and TND programs) is building apositive peer culture with group norms that decrease drug involvementand drug-use control problems The RYrsquos findings suggest that a positivepeer group component carefully fostered by a well-trained and competentRY group leader can direct the group toward lower risk behaviorSimilarly classroom management in Project TND involves developmentof positive norms of classroom behavior Further interaction betweenyouth is encouraged but is primarily teacher-directed and highlystructured (Sussman et al 2003) In both RY and Project TND theteacherrsquos role is to actively develop and maintain peer group support inthe class by modeling support positively reinforcing it among groupmembers and negatively reinforcing deviant peer bonds and activities(Eggert and Herting 1991 Vorrath and Brendtro 1985) The teachercreates and structures interactions among youth in prosocial directions(Sussman et al 2003)

Multiple Problem Behaviors of Adolescents

Acknowledging the relationship of drug use to other commonadolescent problems may facilitate identification of effective methods ofreducing drug use Researchers on tobacco alcohol and other drug useantisocial behavior high-risk sexual behavior and depression increas-ingly recognize that these problems are interrelated (McGee andNewcomb 1992) and stem to a large extent from the same environ-mental and biological factors (Biglan et al in press Eggert et al 1995Sussman and Ames 2001 Wills and Cleary 1995) Clearly it is necessaryto have strategies that address the entire range of problems and thecontext that influences those problems Indeed further reductions in

Motivation Skills and Decision Making 1999

ORDER REPRINTS

many problems require that we comprehensively target youth withmultiple problem behaviors

Biglan and colleagues (in press) provide a comprehensive review ofthe relationships among antisocial behavior tobacco alcohol and otherdrug use and high-risk sexual behavior It is clear that the same youngpeople are prone to the development of the entire range of problems In arecent review Moffitt and colleagues (2002) found that antisocialbehavior in early adolescence (rather than late adolescence) is a greaterrisk factor for developing multiple problems These findings point to theimportance of early intervention before youth develop serious problemsMoreover these different problems largely result from the same set ofenvironmental and biological factors

One implication is that disciplines dealing with these problemsother than drug abuse may contribute to dealing with the problem ofdrug use (Newcomb 1996b 1997) In particular research by dev-elopmental psychologists family social workers and sociologists onthe influence of parents on adolescent problem development and oninterventions to alter parenting practices contributes to our understandingof how to prevent or ameliorate drug abuse and other problems Onealso should note that nonsubstance use is not a guarantee for problemimmunity for the entire age range of people whatever their genderethnicity religiosity socioeconomic status (SEC) domicility etc It maybe argued that the most promising programs are those targeting thesemultiple levels of influence Several multidisciplinary programs haveachieved promising results We describe three of these empiricallyevaluated programs tested in various settings

Functional Family Therapy (FFT)FFT is an indicated intervention involving family treatment designed

for delinquent teenagers (also see Table 1) Developed in the early 1970sby Alexander and colleagues (1973) FFT focuses on family commu-nication and the establishment of rules and consequences Several studiesprovide encouraging reports of the programrsquos effectiveness (Alexander etal 1976 Barton et al 1985 Klein et al 1977 Waldron et al 2001) Inthe Waldron et al (2001) study researchers used FFT and anintervention with cognitive behavior therapy on teens referred formarijuana use Each of the interventions produced significant resultson marijuana use by the teens at four months but only the twointerventions combined maintained these results at seven months Theearlier studies found a greater number of results For example in the twoAlexander studies (1973 1976) improvement in family communicationposttreatment led to reduced delinquency Note that all the teens in these

2000 Sussman et al

ORDER REPRINTS

studies had histories of serious antisocial or delinquent behavior Thusachieving positive outcomes even if only short-term should encouragefurther research into the efficacy of FFT

Multisystemic Therapy (MST)As its name suggestsMST targets individual family peer school and

community influences of those youth offenders with serious problems thatmay include violence substance use and severe emotional problems (alsosee Table 1) Numerous researchers have published the results ofrandomized trials of MST (Henggeler et al 1996 1997 1998 Thorntonet al 2000) The most consistent findings across studies are decreased (1)drug use (2) re-arrest (3) self-reported criminal offense and (4) days inout-of-home placements Other consistent findings are improved familyrelations school attendance and psychiatric functioning One cautionarynote the programrsquos effectiveness lowers considerably if not implementedwith fidelity (Hengler et al 1997 1999) In other words all or key lessonsneed to be delivered as written by educators who are well-trained in usingthe strategies employed and youth need to be able to receive all material inan atmosphere conducive to learning the material The programdevelopers have instituted training strategies that address these fidelityissues thus shaping MST to be a very promising program for at-riskyouth

Multidimensional Treatment Foster Care (MTFC)MTFC targets family and peer factors influencing adolescents with a

pattern of repeat criminal offending (see Table 1) (Chamberlain 1994)This intervention includes placement of the youth into a foster homewith a foster parent trained in behavior management who receivessupport from intervention staff After the adolescent has begun torespond to the intervention in the foster home and after the parents havereceived the same training and support as the foster parents did theadolescent returns home Chamberlain and Reid (1998) tested theintervention with 85 boys with felony and other criminal histories andfound substantial benefits of the program Following treatment the boysassigned to MTFC (compared to those receiving community-based groupcare) showed fewer days in detention or lock-up twice as much timeliving with parents fewer misdemeanor and felony arrests and fewer self-reported index crimes felony arrests and general delinquency TheMTFC is a cost-effective alternative to incarceration however staffrequirements are extensive which may influence the ability of some

Motivation Skills and Decision Making 2001

ORDER REPRINTS

groups to apply the program with fidelity However as with each of theprograms described here the results of the randomized trials areencouraging

Future Research Needs in Targeted Prevention

Future research can help discern when and where targeted preventionprogramming will tend to work rather than produce potentiallydeleterious negative group effects or results that are irrelevant for pro-social healthy adaptation as well as what the critical necessary conditionsare for their effective operation within given de facto realities Comparedto the breadth of evaluated universal drug use prevention programs(Tobler et al 2000) relatively few targeted prevention programs havereceived empirical support Yet previous research suggests that universalschool-based drug use prevention programs implemented in junior highschool have relatively less chance of long-term success especially for thoseyouth that began using drugs before the prevention program wasimplemented Of course there are notable exceptions (eg effects lastedfor one and a half years effects lasted for six years) (Chou et al 1998Griffin et al 2003 Skara and Sussman 2003) Almost no research existsregarding maximization of booster programming with high-risk youthMore research on booster programs would help the field

While continuing to engage in this work there will be numerousissues to manage that go well beyond the scope of this article There willbe a need to avoid producing negative labeling effects while providingprogramming for those who are at risk for drug use It is possible thatcessation information needs to be included in the mix with preventionmaterial to provide better targeted-prevention effects There may be aneed to develop a teacher selection instrument to help select out teacherswho can deliver drug abuse prevention programming adequatelyCertainly definition of outcome variables needs continued explorationincluding analysis to ascertain the effects of programming on drug abusevs drug use and identification of the variables that are most closelylinked to change by targeted prevention components

A transdisciplinary approach helps to better understand the lifesituation of high-risk youth as based to some extent on both constitutionaland environmental factors (Fuqua et al 2004 Rutter et al 1997 Wills etal 1996b) From the transactional perspective their situation is in partconstitutional they may have temperamental characteristics that arepartly heritable and that have set the stage at earlier ages for decrements inself-control ability and academic performance that then increase risk for

2002 Sussman et al

ORDER REPRINTS

drug use However their situation is also part environmental based in parton family socialization and in part on the types of peers they have as well asthe type and quality of the physical and cultural environment-at-largeThere are many points at which a potential chain of failures can beinterrupted and the individualrsquos trajectory turned in a better directionProblems are not inevitable from starting level (Tarter and Vanyukov1994) and environmental modifications to support good self-controlability can help to avert an adverse impact from earlier experiences orcurrent difficulties (Brody et al 2002 Novak and Clayton 2001 Patock-Peckham et al 2001 Rutter et al 1997 Wills et al 2002)

The problems and needs of high-risk youth in our nationrsquos highschools demand our attention for designing and rigorously testingtargeted prevention approaches Substantial evidence shows that theseyouth are at greater risk for drug involvement and co-occurring problemssuch as aggression depression and suicidal behaviors as we previouslydiscussed It is hoped that the information presented in this article willstimulate others to join in extending this work including testing othermodels of targeted prevention

GLOSSARY

Universal programs Programs that aim to influence all subjects in acontext

Selective drug-abuse prevention programs Programs that servegroups at greater risk of ATOD usemdashfor example children of alcoholicparents They are at psychosocial risk for drug use and abuse

Indicated drug-abuse prevention programs Programs that attemptto benefit individuals who already show signs of drug involvement orrelated risk factors In indicated prevention programs the primary goal isto stem the progression of ATOD use or reduce drug involvementamong the high-risk youth

Targeted programming Programming that subsumes selective andindicated programming sometimes the other two types of programs thattarget specific groups lsquolsquoat riskrsquorsquo are considered together

ACKNOWLEDGMENTS

This research was supported by grants from the National Institute onDrug Abuse (DA01070 DA07601 DA13814 and DA16094) and by aResearch Scientist Development Award K02 DA00252 from theNational Institute on Drug Abuse

Motivation Skills and Decision Making 2003

ORDER REPRINTS

REFERENCES

Alexander J F Barton C Schiaro R S Parsons B V (1976)

Systems-behavioral intervention with families of delinquents

therapist characteristics family behavior and outcome Journal of

Consulting and Clinical Psychology 44(4)656ndash664Alexander J F Parsons B V (1973) Short-term behavioral interven-

tion with delinquent families impact on family process and

recidivism Journal of Abnormal Psychology 3219ndash225American psychiatric association (APA) (1994) Diagnostic and

Statistical Manual of Mental Disorders 4th edn (DSM-IV)

Washington DC American Psychiatric AssociationAmes S L Sussman S Dent C W (1999) Pro-drug-use myths and

competing constructs in the prediction of substance use among

youth at continuation high schools a one-year prospective study

Personality and Individual Differences 26987ndash1003Bachman S G Wadsworth K N OrsquoMalley P M Johnston L D

Schulenberg J E (1997) Smoking drinking and drug use in young

adulthood Mahwah NJ Lawrence Erlbaum Associates 8ndash25

153ndash190Bandura A (1986) Social Foundations of Thought and Action A Social

Cognitive Theory Englewood Cliffs NJ Prentice HallBarton C Alexander J F Waldron H Turner C W Warburton J

(1985) Generalizing treatment effects of functional family therapy

Three replications The American Journal of Family Therapy

13(3)16ndash26Battin-Pearson S R Newcomb M D Abbott R D Hill K G

Catalano R F Hawkins J D (2000) Predicting early high school

dropout Journal of Educational Psychology 92568ndash582Biglan A Brennan P A Foster S L Holder H D Miller T L

Cunningham P B et al (in press) Helping Adolescents at Risk

Prevention of Multiple Problem Behaviors New York NY Guilford

PressBindra D Stewart J (1996) Motivation Baltimore MD Penguin

BooksBlanton H Gibbons F X Gerrard M Conger K J Smith G E

(1998) The role of family and peers in the development of

prototypes associated with substance use Journal of Family

Psychology 11271ndash288

2004 Sussman et al

ORDER REPRINTS

Botvin G J (1993) School-based drug abuse prevention Long-termfollow-up results In First Annual Meeting of the Society forPrevention Research Kentuck Lexington Society for PreventionResearch

Botvin G J Baker E Dusenbury L Botvin E M Diaz T (1995)Long-term follow-up results of a randomized drug abuse preven-tion trial in a white middle-class population Journal of theAmerican Medical Association 2731106ndash1012

Brody G H Dorsey S Forehand R Armistead L (2002) Uniquecontributions of parenting and classroom processes to the self-control of AfricanndashAmerican children Child Development73274ndash286

Carroll M E (1996) Reducing drug abuse by enriching the environmentwith alternative nondrug reinforcers In Green L Kagel J Heds Advances in Behavioral Economics Norwood NJ NorwoodPublishing Corp 37ndash68

Carver C S Scheier M F (1998) On the Self-Regulation of BehaviorNew York Cambridge University Press

Catalano R F Hawkins J D (1996) The social developmental modela theory of antisocial behavior In Hawkins J D ed Delinquencyand Crime Current Theories New York Cambridge UniversityPress

Centers for Disease Control (CDC) (October 1999) Youth risk BehaviorSurveillancemdashNational Alternative High School Youth RiskBehavior Survey 1998 Morbidity and Mortality Weekly Report48 No SS-7

Chamberlain P (1994) Family connections A treatment foster caremodel for adolescents with delinquency Eugene OR CastaliaPublishing Company

Chamberlain P Reid J B (1998) Comparison of two communityalternatives to incarceration for chronic juvenile offenders Journalof Consulting and Clinical Psychology 66(4)624ndash633

Chassin L A Presson C C Sherman S J (1985) Stepping backwardin order to step forward an acquisition-oriented approach toprimary prevention Journal of Consulting and Clinical Psychology53612ndash622

Chou C-P Montgomery S Pentz M A Rohrbach L A JohnsonC A Flay B R MacKinnon D P (1998) Effects of acommunity-based prevention program on decreasing drug use inhigh-risk adolescentsAmerican Journal of Public Health 88944ndash948

Conducts Problems Prevention Research Group (CPPRG) (1999) Initialimpact of the fast track prevention trial for conduct problems I

Motivation Skills and Decision Making 2005

ORDER REPRINTS

The high-risk sample Journal of Consulting and Clinical Psychology

67631ndash647Conducts Problems Prevention Research Group (CPPRG) (2000)

Merging universal and indicated prevention programs the fast

track model Addictive Behaviors 25913ndash927Council of Philosophical Studies (1981) Psychology and the Philosophy

of Mind in the Philosophy Curriculum San Francisco San Francisco

State UniversityCummings K M Hellmann R Emont S L (1988) Correlates of

participation in a worksite stop smoking program Journal of

Behavioral Medicine 11267ndash277Curry S Wagner E H Gothaus L C (1990) Intrinsic and extrinsic

motivation for smoking cessation Journal of Consulting and

Clinical Psychology 58310ndash316Dent C W Sussman S McCuller W J Stacy A W (2001) Drug

abuse prevention among youth at comprehensive high schools

Preventive Medicine 32514ndash520Dewey J (1886) Psychology New York HarperDishion T J French D C Patterson G R (1995) The development

and ecology of antisocial behavior In Cicchetti D Cohen D

eds Manual of developmental psychopathology New York John

Wiley 421ndash471Eggert L L Herting J R (1991) Preventing teenage drug abuse

exploratory effects of network social support Youth and Society

22482ndash534 [Reprinted National Prevention Evaluation Research

CollectionRockville MD Aspen 1993]Eggert L L Herting J R Thompson E A Nicholas L J Dicker

B G (1994) Preventing adolescent drug abuse and high school

dropout through an intensive school-based social network devel-

opment program American Journal of Health Promotion

8202ndash214Eggert L L Thompson E A Herting J R Nicholas L J (1995)

Reducing suicide potential among high-risk youth tests of a school-

based prevention program Suicide amp Life-Threatening Behavior

25276ndash296Ellickson P L Bell R M (1990) Drug prevention in junior high a

multi-site longitudinal test Science 2471299ndash1305Elliott D S (Series ed) (2003) Blueprints for violence prevention

Boulder CO Institute of Behavioral Science Regents of the

University of Colorado wwwcoloradoeducspvblueprints

2006 Sussman et al

ORDER REPRINTS

Farrell A D Danish S J (1993) Peer drug associations and emotionalrestraint Causes or consequences of adolescent drug use Journal ofConsulting and Clinical Psychology 61327ndash334

Festinger L A (1957) A Theory of Cognitive Dissonance New YorkHarper amp Row

Fuqua J Stokols D Gress J Phillips K Harvey R (2004)Transdisciplinary collaboration as a basis for enhancing the scienceand prevention of substance use and abuse Substance Use ampMisuse

Giuliano J D (1994) A peer education program to promote the use ofconflict resolution skills among at-risk school-age males PublicHealth Reports 109158ndash169

Glynn K Levanthal H Hirschman R (1985) A cognitivedevelopmental approach to smoking prevention In Bell C SBattjes R eds Prevention research Deterring Drug Abuse AmongChildren and Adolescents Rockville MD NIDA ResearchMonograph 63

Glynn T J (1989) Essential elements of school-based smokingprevention programs Journal of School Health 59181ndash188

Goodman R M Burdine J N Meehan E McLeroy K R eds(1993) Community coalitions for health promotion Special issue ofHealth Education Research Theory and Practice 8309ndash453

Goodyear R D Newcomb M D Locke T F (2002) PregnantLatina teenagers psychosocial and developmental determinants ofhow they select and perceive the men who father their childrenJournal of Counseling Psychology 49187ndash201

Gordon R (1987) An operational classification of disease preventionIn Steinberg J A Silverman M M eds Preventing MentalDisorders Rockville MD DHHS 20ndash26

Graham J W Johnson C A Hansen W B Flay B R Gee M(1990) Drug use prevention programs gender and ethnicityevaluation of three seventh-grade project SMART cohortsPreventive Medicine 19305ndash313

Griffin K W Botvin G J Nichols T R Doyal M M (2003)Effectiveness of a universal drug abuse prevention approach foryouth at high risk for substance use initiation Preventive Medicine36(1)1ndash7

Hamilton S (August 20 2000) Views slowly changing on alternativeschools The Sacramento Bee 1ndash3

Hansen W B (1992) School-based substance abuse prevention a reviewof the state of the art in curriculum 1980ndash1990 Health EducationResearch 7403ndash430

Motivation Skills and Decision Making 2007

ORDER REPRINTS

Hansen W B Johnson C A Flay B R Graham J W Sobel J(1988) Affective and social influences approaches to the preventionof multiple substance abuse among seventh grade students resultsfrom project SMART Preventive Medicine 17135ndash154

Hansen W B Graham J W (1991) Preventing alcohol marijuanaand cigarette use among adolescents peer pressure and resistancetraining versus establishing conservative norms PreventiveMedicine 20414ndash430

Hawkins D H Catalano R F Miller J Y (1992) Risk andprotective factors for alcohol and other drug problems inadolescence and early adulthood Implications for substanceabuse prevention Psychological Bulletin 11254ndash105

Hawkins J D Catalano R F Kosterman R Abbott R Hill K G(1999) Preventing adolescent health-risk behaviors by strengthen-ing protection during childhood Archives of Pediatric amp AdolescentMedicine 153226ndash234

Heider F (1958) The Psychology of Interpersonal Relations New YorkWiley

Henggeler S W Pickrel S G Brondino M J Crouch J L (1996)Eliminating (almost) treatment dropout of substance abusing ordependent delinquents through home-based multisystemic therapyAmerican Journal of Psychiatry 153(3)427ndash428

Henggeler S W Melton G B Brondino M J Scherer D GHanley J H (1997) Multisystemic therapy with violent andchronic juvenile offenders and their families the role of treatmentfidelity in successful dissemination Journal of Consulting andClinical Psychology 65(5)821ndash833

Henggeler S W Schoenwald S K Borduin C M Rowland M DCunningham P B (1998) Multisystemic treatment of antisocialbehavior in children and adolescents New York The Guilford Press

Henggeler S W Pickrel S G Brondino M J (1999) Multisystemictreatment of substance-abusing and dependent delinquents out-comes treatment fidelity and transportability Mental HealthServices Residual 1(3)171ndash84

Johnson C A Pentz M A Weber M D Dwyer J H Baer NMacKinnon D P Hansen W B Flay B R (1990) Relativeeffectiveness of comprehensive community programming for drugabuse prevention with high-risk and low-risk adolescents Journalof Consulting and Clinical Psychology 58447ndash456

Kaftarian S J Hansen W B eds (1994) CSAP special issuecommunity partnership program Journal of Community Psychologypages 205

2008 Sussman et al

ORDER REPRINTS

Karoly P (1993) Mechanisms in self-regulation A systems view AnnualReview of Psychology 4423ndash51

Karoly P (1980) Person variables in therapeutic change and develop-ment In Karoly P Steffen J J eds Improving the Long-TermEffects of Psychotherapy New York Gardner Press 195ndash261

Kendall P C Braswell L (1982) Cognitive-behavioral self-controltherapy for children a components analysis Journal of Consultingand Clinical Psychology 50672ndash689

Kerr M Tremblay R E Pagani L Vitaro F (1997) Boysrsquobehavioral inhibition and the risk of later delinquency Archivesof General Psychiatry 54809ndash816

Klein N C Alexander J F Parsons B V (1977) Impact of familysystems intervention on recidivism and sibling delinquency a modelof primary prevention and program evaluation Journal ofConsulting and Clinical Psychology 45(3)469ndash474

Kumpfer K L (1999) Outcomes measures of interventions in the studyof children of substance-abusing parents Pediatrics 1031128ndash1144

Lau R R Hartman K A Ware J E (1986) Health as a valuemethodological and theoretical considerations Health Psychology525ndash43

Lichtenstein E L Glasgow R E (1997) A pragmatic framework forsmoking cessation implications for clinical and public healthprograms Psychology of Addictive Behaviors 11142ndash151

Locke T F Newcomb M D (in press) Childhood maltreatmentparent drug problems polydrug problems and parenting practicesa test of gender differences and four theoretical perspectivesJournal of Family Psychology

McCreary D R Newcomb M D Sadava S W (1999) The male rolealcohol use and alcohol problems a structural modeling examina-tion in adult women and men Journal of Counseling Psychology46109ndash124

McGee L Newcomb M D (1992) General deviance syndromeexpanded hierarchical evaluations at four ages from earlyadolescence to adulthood Journal of Consulting amp ClinicalPsychology 60766ndash776

Miller W R Brown J M (1991) Self-regulation as a conceptual basisfor the prevention of addictive behaviours In Heather N MillerW R Greeley J eds Self-control and the Addictive BehavioursSydney Australia Maxwell Macmillan 3ndash79

Miller W R Leckman A L Delaney H D Tinkcom M (1993)Long-term follow-up of behavioral self-control training forproblem drinkers Journal of Studies on Alcohol 53249ndash261

Motivation Skills and Decision Making 2009

ORDER REPRINTS

Miller W R Rollnick S (1991) Motivational InterviewingPreparing People to Change Addictive Behavior New YorkGuilford Press

Moffitt T E Caspi A Harrington H Milne B J (2002) Males onthe life-course-persistent and adolescence-limited antisocial path-ways follow-up at age 26 years Development and Psychopathology14(1)179ndash207

National Institute on Drug Abuse (NIDA) (1997) Drug abuseprevention What works NIH Publication 97-4110 DHHSNational Institutes of Health National Institute on Drug AbuseOffice of Science Policy and Communications Rockville MD

Newcomb M D (1992a) Substance abuse and control in the UnitedStates ethical and legal issues Social Science and Medicine35471ndash479

Newcomb M D (1992b) Understanding the multidimensional nature ofdrug use and abuse The role of consumption risk factors andprotective factors In Glantz M D Pickens R eds Vulnerabilityto Drug Abuse Washington DC American PsychologicalAssociation 255ndash298

Newcomb M D (1996a) Pseudomaturity among adolescents constructvalidation sex differences and associations in adulthood Journalof Drug Issues 26477ndash504

Newcomb M D (1996b) Adolescence Pathologizing a normal processThe Counseling Psychologist 24482ndash490

Newcomb M D (1997) Psychosocial predictors and consequences ofdrug use a developmental perspective within a prospective studyJournal of Addictive Diseases 1651ndash89

Newcomb M D Bentler P M (1988) Consequences of Adolescent DrugUse Impact on the Lives of Young Adults Beverly Hills CA Sage

Newcomb M D Bentler P M (1989) Substance use and abuse amongchildren and teenagers American Psychologist 44242ndash248

Newcomb M D Harlow L L (1986) Life events and substance useamong adolescents Mediating effects of perceived loss of controland meaninglessness in life Journal of Personality and SocialPsychology 51564ndash577

Newcomb M D Chou C-P Bentler P M Huba G J (1988)Cognitive motivations for drug use among adolescents longitudinaltests of gender differences and predictors of change in drug useJournal of Counseling Psychology 35426ndash438

Newcomb M D Abbott R D Catalano R F Hawkins J DBattin-Pearson S R Hill K (2002) Mediational and deviancetheories of late high school failure Process roles of structural

2010 Sussman et al

ORDER REPRINTS

strains academic competence and general versus specific problem

behaviors Journal of Counseling Psychology 49172ndash186Nezami E Sussman S Pentz M A (2003) Motivation in tobacco use

cessation research Substance Use amp Misuse 3825ndash5Novak S P Clayton R R (2001) The influence of school environment

and self-regulation on transitions between stages of cigarette

smoking Health Psychology 20196ndash207Offord D R (2000) Selection of levels of prevention Addictive

Behaviors 25833ndash842Palinkas L A Atkins C J Miller C Ferreira D (1996) Social skills

training for drug prevention in high-risk female adolescents

Preventive Medicine 25692ndash701Patock-Peckham J A Cheong J-W Balhorn M E Nagoshi C T

(2001) A model of parenting styles self-regulation perceived

drinking control and alcohol use and problems Alcoholism

Experimental and Clinical Research 251284ndash1292Pentz M A (1994) Directions for future research in drug abuse

prevention Preventive Medicine 23646ndash652Pentz M A Dwyer J H MacKinnon D Flay B R Hansen W B

Wang E Y I Johnson C A (1989) A multi-community trial for

primary prevention of adolescent drug abuse effects on drug use

prevalence JAMA 2623259ndash3266Pentz M A Mares D Schinke S Rohrbach L (in press) Political

science public policy and drug abuse prevention Substance Use amp

MisuseProchaska J O DiClemente C C (1982) Transtheoretical therapy

toward a more integrative model of change Psychotherapy Theory

Research and Practice 19275ndash288Pulkkinen L Pitkanen T (1994) A prospective study of the precursors

to problem drinking in young adulthood Journal of Studies on

Alcohol 55578ndash587Rathus S A Nevid J S (1977) Behavior Therapy Strategies for

Solving Problems in Living New York Doubleday and Company

IncResnicow K Botvin G (1993) School-based substance use prevention

programs why do effects decay Preventive Medicine 22484ndash490Rutter M Dunn J Plomin R Simonoff E Pickles A Maughan

B Ormel J Meyer J Eaves L (1997) Integrating nature and

nurture implications of person-environment interactions for

developmental psychopathology Development and Psychopathology

9335ndash364

Motivation Skills and Decision Making 2011

ORDER REPRINTS

Salomon G Stein Y Eisenberg S Klein L (1984) Adolescent

smokers and nonsmokers profiles and their changing structure

Preventive Medicine 13446ndash461Sambrano S (1999) National cross-site evaluation of high risk youth

programs In Interim findings Bulletin Washington DC CSAP

SAMSHA US DHHS May 1ndash16Schinke S P Gilchrist L D (1985) Preventing substance abuse with

children and adolescents Journal of Consulting and Clinical

Psychology 53596ndash602Skara S N Sussman S (2003) A review of 25 long-term adolescent

tobacco and other drug use prevention program evaluations

Preventive MedicineSmith C Lizotte A J Thornberry T P Krohn M D (1995)

Resilient youth identifying factors that prevent high-risk youth

from engaging in delinquency and drug use Delinquency and

Disrepute in the Life Course Greenwich CT John Hagan JAI

press 217ndash247Sommers P V (1972) The Biology of Behavior Australia Pty ltd

Sydney John Wiley amp SonsSt Pierre T L Kaltreider D L Mark M M Aikin K J (1992)

Drug prevention in a community setting a longitudinal study of the

relative effectiveness of a three-year primary prevention program in

boys and girls clubs across the nation American Journal of

Community Psychology 20673ndash706Stein J A Newcomb M D Bentler P M (1987) An eight year study

of multiple influences on drug use and drug use consequences

Journal of Personality and Social Psychology 531094ndash1105Sully J (1884) Outlines of Psychology New York D Appleton amp CoSussman S (1989) Two social influence perspectives of tobacco use

development and prevention Health Education Research Theory

and Practice 4213ndash223Sussman S (1991) Curriculum development in school-based prevention

research Health Education Research Theory and Practice

6339ndash351Sussman S (1996) Development of a school-based drug abuse

prevention curriculum for high risk youth Journal of

Psychoactive Drugs 28169ndash182Sussman S Ames S L (2001) The social psychology of drug abuse

Buckingham GB Open University PressSussman S Unger J (2004) A drug abuse theoretical integration a

transdisciplinary speculation Substance Use amp Misuse

2012 Sussman et al

ORDER REPRINTS

Sussman S Dent C W Burton D Stacy A W Flay B R (1995a)

Developing school-based tobacco use prevention and cessation

programs Thousand Oaks CA Sage Publications IncSussman S Dent C W Simon T R Stacy A W Galaif E R

Moss M A Craig S Johnson C A (1995b) Effectiveness of

social influence substance abuse prevention curricula in compre-

hensive and continuation high schools Drugs and Society 865ndash81Sussman S Dent C W Galaif E R (1997) The correlates of

substance abuse and dependence among adolescents at high risk

for drug abuse Journal of Substance Abuse 9241ndash255Sussman S Dent C W Stacy A W (1996) The relation of pro-drug

use myths with self-reported drug use among youth at continuation

high schools Journal of Applied Social Psychology 26214ndash267Sussman S Dent C W Stacy A Craig S (1998) One-year outcomes

of project towards no drug abuse Preventive Medicine 27632ndash642

(erratum 766)Sussman S Dent C W Stacy S (2002) Project towards no drug

abuse a review of the findings and future directions American

Journal of Health Behavior 26354ndash365Sussman S McCuller W J Dent C W (2003) The associations of

social self-control personality disorders and demographics with

drug use among high risk youth Addictive Behaviors 281159ndash1166Sussman S Rohrbach L Patel R Holiday K (2003) A look at an

interactive classroom-based drug abuse prevention program

Interactive contents and suggestions for research Journal of Drug

Education 33355ndash368Sussman S Sun P McCuller W J Dent C W (2003) Project

towards no drug abuse two year outcomes of a trial that compares

health educator delivery to self-instruction Preventive Medicine

37155ndash162Tarter R E Vanyukov M (1994) Alcoholism a developmental disorder

Journal of Consulting and Clinical Psychology 621096ndash1107Thornton T N Craft C A Dahlberg L L Lynch B S Baer K

(2000) Best Practices of Youth Violence Prevention A Sourcebook

for Community Action Atlanta GA Division of Violence

Prevention Centers for Disease Control and PreventionTobler N S (1986) Meta-analysis of 143 adolescent drug prevention

programs quantitative outcome of program participants compared to

a control or comparison group Journal of Drug Issues 16537ndash567Tobler N S Roona M R Ochshorn P Marshall D G Streke

A V Stackpole K M (2000) School-based adolescent drug

Motivation Skills and Decision Making 2013

ORDER REPRINTS

prevention programs 1998 Meta-analysis The Journal of Primary

Prevention 20275ndash336US Department of Health and Human Services (USDHHS) (2003)

Substance Abuse andMental Health Services Administration Center

for Substance Abuse Prevention Science-based prevention programs and

principles 2002 Rockville MD US DHHS (SMA)03-3764 Also

see httpmodelprogramssamhsagovUnger J Baezconde-Garbanati L Shakib S Palmer P H Nezami

E Mora J (2004) What are the implications of structuralcultural

theory for drug abuse prevention Substance Use amp MisuseUpshaw H S Ostrom T M (1984) Psychological perspective in

attitude research In Eiser J R ed Attitudinal Judgment New

York Springer-Verlag 23ndash42Valente T W Gallaher P Mouttapa M (2004) Using social network

theory to understand and prevent substance use a transdisciplinary

perspective Substance Use amp MisuseVorrath H Brendtro L (1985) Positive peer culture 2nd edn Aldine

ChicagoWaldron H B Slesnick N Brody J L Turner C W Peterson T R

(2001) Treatment outcomes for adolescent substance abuse at 4-

and 7-month assessments Journal of Consulting amp Clinical

Psychology 69(5)802ndash813Watson D L Tharp R G (2002) Self-directed behavior Self-

modification for personal adjustment 8th edn Belmont CA

WadsworthWeissberg R P Caplan M Z Sivo P J (1989) A new conceptual

framework for establishing school-based social competence promo-

tion programs In Bond L A Compas B E eds Primary

Prevention amp Promotion in the Schools Newbury Park CA Sage

255ndash296Wills T A (1986) Stress and coping in early adolescence relationships

to substance use in urban school samples Health Psychology

5503ndash529Wills T A Cleary S D (1995) Stress-coping model for alcohol-

tobacco interactions in adolescence In Fertig J B Allen J P

eds Alcohol and Tobacco From Basic Science to Clinical Practice

Bethesda MD National Institute on Alcohol Abuse and

Alcoholism 107ndash128Wills T A Cleary S D (1999) Peer and adolescent substance use

among 6thndash9th graders Latent growth analyses of influence versus

selection mechanisms Health Psychology 18453ndash463

2014 Sussman et al

ORDER REPRINTS

Wills T A Hirky A E (1996) Coping and substance abuse InZeidner M Endler N S eds Handbook of Coping TheoryResearch and Applications New York Wiley 279ndash302

Wills T A Stoolmiller M (2002) The role of self-control in earlyescalation of substance use a time-varying analysis Journal ofConsulting and Clinical Psychology 70986ndash997

Wills T A Baker E Botvin G J (1989) Dimensions of assertivenessdifferential relationships to substance use in early adolescenceJournal of Consulting and Clinical Psychology 57(4)473ndash478

Wills T A Vaccaro D McNamara G (1994) Novelty seeking risktaking and related constructs as predictors of adolescent substanceuse an application of Cloningerrsquos theory Journal of SubstanceAbuse 61ndash20

Wills T A McNamara G Vaccaro D Hirky A E (1996a)Escalated substance use a longitudinal grouping analysis fromearly to middle adolescence Journal of Abnormal Psychology105166ndash180

Wills T A Pierce J P Evans R I (1996b) Large-scale environmentalrisk factors for substance use American Behavioral Scientist39808ndash822

Wills T A Windle M Cleary S D (1998) Role of temperamentnovelty-seeking and self-control in adolescent substance useJournal of Personality and Social Psychology 74387ndash406

Wills T A Sandy J M Shinar O (1999) Substance use level andproblems in late adolescence a mediational model based on self-control and coping motives Experimental and ClinicalPsychopharmacology 7122ndash134

Wills T A Cleary S D Filer M Shinar O Mariani J Spera K(2001) Temperament and self-control related to early-onsetsubstance use test of a developmental model Prevention Science2145ndash163

Wills T A Sandy J M Yaeger A (2002) Moderators of therelationship between substance use level and problems test of aself-regulation model in adolescence Journal of AbnormalPsychology 1113ndash21

Wills T A Gibbons F X Gerrard M Murry V Brody G (in press-a) Family communication and religiosity related to substance useand sexual behavior in early adolescence Psychology of AddictiveBehaviors

Wills T A Resko J Ainette M Mendoza D (in press-b) The role ofparent and peer support in adolescent substance use a test ofmediated effects Psychology of Addictive Behaviors

Motivation Skills and Decision Making 2015

ORDER REPRINTS

Young P T (1936) Motivation of Behavior New York John Wiley andSons

Zimmerman B J (2000) Attaining self-regulation a social cognitivemodel In Boekaerts M Pintrich P R eds Handbook of Self-Regulation San Diego Academic Press 13ndash39

2016 Sussman et al

Request PermissionOrder Reprints

Reprints of this article can also be ordered at

httpwwwdekkercomservletproductDOI101081JA200034769

Request Permission or Order Reprints Instantly

Interested in copying and sharing this article In most cases US Copyright Law requires that you get permission from the articlersquos rightsholder before using copyrighted content

All information and materials found in this article including but not limited to text trademarks patents logos graphics and images (the Materials) are the copyrighted works and other forms of intellectual property of Marcel Dekker Inc or its licensors All rights not expressly granted are reserved

Get permission to lawfully reproduce and distribute the Materials or order reprints quickly and painlessly Simply click on the Request Permission Order Reprints link below and follow the instructions Visit the US Copyright Office for information on Fair Use limitations of US copyright law Please refer to The Association of American Publishersrsquo (AAP) website for guidelines on Fair Use in the Classroom

The Materials are for your personal use only and cannot be reformatted reposted resold or distributed by electronic means or otherwise without permission from Marcel Dekker Inc Marcel Dekker Inc grants you the limited right to display the Materials only on your personal computer or personal wireless device and to copy and download single copies of such Materials provided that any copyright trademark or other notice appearing on such Materials is also retained by displayed copied or downloaded as part of the Materials and is not removed or obscured and provided you do not edit modify alter or enhance the Materials Please refer to our Website User Agreement for more details

ORDER REPRINTS

Reconnecting

Youth

(RY)

14ndash18

Atrisk

for

drop-out

School-based

90-session

class

Groupsupport

Yes

Yes

Smallstudent

groups

support

highly

trained

teachera

semester

Decreasedhard

druguse

perceived

stress

improved

grades

Residential

Student

Assistance

Program

(RSAP)

14ndash17

Livingin

residential

facilities

Residential-

based

education

program

assessm

ent

counseling

referral

No

Yes

Yes

Highly

trained

counselors

placedin

residential

facilities

8-session

drug

education

individual

andgroup

counseling

Decreaseduse

ofmarijuana

tobaccoand

alcohol

Strengthening

Families

Program

(SFP)

6ndash12

Childrenof

substance

users

Agency-based

14session

skillstraining

No

Yes

Yes

Highly

trained

counselors

parents

and

childseen

separately

firsthour

together

at

thesecond

hour

Reduces

aggression

increases

family

cohesion

immediate

effectson

druguse

Motivation Skills and Decision Making 1987

ORDER REPRINTS

model of drug abuse prevention We see this intrinsicextrinsic motiva-tion notion as providing intrapersonal and extrapersonal stimuli (cues)for action

Finally self-regulation models posit that one is motivated to achievean optimal state or system balance In essence an awareness of lack ofbalance will lead to efforts to restore balance (Carver and Scheier 1998Karoly 1980 1993) Drug abuse prevention may demand considerationof alternative actions in order to maintain homeostasis Affect may serveas the main homeostatic mechanism If people feel good or neutral theywill tend to maintain a given course of behavior On the other hand ifthey feel poorly they will want to change their behavior (as in the law ofeffect)

Constituents are those elements that when combined togethercompose a theoretical structure Seven constituents of motivation appearacross the four general theories (Nezami et al 2003) First the idea ofdiscrepancies appears in all theories Motivation exists as a distancebetween what is and what could be and these models assume that peopledesire to reduce such discrepancies Second motivation functions by theestablishment of goals Third motivation exists as energymdasha want ordrive Goals and the accompanying drive to achieve them usually appeartogether Fourth motivation may appear as a series of stages that lead toan end Different goals may operate at different stages Fifth motivationreflects ambivalence about two or more competing goals or behaviorsWorking through ambivalence enhances motivation Sixth motivationarises from different sources usually intrapsychic or environmentalrewards Finally a homeostatic conceptualization of motivation rests onthe idea of maintaining an optimal set point within a regulatory system

Integrations of these four models of motivation could help achievethe prevention of drug abuse One view suggests that due to lifeexperiences people consider goals or directions For example teens maystart to experiment with drugs due to curiosity perceived social pressureor as a means to induce a life change They may subsequently take risksthat injure their relations with others or impair their achievement inschool At some point a discrepancy likely develops between currentcircumstances and their goals For example teens may know that drugabuse is inconsistent with some life goals like school achievementHowever they may value social interaction and physical pleasure whichthey may reach through drug use or other means

Multiple goals may conflict with each other leading to ambivalence(Karoly 1993) Extrinsic and intrinsic sources of input may helpresolve ambivalence For example as the rewards associated with drugabuse diminish teens may experience a desire to decrease their drug

1988 Sussman et al

ORDER REPRINTS

consumption They may prove more likely to adopt a new goal ofdecreased drug use especially if they believe that they could achieve thegoal as self-efficacy theory suggests

Teens may exert energy to reduce discrepancies between currentstates and desired states They may learn new life or social skills whichcan lead them to become involved in rewarding but nondrug-usingactivities (Carroll 1996) In addition they may become involved in newtypes of social networks containing low-risk rather than high-risk peers(Valente et al 2004 Wills et al in press-b) Finally attaining a healthiergoal can create a positive optimal set point and the motivation systemprovides more positive feedback Over time through experience ofdifferent life events youth may alter the set point and begin a new goal-searching process (Sussman and Unger 2004) One may experience atraumatic life event for example and again consider drug use as a meansto return to an optimal set point or repeatedly get into trouble because ofassociating with deviant peers and realize that there is a need to turn todifferent types of associations

Research and theory from several disciplines suggest many motiva-tion strategies for a successful prevention program These motivationstrategies include myth correction stereotyping valuing life andachievement of health goals

Myth Correction

The recovery movement often refers to substance use and abuse as aproblem of perception Another closely related expression drug use mythsdescribes questionable or dysfunctional expectancies or beliefs that serveto justify drug use Myths involve more than expectancies or beliefs aboutpositive or negative outcomes they include inaccurate expectancies orbeliefs about the characteristics (or norms) of drugs and drug use and arelikely to confuse drug effects with drug experiences

Some common myths include inflated expectancies of positiveoutcomes from drug use or underestimates of negative outcomes fromdrug use Teens may believe that substance use will create peer groupacceptance or help them cope with family and school problems when infact the drug use only diverts them from actively coping with these socialand academic issues Thus in the long run drug use makes things worsenot better (Wills and Hirky 1996) Other myths include endorsement ofmisleading beliefs For example many adolescents believe that learningto manage drug intake without getting sick is a positive sign that theirbodies are growing tolerant to the drug rather than signaling the

Motivation Skills and Decision Making 1989

ORDER REPRINTS

beginnings of drug dependence or addiction In addition misperceptionsregarding physical consequences of drug use operate For example usersmistakenly believe that if they are able to regulate subjective effects of adrug they have gained control over use In reality warning systems maybe deteriorating as addiction begins (Glynn et al 1985 Sussman et al1995b) Challenging drug myths undoubtedly helps prevent drug abuse

These challenges can prove especially useful with high-risk popula-tions particularly if social influence programs are less effective in thesegroups Several prevention researchers have adopted a similar taxonomyof drug myths when attempting to prevent drug use Sussman Dent andStacy (1996) examined the internal consistency and discriminant validityof a measure of drug-related myths in 362 continuation (alternative) highschool youth They found good internal consistency and discriminantvalidity for the measure Controlling for its relations with socialdesirability perceived friendsrsquo drug use (a social influence measure)ethnicity and gender the myth measure remained significantly associatedwith four drug use measures Ames Sussman Dent and Stacy (1999)found a myth measure to be a relatively strong psychosocial predictor ofdrug use one-year later Cognitive perceptions obviously play a role indrug abuse prevention (Stein et al 1987) These findings suggest thatcontinued research on drug use myths should prove fruitful forprevention efforts (Sussman et al 1998 2003)

Some cognitive restructuring corrects faulty or self-defeatingcognitive structures (myths) In particular elaborating on the logicalsteps involved in the construction of a drug use myth may help to destroyits impact on behavior For example a common myth suggests thathaving trouble finding onersquos car after getting drunk is a funny event Ifone asks (a) lsquolsquoDid you want to find your carrsquorsquo (b) lsquolsquoWere you too drunk tofind it for a long timersquorsquo and (c) lsquolsquoAnd thatrsquos funnyrsquorsquo the apparent humorin the story may dissipate Further one may delineate the kernel of truthin the myth (not finding onersquos car is an odd event) from the falseaspects of the myth (not finding onersquos car indicates failure of functioningwhich is sad worrisome anxiety provoking not funny)

Stereotyping

Lower risk peers tend to perceive lsquolsquoat riskrsquorsquo others (eg alternativehigh school students) as being more deviant than they actually areUnderstandably youth so-labeled students resent this stereotypeAddressing this stereotype may help prevent drug abuse If lsquolsquoat riskrsquorsquoyouth begin to view themselves as being more deviant than they actually

1990 Sussman et al

ORDER REPRINTS

are the situation could lead to self-fulfilling prophesy as if they weregiving in to the stereotype However lowering the estimates of drug useamong their peers can correct this giving in This version of a prevalence-overestimation reduction lesson which includes a motivational featurehas appeared in successful prevention programs (Sussman et al 2002) Astereotype-oriented lesson may also accomplish a second goal If high-risk youth do not view themselves as being deviant as they assumedothers had judged them possibly reactions against this stereotype mayenergize an effort to avoid drug use as well as portray oneself morefavorably (Hamilton August 20 2000)

Valuing Life and Health Goals

Letrsquos consider the example of older teens Most youth report thatthey plan to graduate from high school and continue their educations orfind a job They do not view hanging out as a desirable option They alsosee that drug use could interfere with achieving their goals A lessonexplaining the negative consequences of drug use particularly oneconsistent with data (Newcomb and Bentler 1988) could reveal howearly involvement with drugs creates symptoms of abuse and dependenceand alters job opportunities marriage and family functioning These lifegoals can seem more valuable as students perceive them as attainableEnhancing the value of life goals can increase motivation for learningadaptive coping (Lau et al 1986) Youth have reported that drug usecould interfere with obtaining desired life goals In theme and componentstudies youth positively evaluated a lesson that taught that drug usecould interfere with obtaining desired goals and that placing animportance on health as a value was consistent with achievement of lifegoals (Sussman 1996) Thus it is important for prevention programs tohelp youth connect the importance of health to obtaining their life goalsand develop a sequenced plan so that they know how to proceed step-by-step (Karoly 1993 Watson and Tharp 2002)

Although modifiable understanding the source of positive life goalsis also important since these may occur earlier in life For instanceNewcomb and Harlow (1986) found that perceived loss of control andmeaninglessness in life mediated the relationship between negative lifeevents and drug use While numerous types of stressful events wereconsidered in this study other studies identify an adverse childhoodfamily environment as a potent precursor to later drug use (Locke andNewcomb in press Palinkas et al 1996) An adverse early homeenvironment a modifiable etiological factor should serve as a focus of

Motivation Skills and Decision Making 1991

ORDER REPRINTS

prevention that addresses child abuse and neglect (see later discussion ofthis topic)

Attitudinal Perspectives

Most youth consider themselves as being moderates They can alsoreliably identify drug use as being a deviant immoderate behaviorPresenting them with the disparity between their self-view as a moderateperson despite their deviant drug use can produce a desired behaviorchange (Sussman 1989 Upshaw and Ostrom 1984) An attitudinalperspective lesson can confront students with the inconsistency betweentheir general self-attitude ratings as moderates vs their more extremespecific behaviors (eg drug use) Adopting a self-perception as amoderate may inoculate youth when social pressures to experiment withdrugs arise A desire for internal consistency a similarity betweenattitudes and behavior may increase motivation to abstain from drugs(Festinger 1957 Heider 1958) Youth received lessons like these quitefavorably in previous work (Salomon et al 1984)

Skills

Direct instruction modeling practice and group reinforcementenhance social learning At least three basic kinds of skills needinstruction self-control communication and resource acquisition

Social Self-control Skills

Good self-control protects against substance use and buffers againstthe impact of risk factors (Bandura 1986 Catalano and Hawkins 1996Weissberg et al 1989 Wills et al 1998) Poor self-control involvesbehavioral affective and cognitive deficits Poor behavioral self-controlis associated with a need to regulate and stabilize mood possiblypreceding uncontrolled behavior or stemming from the consequences ofuncontrolled behavior Poor self-control behavior along with difficultiesin mood stabilization increases risk for substance use and rapidescalation to high levels of use which then can lead to physiologicaldependence (Wills and Stoolmiller 2002)

Self-control strategies cross physiological and personality boundariesbecause self-control also relates to coping motives for substance use a

1992 Sussman et al

ORDER REPRINTS

strong predictor of substance use problems (Wills et al 1999) Self-control includes cognition because developing self-control is the substratefor personality organization including not only behavioral and affectivecontrol but also attitudes values and views of the world as accepting orhostile and social perceptions about substance use as being attractive vsunattractive For example studies find poor self-control correlated withattitudinal tolerance for deviance and more favorable perceptions oftobacco and alcohol users whereas good self-control is related tofavorable perceptions of teens that abstain from drug use (Wills et alin press-a) Self-control approaches can be useful for preventionprograms by improving self and other perceptions academic perfor-mance and the impact or facilitation of negative life events goals that aresalient to teenagers and their parents (Wills and Stoolmiller 2002)

Youth often lack adequate coping skills they tend to lack restraint orplanfulness (Farrell and Danish 1993 Rutter et al 1997) Coping skillsinstruction may help increase self-control (Kendall and Braswell 1982)Coping skills instruction receives little attention in typical social influencesprogramming (Hansen 1992) although this material appears in life skillstraining (Botvin 1993 Botvin et al 1995 Wills 1986) In self-controlprogramming youth learn to assess their self-control particularly in socialcontexts (Sussman et al 2003) They learn the importance of thinkingahead and anticipating problem situations so that they are preparedbeforehand to deal with problems that may arise They also learn theimportance of context (eg not laughing at a funeral) Finally they learnassertiveness and anger management to help them better control theirreactions in social settings (Sambrano May 1999 Sussman et al 2002)

Listening and Communication Skills

Youth genuinely benefit from listening to information with an openmind and asking open-ended questions to keep a conversation goingThey can improve social skills by learning how to ask open-endedquestions establish eye contact appropriately nodding and orientingtheir body toward the other speaker (CPPRG 1999 Eggert and Herting1991 Hawkins et al 1999 Sussman et al 2002 2003) Neverthelesssocial skills training can create problems for nondrug using high-riskteens (Palinkas et al 1996 Sussman et al 1995b Wills et al in press-b)Training in drug refusal may create reactance in some samples (Sussmanet al 1996) Among high-risk youth enhancing assertiveness and datingskills may increase the scope of social entertainment options andinadvertently improve a teenrsquos ability to acquire drugs from new sources

Motivation Skills and Decision Making 1993

ORDER REPRINTS

(Wills et al 1989) Also there are cultural variations on what constitutesgood social skill (Unger et al 2004) There are good arguments forplacing high-risk teens together in activities with well-controlled teens sothat they can model adaptive social skills and problem solvingAdditionally utilizing motivation methods prior to instructing thespecific skill channels canalizes health-directed use of social skillsmastered Overall increasing social competence will have protectiveeffects for high-risk teens (Wills et al 1994) This idea is consistent withthe studies that have shown social withdrawal to increase risk for druguse (Kerr et al 1997) though there may be gender differences in theseeffects (Pulkkinen and Pitkanen 1994) Still it is most wise to includesocial skills training in conjunction with material addressing motivationand decision making Motivations regarding drug use need to beaddressed so behaviors learned are not misdirected

Resource Acquisition

Adults often assume that teens can access community services withlittle effort In fact few teens understand the availability of healthservices or other assistance Simple information including phonenumbers and locations can assist teens immensely (Carroll 1996Sussman et al 2002) Coaching teens on techniques for receivingassistance can prove productive Public assistance for drug use-relatedproblems and other life problems can help tremendously but negotiatingthe bureaucratic difficulties inherent in many of these systems can requireconsiderable skill (Eggert and Herting 1991 Sambrano May 1999Sussman et al 2002) Direct instruction modeling and structuredpractice in resource acquisition skills may help youth to increase theirknowledge and self-efficacy on how to acquire resources and to readilyaccess resources when needed (eg use of the bus system) These skillsmay generalize to comparable tasks later in life

Decision-Making

Prevention programs have employed several decision-making strate-gies For example the protocol from Project Reconnecting Youth(Project RY) is STEPS The acronym stands for Stop Think ofoptions Evaluate options Perform or take action on the chosen optionand then Self-praise for using steps for making healthy choices (Eggertand Herting 1991) The participants help set the agenda and take turns

1994 Sussman et al

ORDER REPRINTS

illustrating it on a flip chart This task helps share the leadership andfocuses the group work and time The lesson STEPS to Drug UseControl follows skills training sessions that cover understandingSTEPS as a decision-making model

Project Towards No Drug Abuse (TND)rsquos decision-making sessioninvolves four steps These steps are

1 Brainstorming (making a list of ideas without judging them)2 Weigh the pros and cons (the benefits and costs of each idea)3 Select the best option4 Follow through (try that option and reevaluate the decision)

(Sussman et al 2002)

These decision-making strategies are similar across different pro-grams except that they include some different emphases For exampleSTEPS includes a self-instruction to begin decision making and self-praise whereas the TND sequence includes more of an emphasis onfollowing through with the decision Generally each program requiresgenerating options evaluating them choosing the best and evaluatingthe outcome in an effort to make the next decision Teens tend to enjoypracticing decision making in bogus problem situations Youth soonlearn to engage in steps like these with considerable skill Training indecision making operates on variables that are intermediate in the causalprocess and thereby strengthen individual profiles of self-controlabilities so that they are more resilient in the face of proximal riskfactors for drug use such as life stresses and peer pressures

Modalities of Programming

Both school and nonschool prevention modalities have a rich andimportant history in substance abuse prevention research (Pentz 1994Pentz et al 2004) Schools provide a captive audience for educationalmaterial Youth spend 25 of their waking lives at school so thisenvironment has considerable potential Furthermore the school contextprovides a rich research history for building new studies and evaluatingtheir efficacy (Sussman et al 1995a) Community programs also offerconsiderable opportunity

Community programs often involve local leaders and organizations(eg coalitions community boards) (Goodman et al 1993 Kaftarianand Hansen 1994) that help mobilize numerous community unitsCommunity units include businesses media the family and governmental

Motivation Skills and Decision Making 1995

ORDER REPRINTS

agencies like the police or recreational departments as well as schoolsystems A network of community units working together to developpromote and implement educational programming could increase youthsrsquobonding to others across a wide variety of social contexts (Hawkins et al1992 Pentz 1994) Community units can provide numerous types ofspecific extra-classroom prevention opportunities (Pentz 1994)

Parent-or-family targeted prevention programs include offering earlychildhood education social support for parents managing crisesparenting skills training parent-child communication skills and resourceacquisition instruction or networking Mass media targeted programsinvolve programs or public service announcements with novel fastand unconventional messages (eg the American Legacy FoundationTRUTH campaign) use of the Internet and interactive CDs (eg videogames) Alternative means to involve youth include involvement in hikingclubs drug-free dances or other after-school events with prosocial adultmentors and with means to involve youth outside of school includingentry into different environments (ie outward bound) (Tobler 1986) Inaddition policy implementation and enforcement may contribute toother prevention programs (Pentz et al 1989) Indeed simultaneousprograms within and outside of schools over long periods might maintainthe positive effects that sometimes dissipate when school programsappear alone (Pentz 1994)

The Difference Between Targeted Prevention and Cessation

Targeted (secondary) prevention attempts to keep persons fromcrossing the invisible line where they funnel into a cycle of addiction andaccumulation of negative consequences Cessation programs (sometimesreferred to as tertiary prevention) take the stance that a behavior hasoccurred with definite and perhaps irreversible negative consequencesThe goal is to stop the behavior permit recovery from the damage learnhow to prevent relapse and learn how to live with permanent changes(eg neurotransmitter function drug use-related injury) It is not clearexactly where indicated prevention ends however and where cessationbegins For example an early version of the Project TND curriculum didnot achieve effects on cigarette smoking possibly because 46 of thesample already smoked cigarettes daily (while not engaging often in someother drug use) In a revised curriculum a smoking cessation componentwas added to the program and then an effect on cigarette smoking wasachieved Cessation material can appear with prevention material to

1996 Sussman et al

ORDER REPRINTS

maximize program effectiveness Careful program development can helpdetermine the best mix (Sussman et al 2002)

Summary of Evidence-based Targeted Drug Abuse Prevention

At present approximately 29 drug-use prevention programs havebeen evaluated favorably for their effects on drug use or other problembehavior (see Table 1) These 29 programs have been identified throughtwo sources Blueprints for Violence Prevention (Elliott 2003) and theSubstance Abuse and Mental Health Services Administrationrsquos(SAMSHA) science-based prevention programsrsquo guide (USDHHS2003) PsycINFO and MEDLINE searches of drug abuse preventionstudies since 1970 supplemented searches through these two guides (seeTable 1) Nine definitions of high-risk were used across these programsEleven programs focused on economic deprivation as the definition Sixprograms focused on delinquent behavior as the identifying characteristicto target Two programs each identified single-parent homes drug use orexposure to drug use family problems alternative high school attendanceor being at risk for dropout at a regular high school as the characteristicsto target subjects Finally one program each identified new immigrantstatus or residential facility placement as the defining characteristic ofbeing at high risk for drug use

Among these programs eight focused on preteens For example theEarly Risers program defined its high-risk youth as those 6ndash10 year-oldsthat suffered economic deprivation and exhibited aggressive or opposi-tional behavior Another five programs focused on a young teen agegroup For example Preventive Intervention defined its high-risk youthas those seventh to eighth graders who exhibited poor school andacademic discipline and reported family problems Another sevenprograms focused on an older teen age group For example ProjectTND defined its high-risk youth as those youth that attended alternativehigh schools Finally nine programs encompassed wide age ranges Forinstance Big Brothers Big Sisters of America defined its high-risk youthas 6ndash18 year-olds that lived in single-parent homes

Of these programs 10 involved multiple often flexible settings ofimplementation Another 13 programs focused on the school settingFour programs focused on the home setting Finally two programsfocused on a community agency setting In general these programsinvolved implementation by highly trained personnel Eighteen of theseprograms involved some motivation aspect generally motivationenhancement but sometimes including extrinsic reinforcement strategies

Motivation Skills and Decision Making 1997

ORDER REPRINTS

Twenty-six of these programs provided skills training Finally 18programs provided instruction in decision making Thus the MSDmodel tends to appear in a majority of these programs however all threecomponents were included together in only nine of these programs

Twenty of these programs involved at least one replication of theprogram and 14 involved three or more replications Further 14 of theseprograms were tested through use of experimental designs and nineinvolved use of only quasi-experimental designs Effects on drug use wereassessed and found in 22 of these programs For example theReconnecting Youth program was implemented to youth at risk fordropout This program involved 90 sessions within a comprehensive highschool class delivered generally over a semester with small studentgroups and a highly trained teacher Instruction included use of groupsupport and providing life skills training (norm setting self-esteem moodmanagement communication skills self-monitoring monitoring goalsschool bonding and social activities) with feedback to parents Programgoals were achieved through use of a quasi-experimental design showingeffects for school performance (18 improvement in grades) drug use(54 decrease in hard drug use) and suicide risk (32 decline inperceived stress) This programrsquos results have been replicated numeroustimes in numerous locations This program involved all three componentsof the MSD model except that motivation was provided through peergroup support not through provision motivation enhancement strate-gies These targeted programs present an optimistic picture for drug-useprevention that is focused on at-risk youth (see Table 1)

Not all targeted prevention programs have been found to beeffective One published program that failed to find positive effects wasProject PALS (Palinkas et al 1996) This project was developed for teengirls who were pregnant or at risk for pregnancy and drug use Theprogram consisted of school-based delivery of 16 sessions once a weekin a class The goal was to decrease drug use The PALS Skills TrainingProgram involved instruction in assertiveness providing and receivingfeedback social conversation handling requests and asking for help andmood management This program was tested against a normativeeducation program (called Facts of Life or FOL) which instructedvalues and decision making sexuality issues and contraception sexuallytransmitted diseases (STDs) drug use risks sexual assault prevalenceand norms material An experimental evaluation with a seven-monthspost-baseline was used The results indicated that the PALS programsubjects reported 29 times greater marijuana use than FOL amongbaseline nonusers No other differences were found It is possible that theprogram was not targeted to the right population that the mix of skills

1998 Sussman et al

ORDER REPRINTS

instructed was not appropriate or that skill training alone (withoutappropriate motivation material) may not be effective in drug useprevention Researchers should examine these possibilities and others tofurther understand program failures as well as program successes

Potential Limitations of Targeted Prevention

Dishion and colleagues (1995) suggest from various findings thatgrouping high-risk youth may lead to increased drug use This outcomecan result if youth come to learn deviant behavior from each other Theycan learn deviant behavior from each other in a program if they haveunstructured or unsupervised time together An essential feature ofseveral targeted programs (eg the RY and TND programs) is building apositive peer culture with group norms that decrease drug involvementand drug-use control problems The RYrsquos findings suggest that a positivepeer group component carefully fostered by a well-trained and competentRY group leader can direct the group toward lower risk behaviorSimilarly classroom management in Project TND involves developmentof positive norms of classroom behavior Further interaction betweenyouth is encouraged but is primarily teacher-directed and highlystructured (Sussman et al 2003) In both RY and Project TND theteacherrsquos role is to actively develop and maintain peer group support inthe class by modeling support positively reinforcing it among groupmembers and negatively reinforcing deviant peer bonds and activities(Eggert and Herting 1991 Vorrath and Brendtro 1985) The teachercreates and structures interactions among youth in prosocial directions(Sussman et al 2003)

Multiple Problem Behaviors of Adolescents

Acknowledging the relationship of drug use to other commonadolescent problems may facilitate identification of effective methods ofreducing drug use Researchers on tobacco alcohol and other drug useantisocial behavior high-risk sexual behavior and depression increas-ingly recognize that these problems are interrelated (McGee andNewcomb 1992) and stem to a large extent from the same environ-mental and biological factors (Biglan et al in press Eggert et al 1995Sussman and Ames 2001 Wills and Cleary 1995) Clearly it is necessaryto have strategies that address the entire range of problems and thecontext that influences those problems Indeed further reductions in

Motivation Skills and Decision Making 1999

ORDER REPRINTS

many problems require that we comprehensively target youth withmultiple problem behaviors

Biglan and colleagues (in press) provide a comprehensive review ofthe relationships among antisocial behavior tobacco alcohol and otherdrug use and high-risk sexual behavior It is clear that the same youngpeople are prone to the development of the entire range of problems In arecent review Moffitt and colleagues (2002) found that antisocialbehavior in early adolescence (rather than late adolescence) is a greaterrisk factor for developing multiple problems These findings point to theimportance of early intervention before youth develop serious problemsMoreover these different problems largely result from the same set ofenvironmental and biological factors

One implication is that disciplines dealing with these problemsother than drug abuse may contribute to dealing with the problem ofdrug use (Newcomb 1996b 1997) In particular research by dev-elopmental psychologists family social workers and sociologists onthe influence of parents on adolescent problem development and oninterventions to alter parenting practices contributes to our understandingof how to prevent or ameliorate drug abuse and other problems Onealso should note that nonsubstance use is not a guarantee for problemimmunity for the entire age range of people whatever their genderethnicity religiosity socioeconomic status (SEC) domicility etc It maybe argued that the most promising programs are those targeting thesemultiple levels of influence Several multidisciplinary programs haveachieved promising results We describe three of these empiricallyevaluated programs tested in various settings

Functional Family Therapy (FFT)FFT is an indicated intervention involving family treatment designed

for delinquent teenagers (also see Table 1) Developed in the early 1970sby Alexander and colleagues (1973) FFT focuses on family commu-nication and the establishment of rules and consequences Several studiesprovide encouraging reports of the programrsquos effectiveness (Alexander etal 1976 Barton et al 1985 Klein et al 1977 Waldron et al 2001) Inthe Waldron et al (2001) study researchers used FFT and anintervention with cognitive behavior therapy on teens referred formarijuana use Each of the interventions produced significant resultson marijuana use by the teens at four months but only the twointerventions combined maintained these results at seven months Theearlier studies found a greater number of results For example in the twoAlexander studies (1973 1976) improvement in family communicationposttreatment led to reduced delinquency Note that all the teens in these

2000 Sussman et al

ORDER REPRINTS

studies had histories of serious antisocial or delinquent behavior Thusachieving positive outcomes even if only short-term should encouragefurther research into the efficacy of FFT

Multisystemic Therapy (MST)As its name suggestsMST targets individual family peer school and

community influences of those youth offenders with serious problems thatmay include violence substance use and severe emotional problems (alsosee Table 1) Numerous researchers have published the results ofrandomized trials of MST (Henggeler et al 1996 1997 1998 Thorntonet al 2000) The most consistent findings across studies are decreased (1)drug use (2) re-arrest (3) self-reported criminal offense and (4) days inout-of-home placements Other consistent findings are improved familyrelations school attendance and psychiatric functioning One cautionarynote the programrsquos effectiveness lowers considerably if not implementedwith fidelity (Hengler et al 1997 1999) In other words all or key lessonsneed to be delivered as written by educators who are well-trained in usingthe strategies employed and youth need to be able to receive all material inan atmosphere conducive to learning the material The programdevelopers have instituted training strategies that address these fidelityissues thus shaping MST to be a very promising program for at-riskyouth

Multidimensional Treatment Foster Care (MTFC)MTFC targets family and peer factors influencing adolescents with a

pattern of repeat criminal offending (see Table 1) (Chamberlain 1994)This intervention includes placement of the youth into a foster homewith a foster parent trained in behavior management who receivessupport from intervention staff After the adolescent has begun torespond to the intervention in the foster home and after the parents havereceived the same training and support as the foster parents did theadolescent returns home Chamberlain and Reid (1998) tested theintervention with 85 boys with felony and other criminal histories andfound substantial benefits of the program Following treatment the boysassigned to MTFC (compared to those receiving community-based groupcare) showed fewer days in detention or lock-up twice as much timeliving with parents fewer misdemeanor and felony arrests and fewer self-reported index crimes felony arrests and general delinquency TheMTFC is a cost-effective alternative to incarceration however staffrequirements are extensive which may influence the ability of some

Motivation Skills and Decision Making 2001

ORDER REPRINTS

groups to apply the program with fidelity However as with each of theprograms described here the results of the randomized trials areencouraging

Future Research Needs in Targeted Prevention

Future research can help discern when and where targeted preventionprogramming will tend to work rather than produce potentiallydeleterious negative group effects or results that are irrelevant for pro-social healthy adaptation as well as what the critical necessary conditionsare for their effective operation within given de facto realities Comparedto the breadth of evaluated universal drug use prevention programs(Tobler et al 2000) relatively few targeted prevention programs havereceived empirical support Yet previous research suggests that universalschool-based drug use prevention programs implemented in junior highschool have relatively less chance of long-term success especially for thoseyouth that began using drugs before the prevention program wasimplemented Of course there are notable exceptions (eg effects lastedfor one and a half years effects lasted for six years) (Chou et al 1998Griffin et al 2003 Skara and Sussman 2003) Almost no research existsregarding maximization of booster programming with high-risk youthMore research on booster programs would help the field

While continuing to engage in this work there will be numerousissues to manage that go well beyond the scope of this article There willbe a need to avoid producing negative labeling effects while providingprogramming for those who are at risk for drug use It is possible thatcessation information needs to be included in the mix with preventionmaterial to provide better targeted-prevention effects There may be aneed to develop a teacher selection instrument to help select out teacherswho can deliver drug abuse prevention programming adequatelyCertainly definition of outcome variables needs continued explorationincluding analysis to ascertain the effects of programming on drug abusevs drug use and identification of the variables that are most closelylinked to change by targeted prevention components

A transdisciplinary approach helps to better understand the lifesituation of high-risk youth as based to some extent on both constitutionaland environmental factors (Fuqua et al 2004 Rutter et al 1997 Wills etal 1996b) From the transactional perspective their situation is in partconstitutional they may have temperamental characteristics that arepartly heritable and that have set the stage at earlier ages for decrements inself-control ability and academic performance that then increase risk for

2002 Sussman et al

ORDER REPRINTS

drug use However their situation is also part environmental based in parton family socialization and in part on the types of peers they have as well asthe type and quality of the physical and cultural environment-at-largeThere are many points at which a potential chain of failures can beinterrupted and the individualrsquos trajectory turned in a better directionProblems are not inevitable from starting level (Tarter and Vanyukov1994) and environmental modifications to support good self-controlability can help to avert an adverse impact from earlier experiences orcurrent difficulties (Brody et al 2002 Novak and Clayton 2001 Patock-Peckham et al 2001 Rutter et al 1997 Wills et al 2002)

The problems and needs of high-risk youth in our nationrsquos highschools demand our attention for designing and rigorously testingtargeted prevention approaches Substantial evidence shows that theseyouth are at greater risk for drug involvement and co-occurring problemssuch as aggression depression and suicidal behaviors as we previouslydiscussed It is hoped that the information presented in this article willstimulate others to join in extending this work including testing othermodels of targeted prevention

GLOSSARY

Universal programs Programs that aim to influence all subjects in acontext

Selective drug-abuse prevention programs Programs that servegroups at greater risk of ATOD usemdashfor example children of alcoholicparents They are at psychosocial risk for drug use and abuse

Indicated drug-abuse prevention programs Programs that attemptto benefit individuals who already show signs of drug involvement orrelated risk factors In indicated prevention programs the primary goal isto stem the progression of ATOD use or reduce drug involvementamong the high-risk youth

Targeted programming Programming that subsumes selective andindicated programming sometimes the other two types of programs thattarget specific groups lsquolsquoat riskrsquorsquo are considered together

ACKNOWLEDGMENTS

This research was supported by grants from the National Institute onDrug Abuse (DA01070 DA07601 DA13814 and DA16094) and by aResearch Scientist Development Award K02 DA00252 from theNational Institute on Drug Abuse

Motivation Skills and Decision Making 2003

ORDER REPRINTS

REFERENCES

Alexander J F Barton C Schiaro R S Parsons B V (1976)

Systems-behavioral intervention with families of delinquents

therapist characteristics family behavior and outcome Journal of

Consulting and Clinical Psychology 44(4)656ndash664Alexander J F Parsons B V (1973) Short-term behavioral interven-

tion with delinquent families impact on family process and

recidivism Journal of Abnormal Psychology 3219ndash225American psychiatric association (APA) (1994) Diagnostic and

Statistical Manual of Mental Disorders 4th edn (DSM-IV)

Washington DC American Psychiatric AssociationAmes S L Sussman S Dent C W (1999) Pro-drug-use myths and

competing constructs in the prediction of substance use among

youth at continuation high schools a one-year prospective study

Personality and Individual Differences 26987ndash1003Bachman S G Wadsworth K N OrsquoMalley P M Johnston L D

Schulenberg J E (1997) Smoking drinking and drug use in young

adulthood Mahwah NJ Lawrence Erlbaum Associates 8ndash25

153ndash190Bandura A (1986) Social Foundations of Thought and Action A Social

Cognitive Theory Englewood Cliffs NJ Prentice HallBarton C Alexander J F Waldron H Turner C W Warburton J

(1985) Generalizing treatment effects of functional family therapy

Three replications The American Journal of Family Therapy

13(3)16ndash26Battin-Pearson S R Newcomb M D Abbott R D Hill K G

Catalano R F Hawkins J D (2000) Predicting early high school

dropout Journal of Educational Psychology 92568ndash582Biglan A Brennan P A Foster S L Holder H D Miller T L

Cunningham P B et al (in press) Helping Adolescents at Risk

Prevention of Multiple Problem Behaviors New York NY Guilford

PressBindra D Stewart J (1996) Motivation Baltimore MD Penguin

BooksBlanton H Gibbons F X Gerrard M Conger K J Smith G E

(1998) The role of family and peers in the development of

prototypes associated with substance use Journal of Family

Psychology 11271ndash288

2004 Sussman et al

ORDER REPRINTS

Botvin G J (1993) School-based drug abuse prevention Long-termfollow-up results In First Annual Meeting of the Society forPrevention Research Kentuck Lexington Society for PreventionResearch

Botvin G J Baker E Dusenbury L Botvin E M Diaz T (1995)Long-term follow-up results of a randomized drug abuse preven-tion trial in a white middle-class population Journal of theAmerican Medical Association 2731106ndash1012

Brody G H Dorsey S Forehand R Armistead L (2002) Uniquecontributions of parenting and classroom processes to the self-control of AfricanndashAmerican children Child Development73274ndash286

Carroll M E (1996) Reducing drug abuse by enriching the environmentwith alternative nondrug reinforcers In Green L Kagel J Heds Advances in Behavioral Economics Norwood NJ NorwoodPublishing Corp 37ndash68

Carver C S Scheier M F (1998) On the Self-Regulation of BehaviorNew York Cambridge University Press

Catalano R F Hawkins J D (1996) The social developmental modela theory of antisocial behavior In Hawkins J D ed Delinquencyand Crime Current Theories New York Cambridge UniversityPress

Centers for Disease Control (CDC) (October 1999) Youth risk BehaviorSurveillancemdashNational Alternative High School Youth RiskBehavior Survey 1998 Morbidity and Mortality Weekly Report48 No SS-7

Chamberlain P (1994) Family connections A treatment foster caremodel for adolescents with delinquency Eugene OR CastaliaPublishing Company

Chamberlain P Reid J B (1998) Comparison of two communityalternatives to incarceration for chronic juvenile offenders Journalof Consulting and Clinical Psychology 66(4)624ndash633

Chassin L A Presson C C Sherman S J (1985) Stepping backwardin order to step forward an acquisition-oriented approach toprimary prevention Journal of Consulting and Clinical Psychology53612ndash622

Chou C-P Montgomery S Pentz M A Rohrbach L A JohnsonC A Flay B R MacKinnon D P (1998) Effects of acommunity-based prevention program on decreasing drug use inhigh-risk adolescentsAmerican Journal of Public Health 88944ndash948

Conducts Problems Prevention Research Group (CPPRG) (1999) Initialimpact of the fast track prevention trial for conduct problems I

Motivation Skills and Decision Making 2005

ORDER REPRINTS

The high-risk sample Journal of Consulting and Clinical Psychology

67631ndash647Conducts Problems Prevention Research Group (CPPRG) (2000)

Merging universal and indicated prevention programs the fast

track model Addictive Behaviors 25913ndash927Council of Philosophical Studies (1981) Psychology and the Philosophy

of Mind in the Philosophy Curriculum San Francisco San Francisco

State UniversityCummings K M Hellmann R Emont S L (1988) Correlates of

participation in a worksite stop smoking program Journal of

Behavioral Medicine 11267ndash277Curry S Wagner E H Gothaus L C (1990) Intrinsic and extrinsic

motivation for smoking cessation Journal of Consulting and

Clinical Psychology 58310ndash316Dent C W Sussman S McCuller W J Stacy A W (2001) Drug

abuse prevention among youth at comprehensive high schools

Preventive Medicine 32514ndash520Dewey J (1886) Psychology New York HarperDishion T J French D C Patterson G R (1995) The development

and ecology of antisocial behavior In Cicchetti D Cohen D

eds Manual of developmental psychopathology New York John

Wiley 421ndash471Eggert L L Herting J R (1991) Preventing teenage drug abuse

exploratory effects of network social support Youth and Society

22482ndash534 [Reprinted National Prevention Evaluation Research

CollectionRockville MD Aspen 1993]Eggert L L Herting J R Thompson E A Nicholas L J Dicker

B G (1994) Preventing adolescent drug abuse and high school

dropout through an intensive school-based social network devel-

opment program American Journal of Health Promotion

8202ndash214Eggert L L Thompson E A Herting J R Nicholas L J (1995)

Reducing suicide potential among high-risk youth tests of a school-

based prevention program Suicide amp Life-Threatening Behavior

25276ndash296Ellickson P L Bell R M (1990) Drug prevention in junior high a

multi-site longitudinal test Science 2471299ndash1305Elliott D S (Series ed) (2003) Blueprints for violence prevention

Boulder CO Institute of Behavioral Science Regents of the

University of Colorado wwwcoloradoeducspvblueprints

2006 Sussman et al

ORDER REPRINTS

Farrell A D Danish S J (1993) Peer drug associations and emotionalrestraint Causes or consequences of adolescent drug use Journal ofConsulting and Clinical Psychology 61327ndash334

Festinger L A (1957) A Theory of Cognitive Dissonance New YorkHarper amp Row

Fuqua J Stokols D Gress J Phillips K Harvey R (2004)Transdisciplinary collaboration as a basis for enhancing the scienceand prevention of substance use and abuse Substance Use ampMisuse

Giuliano J D (1994) A peer education program to promote the use ofconflict resolution skills among at-risk school-age males PublicHealth Reports 109158ndash169

Glynn K Levanthal H Hirschman R (1985) A cognitivedevelopmental approach to smoking prevention In Bell C SBattjes R eds Prevention research Deterring Drug Abuse AmongChildren and Adolescents Rockville MD NIDA ResearchMonograph 63

Glynn T J (1989) Essential elements of school-based smokingprevention programs Journal of School Health 59181ndash188

Goodman R M Burdine J N Meehan E McLeroy K R eds(1993) Community coalitions for health promotion Special issue ofHealth Education Research Theory and Practice 8309ndash453

Goodyear R D Newcomb M D Locke T F (2002) PregnantLatina teenagers psychosocial and developmental determinants ofhow they select and perceive the men who father their childrenJournal of Counseling Psychology 49187ndash201

Gordon R (1987) An operational classification of disease preventionIn Steinberg J A Silverman M M eds Preventing MentalDisorders Rockville MD DHHS 20ndash26

Graham J W Johnson C A Hansen W B Flay B R Gee M(1990) Drug use prevention programs gender and ethnicityevaluation of three seventh-grade project SMART cohortsPreventive Medicine 19305ndash313

Griffin K W Botvin G J Nichols T R Doyal M M (2003)Effectiveness of a universal drug abuse prevention approach foryouth at high risk for substance use initiation Preventive Medicine36(1)1ndash7

Hamilton S (August 20 2000) Views slowly changing on alternativeschools The Sacramento Bee 1ndash3

Hansen W B (1992) School-based substance abuse prevention a reviewof the state of the art in curriculum 1980ndash1990 Health EducationResearch 7403ndash430

Motivation Skills and Decision Making 2007

ORDER REPRINTS

Hansen W B Johnson C A Flay B R Graham J W Sobel J(1988) Affective and social influences approaches to the preventionof multiple substance abuse among seventh grade students resultsfrom project SMART Preventive Medicine 17135ndash154

Hansen W B Graham J W (1991) Preventing alcohol marijuanaand cigarette use among adolescents peer pressure and resistancetraining versus establishing conservative norms PreventiveMedicine 20414ndash430

Hawkins D H Catalano R F Miller J Y (1992) Risk andprotective factors for alcohol and other drug problems inadolescence and early adulthood Implications for substanceabuse prevention Psychological Bulletin 11254ndash105

Hawkins J D Catalano R F Kosterman R Abbott R Hill K G(1999) Preventing adolescent health-risk behaviors by strengthen-ing protection during childhood Archives of Pediatric amp AdolescentMedicine 153226ndash234

Heider F (1958) The Psychology of Interpersonal Relations New YorkWiley

Henggeler S W Pickrel S G Brondino M J Crouch J L (1996)Eliminating (almost) treatment dropout of substance abusing ordependent delinquents through home-based multisystemic therapyAmerican Journal of Psychiatry 153(3)427ndash428

Henggeler S W Melton G B Brondino M J Scherer D GHanley J H (1997) Multisystemic therapy with violent andchronic juvenile offenders and their families the role of treatmentfidelity in successful dissemination Journal of Consulting andClinical Psychology 65(5)821ndash833

Henggeler S W Schoenwald S K Borduin C M Rowland M DCunningham P B (1998) Multisystemic treatment of antisocialbehavior in children and adolescents New York The Guilford Press

Henggeler S W Pickrel S G Brondino M J (1999) Multisystemictreatment of substance-abusing and dependent delinquents out-comes treatment fidelity and transportability Mental HealthServices Residual 1(3)171ndash84

Johnson C A Pentz M A Weber M D Dwyer J H Baer NMacKinnon D P Hansen W B Flay B R (1990) Relativeeffectiveness of comprehensive community programming for drugabuse prevention with high-risk and low-risk adolescents Journalof Consulting and Clinical Psychology 58447ndash456

Kaftarian S J Hansen W B eds (1994) CSAP special issuecommunity partnership program Journal of Community Psychologypages 205

2008 Sussman et al

ORDER REPRINTS

Karoly P (1993) Mechanisms in self-regulation A systems view AnnualReview of Psychology 4423ndash51

Karoly P (1980) Person variables in therapeutic change and develop-ment In Karoly P Steffen J J eds Improving the Long-TermEffects of Psychotherapy New York Gardner Press 195ndash261

Kendall P C Braswell L (1982) Cognitive-behavioral self-controltherapy for children a components analysis Journal of Consultingand Clinical Psychology 50672ndash689

Kerr M Tremblay R E Pagani L Vitaro F (1997) Boysrsquobehavioral inhibition and the risk of later delinquency Archivesof General Psychiatry 54809ndash816

Klein N C Alexander J F Parsons B V (1977) Impact of familysystems intervention on recidivism and sibling delinquency a modelof primary prevention and program evaluation Journal ofConsulting and Clinical Psychology 45(3)469ndash474

Kumpfer K L (1999) Outcomes measures of interventions in the studyof children of substance-abusing parents Pediatrics 1031128ndash1144

Lau R R Hartman K A Ware J E (1986) Health as a valuemethodological and theoretical considerations Health Psychology525ndash43

Lichtenstein E L Glasgow R E (1997) A pragmatic framework forsmoking cessation implications for clinical and public healthprograms Psychology of Addictive Behaviors 11142ndash151

Locke T F Newcomb M D (in press) Childhood maltreatmentparent drug problems polydrug problems and parenting practicesa test of gender differences and four theoretical perspectivesJournal of Family Psychology

McCreary D R Newcomb M D Sadava S W (1999) The male rolealcohol use and alcohol problems a structural modeling examina-tion in adult women and men Journal of Counseling Psychology46109ndash124

McGee L Newcomb M D (1992) General deviance syndromeexpanded hierarchical evaluations at four ages from earlyadolescence to adulthood Journal of Consulting amp ClinicalPsychology 60766ndash776

Miller W R Brown J M (1991) Self-regulation as a conceptual basisfor the prevention of addictive behaviours In Heather N MillerW R Greeley J eds Self-control and the Addictive BehavioursSydney Australia Maxwell Macmillan 3ndash79

Miller W R Leckman A L Delaney H D Tinkcom M (1993)Long-term follow-up of behavioral self-control training forproblem drinkers Journal of Studies on Alcohol 53249ndash261

Motivation Skills and Decision Making 2009

ORDER REPRINTS

Miller W R Rollnick S (1991) Motivational InterviewingPreparing People to Change Addictive Behavior New YorkGuilford Press

Moffitt T E Caspi A Harrington H Milne B J (2002) Males onthe life-course-persistent and adolescence-limited antisocial path-ways follow-up at age 26 years Development and Psychopathology14(1)179ndash207

National Institute on Drug Abuse (NIDA) (1997) Drug abuseprevention What works NIH Publication 97-4110 DHHSNational Institutes of Health National Institute on Drug AbuseOffice of Science Policy and Communications Rockville MD

Newcomb M D (1992a) Substance abuse and control in the UnitedStates ethical and legal issues Social Science and Medicine35471ndash479

Newcomb M D (1992b) Understanding the multidimensional nature ofdrug use and abuse The role of consumption risk factors andprotective factors In Glantz M D Pickens R eds Vulnerabilityto Drug Abuse Washington DC American PsychologicalAssociation 255ndash298

Newcomb M D (1996a) Pseudomaturity among adolescents constructvalidation sex differences and associations in adulthood Journalof Drug Issues 26477ndash504

Newcomb M D (1996b) Adolescence Pathologizing a normal processThe Counseling Psychologist 24482ndash490

Newcomb M D (1997) Psychosocial predictors and consequences ofdrug use a developmental perspective within a prospective studyJournal of Addictive Diseases 1651ndash89

Newcomb M D Bentler P M (1988) Consequences of Adolescent DrugUse Impact on the Lives of Young Adults Beverly Hills CA Sage

Newcomb M D Bentler P M (1989) Substance use and abuse amongchildren and teenagers American Psychologist 44242ndash248

Newcomb M D Harlow L L (1986) Life events and substance useamong adolescents Mediating effects of perceived loss of controland meaninglessness in life Journal of Personality and SocialPsychology 51564ndash577

Newcomb M D Chou C-P Bentler P M Huba G J (1988)Cognitive motivations for drug use among adolescents longitudinaltests of gender differences and predictors of change in drug useJournal of Counseling Psychology 35426ndash438

Newcomb M D Abbott R D Catalano R F Hawkins J DBattin-Pearson S R Hill K (2002) Mediational and deviancetheories of late high school failure Process roles of structural

2010 Sussman et al

ORDER REPRINTS

strains academic competence and general versus specific problem

behaviors Journal of Counseling Psychology 49172ndash186Nezami E Sussman S Pentz M A (2003) Motivation in tobacco use

cessation research Substance Use amp Misuse 3825ndash5Novak S P Clayton R R (2001) The influence of school environment

and self-regulation on transitions between stages of cigarette

smoking Health Psychology 20196ndash207Offord D R (2000) Selection of levels of prevention Addictive

Behaviors 25833ndash842Palinkas L A Atkins C J Miller C Ferreira D (1996) Social skills

training for drug prevention in high-risk female adolescents

Preventive Medicine 25692ndash701Patock-Peckham J A Cheong J-W Balhorn M E Nagoshi C T

(2001) A model of parenting styles self-regulation perceived

drinking control and alcohol use and problems Alcoholism

Experimental and Clinical Research 251284ndash1292Pentz M A (1994) Directions for future research in drug abuse

prevention Preventive Medicine 23646ndash652Pentz M A Dwyer J H MacKinnon D Flay B R Hansen W B

Wang E Y I Johnson C A (1989) A multi-community trial for

primary prevention of adolescent drug abuse effects on drug use

prevalence JAMA 2623259ndash3266Pentz M A Mares D Schinke S Rohrbach L (in press) Political

science public policy and drug abuse prevention Substance Use amp

MisuseProchaska J O DiClemente C C (1982) Transtheoretical therapy

toward a more integrative model of change Psychotherapy Theory

Research and Practice 19275ndash288Pulkkinen L Pitkanen T (1994) A prospective study of the precursors

to problem drinking in young adulthood Journal of Studies on

Alcohol 55578ndash587Rathus S A Nevid J S (1977) Behavior Therapy Strategies for

Solving Problems in Living New York Doubleday and Company

IncResnicow K Botvin G (1993) School-based substance use prevention

programs why do effects decay Preventive Medicine 22484ndash490Rutter M Dunn J Plomin R Simonoff E Pickles A Maughan

B Ormel J Meyer J Eaves L (1997) Integrating nature and

nurture implications of person-environment interactions for

developmental psychopathology Development and Psychopathology

9335ndash364

Motivation Skills and Decision Making 2011

ORDER REPRINTS

Salomon G Stein Y Eisenberg S Klein L (1984) Adolescent

smokers and nonsmokers profiles and their changing structure

Preventive Medicine 13446ndash461Sambrano S (1999) National cross-site evaluation of high risk youth

programs In Interim findings Bulletin Washington DC CSAP

SAMSHA US DHHS May 1ndash16Schinke S P Gilchrist L D (1985) Preventing substance abuse with

children and adolescents Journal of Consulting and Clinical

Psychology 53596ndash602Skara S N Sussman S (2003) A review of 25 long-term adolescent

tobacco and other drug use prevention program evaluations

Preventive MedicineSmith C Lizotte A J Thornberry T P Krohn M D (1995)

Resilient youth identifying factors that prevent high-risk youth

from engaging in delinquency and drug use Delinquency and

Disrepute in the Life Course Greenwich CT John Hagan JAI

press 217ndash247Sommers P V (1972) The Biology of Behavior Australia Pty ltd

Sydney John Wiley amp SonsSt Pierre T L Kaltreider D L Mark M M Aikin K J (1992)

Drug prevention in a community setting a longitudinal study of the

relative effectiveness of a three-year primary prevention program in

boys and girls clubs across the nation American Journal of

Community Psychology 20673ndash706Stein J A Newcomb M D Bentler P M (1987) An eight year study

of multiple influences on drug use and drug use consequences

Journal of Personality and Social Psychology 531094ndash1105Sully J (1884) Outlines of Psychology New York D Appleton amp CoSussman S (1989) Two social influence perspectives of tobacco use

development and prevention Health Education Research Theory

and Practice 4213ndash223Sussman S (1991) Curriculum development in school-based prevention

research Health Education Research Theory and Practice

6339ndash351Sussman S (1996) Development of a school-based drug abuse

prevention curriculum for high risk youth Journal of

Psychoactive Drugs 28169ndash182Sussman S Ames S L (2001) The social psychology of drug abuse

Buckingham GB Open University PressSussman S Unger J (2004) A drug abuse theoretical integration a

transdisciplinary speculation Substance Use amp Misuse

2012 Sussman et al

ORDER REPRINTS

Sussman S Dent C W Burton D Stacy A W Flay B R (1995a)

Developing school-based tobacco use prevention and cessation

programs Thousand Oaks CA Sage Publications IncSussman S Dent C W Simon T R Stacy A W Galaif E R

Moss M A Craig S Johnson C A (1995b) Effectiveness of

social influence substance abuse prevention curricula in compre-

hensive and continuation high schools Drugs and Society 865ndash81Sussman S Dent C W Galaif E R (1997) The correlates of

substance abuse and dependence among adolescents at high risk

for drug abuse Journal of Substance Abuse 9241ndash255Sussman S Dent C W Stacy A W (1996) The relation of pro-drug

use myths with self-reported drug use among youth at continuation

high schools Journal of Applied Social Psychology 26214ndash267Sussman S Dent C W Stacy A Craig S (1998) One-year outcomes

of project towards no drug abuse Preventive Medicine 27632ndash642

(erratum 766)Sussman S Dent C W Stacy S (2002) Project towards no drug

abuse a review of the findings and future directions American

Journal of Health Behavior 26354ndash365Sussman S McCuller W J Dent C W (2003) The associations of

social self-control personality disorders and demographics with

drug use among high risk youth Addictive Behaviors 281159ndash1166Sussman S Rohrbach L Patel R Holiday K (2003) A look at an

interactive classroom-based drug abuse prevention program

Interactive contents and suggestions for research Journal of Drug

Education 33355ndash368Sussman S Sun P McCuller W J Dent C W (2003) Project

towards no drug abuse two year outcomes of a trial that compares

health educator delivery to self-instruction Preventive Medicine

37155ndash162Tarter R E Vanyukov M (1994) Alcoholism a developmental disorder

Journal of Consulting and Clinical Psychology 621096ndash1107Thornton T N Craft C A Dahlberg L L Lynch B S Baer K

(2000) Best Practices of Youth Violence Prevention A Sourcebook

for Community Action Atlanta GA Division of Violence

Prevention Centers for Disease Control and PreventionTobler N S (1986) Meta-analysis of 143 adolescent drug prevention

programs quantitative outcome of program participants compared to

a control or comparison group Journal of Drug Issues 16537ndash567Tobler N S Roona M R Ochshorn P Marshall D G Streke

A V Stackpole K M (2000) School-based adolescent drug

Motivation Skills and Decision Making 2013

ORDER REPRINTS

prevention programs 1998 Meta-analysis The Journal of Primary

Prevention 20275ndash336US Department of Health and Human Services (USDHHS) (2003)

Substance Abuse andMental Health Services Administration Center

for Substance Abuse Prevention Science-based prevention programs and

principles 2002 Rockville MD US DHHS (SMA)03-3764 Also

see httpmodelprogramssamhsagovUnger J Baezconde-Garbanati L Shakib S Palmer P H Nezami

E Mora J (2004) What are the implications of structuralcultural

theory for drug abuse prevention Substance Use amp MisuseUpshaw H S Ostrom T M (1984) Psychological perspective in

attitude research In Eiser J R ed Attitudinal Judgment New

York Springer-Verlag 23ndash42Valente T W Gallaher P Mouttapa M (2004) Using social network

theory to understand and prevent substance use a transdisciplinary

perspective Substance Use amp MisuseVorrath H Brendtro L (1985) Positive peer culture 2nd edn Aldine

ChicagoWaldron H B Slesnick N Brody J L Turner C W Peterson T R

(2001) Treatment outcomes for adolescent substance abuse at 4-

and 7-month assessments Journal of Consulting amp Clinical

Psychology 69(5)802ndash813Watson D L Tharp R G (2002) Self-directed behavior Self-

modification for personal adjustment 8th edn Belmont CA

WadsworthWeissberg R P Caplan M Z Sivo P J (1989) A new conceptual

framework for establishing school-based social competence promo-

tion programs In Bond L A Compas B E eds Primary

Prevention amp Promotion in the Schools Newbury Park CA Sage

255ndash296Wills T A (1986) Stress and coping in early adolescence relationships

to substance use in urban school samples Health Psychology

5503ndash529Wills T A Cleary S D (1995) Stress-coping model for alcohol-

tobacco interactions in adolescence In Fertig J B Allen J P

eds Alcohol and Tobacco From Basic Science to Clinical Practice

Bethesda MD National Institute on Alcohol Abuse and

Alcoholism 107ndash128Wills T A Cleary S D (1999) Peer and adolescent substance use

among 6thndash9th graders Latent growth analyses of influence versus

selection mechanisms Health Psychology 18453ndash463

2014 Sussman et al

ORDER REPRINTS

Wills T A Hirky A E (1996) Coping and substance abuse InZeidner M Endler N S eds Handbook of Coping TheoryResearch and Applications New York Wiley 279ndash302

Wills T A Stoolmiller M (2002) The role of self-control in earlyescalation of substance use a time-varying analysis Journal ofConsulting and Clinical Psychology 70986ndash997

Wills T A Baker E Botvin G J (1989) Dimensions of assertivenessdifferential relationships to substance use in early adolescenceJournal of Consulting and Clinical Psychology 57(4)473ndash478

Wills T A Vaccaro D McNamara G (1994) Novelty seeking risktaking and related constructs as predictors of adolescent substanceuse an application of Cloningerrsquos theory Journal of SubstanceAbuse 61ndash20

Wills T A McNamara G Vaccaro D Hirky A E (1996a)Escalated substance use a longitudinal grouping analysis fromearly to middle adolescence Journal of Abnormal Psychology105166ndash180

Wills T A Pierce J P Evans R I (1996b) Large-scale environmentalrisk factors for substance use American Behavioral Scientist39808ndash822

Wills T A Windle M Cleary S D (1998) Role of temperamentnovelty-seeking and self-control in adolescent substance useJournal of Personality and Social Psychology 74387ndash406

Wills T A Sandy J M Shinar O (1999) Substance use level andproblems in late adolescence a mediational model based on self-control and coping motives Experimental and ClinicalPsychopharmacology 7122ndash134

Wills T A Cleary S D Filer M Shinar O Mariani J Spera K(2001) Temperament and self-control related to early-onsetsubstance use test of a developmental model Prevention Science2145ndash163

Wills T A Sandy J M Yaeger A (2002) Moderators of therelationship between substance use level and problems test of aself-regulation model in adolescence Journal of AbnormalPsychology 1113ndash21

Wills T A Gibbons F X Gerrard M Murry V Brody G (in press-a) Family communication and religiosity related to substance useand sexual behavior in early adolescence Psychology of AddictiveBehaviors

Wills T A Resko J Ainette M Mendoza D (in press-b) The role ofparent and peer support in adolescent substance use a test ofmediated effects Psychology of Addictive Behaviors

Motivation Skills and Decision Making 2015

ORDER REPRINTS

Young P T (1936) Motivation of Behavior New York John Wiley andSons

Zimmerman B J (2000) Attaining self-regulation a social cognitivemodel In Boekaerts M Pintrich P R eds Handbook of Self-Regulation San Diego Academic Press 13ndash39

2016 Sussman et al

Request PermissionOrder Reprints

Reprints of this article can also be ordered at

httpwwwdekkercomservletproductDOI101081JA200034769

Request Permission or Order Reprints Instantly

Interested in copying and sharing this article In most cases US Copyright Law requires that you get permission from the articlersquos rightsholder before using copyrighted content

All information and materials found in this article including but not limited to text trademarks patents logos graphics and images (the Materials) are the copyrighted works and other forms of intellectual property of Marcel Dekker Inc or its licensors All rights not expressly granted are reserved

Get permission to lawfully reproduce and distribute the Materials or order reprints quickly and painlessly Simply click on the Request Permission Order Reprints link below and follow the instructions Visit the US Copyright Office for information on Fair Use limitations of US copyright law Please refer to The Association of American Publishersrsquo (AAP) website for guidelines on Fair Use in the Classroom

The Materials are for your personal use only and cannot be reformatted reposted resold or distributed by electronic means or otherwise without permission from Marcel Dekker Inc Marcel Dekker Inc grants you the limited right to display the Materials only on your personal computer or personal wireless device and to copy and download single copies of such Materials provided that any copyright trademark or other notice appearing on such Materials is also retained by displayed copied or downloaded as part of the Materials and is not removed or obscured and provided you do not edit modify alter or enhance the Materials Please refer to our Website User Agreement for more details

ORDER REPRINTS

model of drug abuse prevention We see this intrinsicextrinsic motiva-tion notion as providing intrapersonal and extrapersonal stimuli (cues)for action

Finally self-regulation models posit that one is motivated to achievean optimal state or system balance In essence an awareness of lack ofbalance will lead to efforts to restore balance (Carver and Scheier 1998Karoly 1980 1993) Drug abuse prevention may demand considerationof alternative actions in order to maintain homeostasis Affect may serveas the main homeostatic mechanism If people feel good or neutral theywill tend to maintain a given course of behavior On the other hand ifthey feel poorly they will want to change their behavior (as in the law ofeffect)

Constituents are those elements that when combined togethercompose a theoretical structure Seven constituents of motivation appearacross the four general theories (Nezami et al 2003) First the idea ofdiscrepancies appears in all theories Motivation exists as a distancebetween what is and what could be and these models assume that peopledesire to reduce such discrepancies Second motivation functions by theestablishment of goals Third motivation exists as energymdasha want ordrive Goals and the accompanying drive to achieve them usually appeartogether Fourth motivation may appear as a series of stages that lead toan end Different goals may operate at different stages Fifth motivationreflects ambivalence about two or more competing goals or behaviorsWorking through ambivalence enhances motivation Sixth motivationarises from different sources usually intrapsychic or environmentalrewards Finally a homeostatic conceptualization of motivation rests onthe idea of maintaining an optimal set point within a regulatory system

Integrations of these four models of motivation could help achievethe prevention of drug abuse One view suggests that due to lifeexperiences people consider goals or directions For example teens maystart to experiment with drugs due to curiosity perceived social pressureor as a means to induce a life change They may subsequently take risksthat injure their relations with others or impair their achievement inschool At some point a discrepancy likely develops between currentcircumstances and their goals For example teens may know that drugabuse is inconsistent with some life goals like school achievementHowever they may value social interaction and physical pleasure whichthey may reach through drug use or other means

Multiple goals may conflict with each other leading to ambivalence(Karoly 1993) Extrinsic and intrinsic sources of input may helpresolve ambivalence For example as the rewards associated with drugabuse diminish teens may experience a desire to decrease their drug

1988 Sussman et al

ORDER REPRINTS

consumption They may prove more likely to adopt a new goal ofdecreased drug use especially if they believe that they could achieve thegoal as self-efficacy theory suggests

Teens may exert energy to reduce discrepancies between currentstates and desired states They may learn new life or social skills whichcan lead them to become involved in rewarding but nondrug-usingactivities (Carroll 1996) In addition they may become involved in newtypes of social networks containing low-risk rather than high-risk peers(Valente et al 2004 Wills et al in press-b) Finally attaining a healthiergoal can create a positive optimal set point and the motivation systemprovides more positive feedback Over time through experience ofdifferent life events youth may alter the set point and begin a new goal-searching process (Sussman and Unger 2004) One may experience atraumatic life event for example and again consider drug use as a meansto return to an optimal set point or repeatedly get into trouble because ofassociating with deviant peers and realize that there is a need to turn todifferent types of associations

Research and theory from several disciplines suggest many motiva-tion strategies for a successful prevention program These motivationstrategies include myth correction stereotyping valuing life andachievement of health goals

Myth Correction

The recovery movement often refers to substance use and abuse as aproblem of perception Another closely related expression drug use mythsdescribes questionable or dysfunctional expectancies or beliefs that serveto justify drug use Myths involve more than expectancies or beliefs aboutpositive or negative outcomes they include inaccurate expectancies orbeliefs about the characteristics (or norms) of drugs and drug use and arelikely to confuse drug effects with drug experiences

Some common myths include inflated expectancies of positiveoutcomes from drug use or underestimates of negative outcomes fromdrug use Teens may believe that substance use will create peer groupacceptance or help them cope with family and school problems when infact the drug use only diverts them from actively coping with these socialand academic issues Thus in the long run drug use makes things worsenot better (Wills and Hirky 1996) Other myths include endorsement ofmisleading beliefs For example many adolescents believe that learningto manage drug intake without getting sick is a positive sign that theirbodies are growing tolerant to the drug rather than signaling the

Motivation Skills and Decision Making 1989

ORDER REPRINTS

beginnings of drug dependence or addiction In addition misperceptionsregarding physical consequences of drug use operate For example usersmistakenly believe that if they are able to regulate subjective effects of adrug they have gained control over use In reality warning systems maybe deteriorating as addiction begins (Glynn et al 1985 Sussman et al1995b) Challenging drug myths undoubtedly helps prevent drug abuse

These challenges can prove especially useful with high-risk popula-tions particularly if social influence programs are less effective in thesegroups Several prevention researchers have adopted a similar taxonomyof drug myths when attempting to prevent drug use Sussman Dent andStacy (1996) examined the internal consistency and discriminant validityof a measure of drug-related myths in 362 continuation (alternative) highschool youth They found good internal consistency and discriminantvalidity for the measure Controlling for its relations with socialdesirability perceived friendsrsquo drug use (a social influence measure)ethnicity and gender the myth measure remained significantly associatedwith four drug use measures Ames Sussman Dent and Stacy (1999)found a myth measure to be a relatively strong psychosocial predictor ofdrug use one-year later Cognitive perceptions obviously play a role indrug abuse prevention (Stein et al 1987) These findings suggest thatcontinued research on drug use myths should prove fruitful forprevention efforts (Sussman et al 1998 2003)

Some cognitive restructuring corrects faulty or self-defeatingcognitive structures (myths) In particular elaborating on the logicalsteps involved in the construction of a drug use myth may help to destroyits impact on behavior For example a common myth suggests thathaving trouble finding onersquos car after getting drunk is a funny event Ifone asks (a) lsquolsquoDid you want to find your carrsquorsquo (b) lsquolsquoWere you too drunk tofind it for a long timersquorsquo and (c) lsquolsquoAnd thatrsquos funnyrsquorsquo the apparent humorin the story may dissipate Further one may delineate the kernel of truthin the myth (not finding onersquos car is an odd event) from the falseaspects of the myth (not finding onersquos car indicates failure of functioningwhich is sad worrisome anxiety provoking not funny)

Stereotyping

Lower risk peers tend to perceive lsquolsquoat riskrsquorsquo others (eg alternativehigh school students) as being more deviant than they actually areUnderstandably youth so-labeled students resent this stereotypeAddressing this stereotype may help prevent drug abuse If lsquolsquoat riskrsquorsquoyouth begin to view themselves as being more deviant than they actually

1990 Sussman et al

ORDER REPRINTS

are the situation could lead to self-fulfilling prophesy as if they weregiving in to the stereotype However lowering the estimates of drug useamong their peers can correct this giving in This version of a prevalence-overestimation reduction lesson which includes a motivational featurehas appeared in successful prevention programs (Sussman et al 2002) Astereotype-oriented lesson may also accomplish a second goal If high-risk youth do not view themselves as being deviant as they assumedothers had judged them possibly reactions against this stereotype mayenergize an effort to avoid drug use as well as portray oneself morefavorably (Hamilton August 20 2000)

Valuing Life and Health Goals

Letrsquos consider the example of older teens Most youth report thatthey plan to graduate from high school and continue their educations orfind a job They do not view hanging out as a desirable option They alsosee that drug use could interfere with achieving their goals A lessonexplaining the negative consequences of drug use particularly oneconsistent with data (Newcomb and Bentler 1988) could reveal howearly involvement with drugs creates symptoms of abuse and dependenceand alters job opportunities marriage and family functioning These lifegoals can seem more valuable as students perceive them as attainableEnhancing the value of life goals can increase motivation for learningadaptive coping (Lau et al 1986) Youth have reported that drug usecould interfere with obtaining desired life goals In theme and componentstudies youth positively evaluated a lesson that taught that drug usecould interfere with obtaining desired goals and that placing animportance on health as a value was consistent with achievement of lifegoals (Sussman 1996) Thus it is important for prevention programs tohelp youth connect the importance of health to obtaining their life goalsand develop a sequenced plan so that they know how to proceed step-by-step (Karoly 1993 Watson and Tharp 2002)

Although modifiable understanding the source of positive life goalsis also important since these may occur earlier in life For instanceNewcomb and Harlow (1986) found that perceived loss of control andmeaninglessness in life mediated the relationship between negative lifeevents and drug use While numerous types of stressful events wereconsidered in this study other studies identify an adverse childhoodfamily environment as a potent precursor to later drug use (Locke andNewcomb in press Palinkas et al 1996) An adverse early homeenvironment a modifiable etiological factor should serve as a focus of

Motivation Skills and Decision Making 1991

ORDER REPRINTS

prevention that addresses child abuse and neglect (see later discussion ofthis topic)

Attitudinal Perspectives

Most youth consider themselves as being moderates They can alsoreliably identify drug use as being a deviant immoderate behaviorPresenting them with the disparity between their self-view as a moderateperson despite their deviant drug use can produce a desired behaviorchange (Sussman 1989 Upshaw and Ostrom 1984) An attitudinalperspective lesson can confront students with the inconsistency betweentheir general self-attitude ratings as moderates vs their more extremespecific behaviors (eg drug use) Adopting a self-perception as amoderate may inoculate youth when social pressures to experiment withdrugs arise A desire for internal consistency a similarity betweenattitudes and behavior may increase motivation to abstain from drugs(Festinger 1957 Heider 1958) Youth received lessons like these quitefavorably in previous work (Salomon et al 1984)

Skills

Direct instruction modeling practice and group reinforcementenhance social learning At least three basic kinds of skills needinstruction self-control communication and resource acquisition

Social Self-control Skills

Good self-control protects against substance use and buffers againstthe impact of risk factors (Bandura 1986 Catalano and Hawkins 1996Weissberg et al 1989 Wills et al 1998) Poor self-control involvesbehavioral affective and cognitive deficits Poor behavioral self-controlis associated with a need to regulate and stabilize mood possiblypreceding uncontrolled behavior or stemming from the consequences ofuncontrolled behavior Poor self-control behavior along with difficultiesin mood stabilization increases risk for substance use and rapidescalation to high levels of use which then can lead to physiologicaldependence (Wills and Stoolmiller 2002)

Self-control strategies cross physiological and personality boundariesbecause self-control also relates to coping motives for substance use a

1992 Sussman et al

ORDER REPRINTS

strong predictor of substance use problems (Wills et al 1999) Self-control includes cognition because developing self-control is the substratefor personality organization including not only behavioral and affectivecontrol but also attitudes values and views of the world as accepting orhostile and social perceptions about substance use as being attractive vsunattractive For example studies find poor self-control correlated withattitudinal tolerance for deviance and more favorable perceptions oftobacco and alcohol users whereas good self-control is related tofavorable perceptions of teens that abstain from drug use (Wills et alin press-a) Self-control approaches can be useful for preventionprograms by improving self and other perceptions academic perfor-mance and the impact or facilitation of negative life events goals that aresalient to teenagers and their parents (Wills and Stoolmiller 2002)

Youth often lack adequate coping skills they tend to lack restraint orplanfulness (Farrell and Danish 1993 Rutter et al 1997) Coping skillsinstruction may help increase self-control (Kendall and Braswell 1982)Coping skills instruction receives little attention in typical social influencesprogramming (Hansen 1992) although this material appears in life skillstraining (Botvin 1993 Botvin et al 1995 Wills 1986) In self-controlprogramming youth learn to assess their self-control particularly in socialcontexts (Sussman et al 2003) They learn the importance of thinkingahead and anticipating problem situations so that they are preparedbeforehand to deal with problems that may arise They also learn theimportance of context (eg not laughing at a funeral) Finally they learnassertiveness and anger management to help them better control theirreactions in social settings (Sambrano May 1999 Sussman et al 2002)

Listening and Communication Skills

Youth genuinely benefit from listening to information with an openmind and asking open-ended questions to keep a conversation goingThey can improve social skills by learning how to ask open-endedquestions establish eye contact appropriately nodding and orientingtheir body toward the other speaker (CPPRG 1999 Eggert and Herting1991 Hawkins et al 1999 Sussman et al 2002 2003) Neverthelesssocial skills training can create problems for nondrug using high-riskteens (Palinkas et al 1996 Sussman et al 1995b Wills et al in press-b)Training in drug refusal may create reactance in some samples (Sussmanet al 1996) Among high-risk youth enhancing assertiveness and datingskills may increase the scope of social entertainment options andinadvertently improve a teenrsquos ability to acquire drugs from new sources

Motivation Skills and Decision Making 1993

ORDER REPRINTS

(Wills et al 1989) Also there are cultural variations on what constitutesgood social skill (Unger et al 2004) There are good arguments forplacing high-risk teens together in activities with well-controlled teens sothat they can model adaptive social skills and problem solvingAdditionally utilizing motivation methods prior to instructing thespecific skill channels canalizes health-directed use of social skillsmastered Overall increasing social competence will have protectiveeffects for high-risk teens (Wills et al 1994) This idea is consistent withthe studies that have shown social withdrawal to increase risk for druguse (Kerr et al 1997) though there may be gender differences in theseeffects (Pulkkinen and Pitkanen 1994) Still it is most wise to includesocial skills training in conjunction with material addressing motivationand decision making Motivations regarding drug use need to beaddressed so behaviors learned are not misdirected

Resource Acquisition

Adults often assume that teens can access community services withlittle effort In fact few teens understand the availability of healthservices or other assistance Simple information including phonenumbers and locations can assist teens immensely (Carroll 1996Sussman et al 2002) Coaching teens on techniques for receivingassistance can prove productive Public assistance for drug use-relatedproblems and other life problems can help tremendously but negotiatingthe bureaucratic difficulties inherent in many of these systems can requireconsiderable skill (Eggert and Herting 1991 Sambrano May 1999Sussman et al 2002) Direct instruction modeling and structuredpractice in resource acquisition skills may help youth to increase theirknowledge and self-efficacy on how to acquire resources and to readilyaccess resources when needed (eg use of the bus system) These skillsmay generalize to comparable tasks later in life

Decision-Making

Prevention programs have employed several decision-making strate-gies For example the protocol from Project Reconnecting Youth(Project RY) is STEPS The acronym stands for Stop Think ofoptions Evaluate options Perform or take action on the chosen optionand then Self-praise for using steps for making healthy choices (Eggertand Herting 1991) The participants help set the agenda and take turns

1994 Sussman et al

ORDER REPRINTS

illustrating it on a flip chart This task helps share the leadership andfocuses the group work and time The lesson STEPS to Drug UseControl follows skills training sessions that cover understandingSTEPS as a decision-making model

Project Towards No Drug Abuse (TND)rsquos decision-making sessioninvolves four steps These steps are

1 Brainstorming (making a list of ideas without judging them)2 Weigh the pros and cons (the benefits and costs of each idea)3 Select the best option4 Follow through (try that option and reevaluate the decision)

(Sussman et al 2002)

These decision-making strategies are similar across different pro-grams except that they include some different emphases For exampleSTEPS includes a self-instruction to begin decision making and self-praise whereas the TND sequence includes more of an emphasis onfollowing through with the decision Generally each program requiresgenerating options evaluating them choosing the best and evaluatingthe outcome in an effort to make the next decision Teens tend to enjoypracticing decision making in bogus problem situations Youth soonlearn to engage in steps like these with considerable skill Training indecision making operates on variables that are intermediate in the causalprocess and thereby strengthen individual profiles of self-controlabilities so that they are more resilient in the face of proximal riskfactors for drug use such as life stresses and peer pressures

Modalities of Programming

Both school and nonschool prevention modalities have a rich andimportant history in substance abuse prevention research (Pentz 1994Pentz et al 2004) Schools provide a captive audience for educationalmaterial Youth spend 25 of their waking lives at school so thisenvironment has considerable potential Furthermore the school contextprovides a rich research history for building new studies and evaluatingtheir efficacy (Sussman et al 1995a) Community programs also offerconsiderable opportunity

Community programs often involve local leaders and organizations(eg coalitions community boards) (Goodman et al 1993 Kaftarianand Hansen 1994) that help mobilize numerous community unitsCommunity units include businesses media the family and governmental

Motivation Skills and Decision Making 1995

ORDER REPRINTS

agencies like the police or recreational departments as well as schoolsystems A network of community units working together to developpromote and implement educational programming could increase youthsrsquobonding to others across a wide variety of social contexts (Hawkins et al1992 Pentz 1994) Community units can provide numerous types ofspecific extra-classroom prevention opportunities (Pentz 1994)

Parent-or-family targeted prevention programs include offering earlychildhood education social support for parents managing crisesparenting skills training parent-child communication skills and resourceacquisition instruction or networking Mass media targeted programsinvolve programs or public service announcements with novel fastand unconventional messages (eg the American Legacy FoundationTRUTH campaign) use of the Internet and interactive CDs (eg videogames) Alternative means to involve youth include involvement in hikingclubs drug-free dances or other after-school events with prosocial adultmentors and with means to involve youth outside of school includingentry into different environments (ie outward bound) (Tobler 1986) Inaddition policy implementation and enforcement may contribute toother prevention programs (Pentz et al 1989) Indeed simultaneousprograms within and outside of schools over long periods might maintainthe positive effects that sometimes dissipate when school programsappear alone (Pentz 1994)

The Difference Between Targeted Prevention and Cessation

Targeted (secondary) prevention attempts to keep persons fromcrossing the invisible line where they funnel into a cycle of addiction andaccumulation of negative consequences Cessation programs (sometimesreferred to as tertiary prevention) take the stance that a behavior hasoccurred with definite and perhaps irreversible negative consequencesThe goal is to stop the behavior permit recovery from the damage learnhow to prevent relapse and learn how to live with permanent changes(eg neurotransmitter function drug use-related injury) It is not clearexactly where indicated prevention ends however and where cessationbegins For example an early version of the Project TND curriculum didnot achieve effects on cigarette smoking possibly because 46 of thesample already smoked cigarettes daily (while not engaging often in someother drug use) In a revised curriculum a smoking cessation componentwas added to the program and then an effect on cigarette smoking wasachieved Cessation material can appear with prevention material to

1996 Sussman et al

ORDER REPRINTS

maximize program effectiveness Careful program development can helpdetermine the best mix (Sussman et al 2002)

Summary of Evidence-based Targeted Drug Abuse Prevention

At present approximately 29 drug-use prevention programs havebeen evaluated favorably for their effects on drug use or other problembehavior (see Table 1) These 29 programs have been identified throughtwo sources Blueprints for Violence Prevention (Elliott 2003) and theSubstance Abuse and Mental Health Services Administrationrsquos(SAMSHA) science-based prevention programsrsquo guide (USDHHS2003) PsycINFO and MEDLINE searches of drug abuse preventionstudies since 1970 supplemented searches through these two guides (seeTable 1) Nine definitions of high-risk were used across these programsEleven programs focused on economic deprivation as the definition Sixprograms focused on delinquent behavior as the identifying characteristicto target Two programs each identified single-parent homes drug use orexposure to drug use family problems alternative high school attendanceor being at risk for dropout at a regular high school as the characteristicsto target subjects Finally one program each identified new immigrantstatus or residential facility placement as the defining characteristic ofbeing at high risk for drug use

Among these programs eight focused on preteens For example theEarly Risers program defined its high-risk youth as those 6ndash10 year-oldsthat suffered economic deprivation and exhibited aggressive or opposi-tional behavior Another five programs focused on a young teen agegroup For example Preventive Intervention defined its high-risk youthas those seventh to eighth graders who exhibited poor school andacademic discipline and reported family problems Another sevenprograms focused on an older teen age group For example ProjectTND defined its high-risk youth as those youth that attended alternativehigh schools Finally nine programs encompassed wide age ranges Forinstance Big Brothers Big Sisters of America defined its high-risk youthas 6ndash18 year-olds that lived in single-parent homes

Of these programs 10 involved multiple often flexible settings ofimplementation Another 13 programs focused on the school settingFour programs focused on the home setting Finally two programsfocused on a community agency setting In general these programsinvolved implementation by highly trained personnel Eighteen of theseprograms involved some motivation aspect generally motivationenhancement but sometimes including extrinsic reinforcement strategies

Motivation Skills and Decision Making 1997

ORDER REPRINTS

Twenty-six of these programs provided skills training Finally 18programs provided instruction in decision making Thus the MSDmodel tends to appear in a majority of these programs however all threecomponents were included together in only nine of these programs

Twenty of these programs involved at least one replication of theprogram and 14 involved three or more replications Further 14 of theseprograms were tested through use of experimental designs and nineinvolved use of only quasi-experimental designs Effects on drug use wereassessed and found in 22 of these programs For example theReconnecting Youth program was implemented to youth at risk fordropout This program involved 90 sessions within a comprehensive highschool class delivered generally over a semester with small studentgroups and a highly trained teacher Instruction included use of groupsupport and providing life skills training (norm setting self-esteem moodmanagement communication skills self-monitoring monitoring goalsschool bonding and social activities) with feedback to parents Programgoals were achieved through use of a quasi-experimental design showingeffects for school performance (18 improvement in grades) drug use(54 decrease in hard drug use) and suicide risk (32 decline inperceived stress) This programrsquos results have been replicated numeroustimes in numerous locations This program involved all three componentsof the MSD model except that motivation was provided through peergroup support not through provision motivation enhancement strate-gies These targeted programs present an optimistic picture for drug-useprevention that is focused on at-risk youth (see Table 1)

Not all targeted prevention programs have been found to beeffective One published program that failed to find positive effects wasProject PALS (Palinkas et al 1996) This project was developed for teengirls who were pregnant or at risk for pregnancy and drug use Theprogram consisted of school-based delivery of 16 sessions once a weekin a class The goal was to decrease drug use The PALS Skills TrainingProgram involved instruction in assertiveness providing and receivingfeedback social conversation handling requests and asking for help andmood management This program was tested against a normativeeducation program (called Facts of Life or FOL) which instructedvalues and decision making sexuality issues and contraception sexuallytransmitted diseases (STDs) drug use risks sexual assault prevalenceand norms material An experimental evaluation with a seven-monthspost-baseline was used The results indicated that the PALS programsubjects reported 29 times greater marijuana use than FOL amongbaseline nonusers No other differences were found It is possible that theprogram was not targeted to the right population that the mix of skills

1998 Sussman et al

ORDER REPRINTS

instructed was not appropriate or that skill training alone (withoutappropriate motivation material) may not be effective in drug useprevention Researchers should examine these possibilities and others tofurther understand program failures as well as program successes

Potential Limitations of Targeted Prevention

Dishion and colleagues (1995) suggest from various findings thatgrouping high-risk youth may lead to increased drug use This outcomecan result if youth come to learn deviant behavior from each other Theycan learn deviant behavior from each other in a program if they haveunstructured or unsupervised time together An essential feature ofseveral targeted programs (eg the RY and TND programs) is building apositive peer culture with group norms that decrease drug involvementand drug-use control problems The RYrsquos findings suggest that a positivepeer group component carefully fostered by a well-trained and competentRY group leader can direct the group toward lower risk behaviorSimilarly classroom management in Project TND involves developmentof positive norms of classroom behavior Further interaction betweenyouth is encouraged but is primarily teacher-directed and highlystructured (Sussman et al 2003) In both RY and Project TND theteacherrsquos role is to actively develop and maintain peer group support inthe class by modeling support positively reinforcing it among groupmembers and negatively reinforcing deviant peer bonds and activities(Eggert and Herting 1991 Vorrath and Brendtro 1985) The teachercreates and structures interactions among youth in prosocial directions(Sussman et al 2003)

Multiple Problem Behaviors of Adolescents

Acknowledging the relationship of drug use to other commonadolescent problems may facilitate identification of effective methods ofreducing drug use Researchers on tobacco alcohol and other drug useantisocial behavior high-risk sexual behavior and depression increas-ingly recognize that these problems are interrelated (McGee andNewcomb 1992) and stem to a large extent from the same environ-mental and biological factors (Biglan et al in press Eggert et al 1995Sussman and Ames 2001 Wills and Cleary 1995) Clearly it is necessaryto have strategies that address the entire range of problems and thecontext that influences those problems Indeed further reductions in

Motivation Skills and Decision Making 1999

ORDER REPRINTS

many problems require that we comprehensively target youth withmultiple problem behaviors

Biglan and colleagues (in press) provide a comprehensive review ofthe relationships among antisocial behavior tobacco alcohol and otherdrug use and high-risk sexual behavior It is clear that the same youngpeople are prone to the development of the entire range of problems In arecent review Moffitt and colleagues (2002) found that antisocialbehavior in early adolescence (rather than late adolescence) is a greaterrisk factor for developing multiple problems These findings point to theimportance of early intervention before youth develop serious problemsMoreover these different problems largely result from the same set ofenvironmental and biological factors

One implication is that disciplines dealing with these problemsother than drug abuse may contribute to dealing with the problem ofdrug use (Newcomb 1996b 1997) In particular research by dev-elopmental psychologists family social workers and sociologists onthe influence of parents on adolescent problem development and oninterventions to alter parenting practices contributes to our understandingof how to prevent or ameliorate drug abuse and other problems Onealso should note that nonsubstance use is not a guarantee for problemimmunity for the entire age range of people whatever their genderethnicity religiosity socioeconomic status (SEC) domicility etc It maybe argued that the most promising programs are those targeting thesemultiple levels of influence Several multidisciplinary programs haveachieved promising results We describe three of these empiricallyevaluated programs tested in various settings

Functional Family Therapy (FFT)FFT is an indicated intervention involving family treatment designed

for delinquent teenagers (also see Table 1) Developed in the early 1970sby Alexander and colleagues (1973) FFT focuses on family commu-nication and the establishment of rules and consequences Several studiesprovide encouraging reports of the programrsquos effectiveness (Alexander etal 1976 Barton et al 1985 Klein et al 1977 Waldron et al 2001) Inthe Waldron et al (2001) study researchers used FFT and anintervention with cognitive behavior therapy on teens referred formarijuana use Each of the interventions produced significant resultson marijuana use by the teens at four months but only the twointerventions combined maintained these results at seven months Theearlier studies found a greater number of results For example in the twoAlexander studies (1973 1976) improvement in family communicationposttreatment led to reduced delinquency Note that all the teens in these

2000 Sussman et al

ORDER REPRINTS

studies had histories of serious antisocial or delinquent behavior Thusachieving positive outcomes even if only short-term should encouragefurther research into the efficacy of FFT

Multisystemic Therapy (MST)As its name suggestsMST targets individual family peer school and

community influences of those youth offenders with serious problems thatmay include violence substance use and severe emotional problems (alsosee Table 1) Numerous researchers have published the results ofrandomized trials of MST (Henggeler et al 1996 1997 1998 Thorntonet al 2000) The most consistent findings across studies are decreased (1)drug use (2) re-arrest (3) self-reported criminal offense and (4) days inout-of-home placements Other consistent findings are improved familyrelations school attendance and psychiatric functioning One cautionarynote the programrsquos effectiveness lowers considerably if not implementedwith fidelity (Hengler et al 1997 1999) In other words all or key lessonsneed to be delivered as written by educators who are well-trained in usingthe strategies employed and youth need to be able to receive all material inan atmosphere conducive to learning the material The programdevelopers have instituted training strategies that address these fidelityissues thus shaping MST to be a very promising program for at-riskyouth

Multidimensional Treatment Foster Care (MTFC)MTFC targets family and peer factors influencing adolescents with a

pattern of repeat criminal offending (see Table 1) (Chamberlain 1994)This intervention includes placement of the youth into a foster homewith a foster parent trained in behavior management who receivessupport from intervention staff After the adolescent has begun torespond to the intervention in the foster home and after the parents havereceived the same training and support as the foster parents did theadolescent returns home Chamberlain and Reid (1998) tested theintervention with 85 boys with felony and other criminal histories andfound substantial benefits of the program Following treatment the boysassigned to MTFC (compared to those receiving community-based groupcare) showed fewer days in detention or lock-up twice as much timeliving with parents fewer misdemeanor and felony arrests and fewer self-reported index crimes felony arrests and general delinquency TheMTFC is a cost-effective alternative to incarceration however staffrequirements are extensive which may influence the ability of some

Motivation Skills and Decision Making 2001

ORDER REPRINTS

groups to apply the program with fidelity However as with each of theprograms described here the results of the randomized trials areencouraging

Future Research Needs in Targeted Prevention

Future research can help discern when and where targeted preventionprogramming will tend to work rather than produce potentiallydeleterious negative group effects or results that are irrelevant for pro-social healthy adaptation as well as what the critical necessary conditionsare for their effective operation within given de facto realities Comparedto the breadth of evaluated universal drug use prevention programs(Tobler et al 2000) relatively few targeted prevention programs havereceived empirical support Yet previous research suggests that universalschool-based drug use prevention programs implemented in junior highschool have relatively less chance of long-term success especially for thoseyouth that began using drugs before the prevention program wasimplemented Of course there are notable exceptions (eg effects lastedfor one and a half years effects lasted for six years) (Chou et al 1998Griffin et al 2003 Skara and Sussman 2003) Almost no research existsregarding maximization of booster programming with high-risk youthMore research on booster programs would help the field

While continuing to engage in this work there will be numerousissues to manage that go well beyond the scope of this article There willbe a need to avoid producing negative labeling effects while providingprogramming for those who are at risk for drug use It is possible thatcessation information needs to be included in the mix with preventionmaterial to provide better targeted-prevention effects There may be aneed to develop a teacher selection instrument to help select out teacherswho can deliver drug abuse prevention programming adequatelyCertainly definition of outcome variables needs continued explorationincluding analysis to ascertain the effects of programming on drug abusevs drug use and identification of the variables that are most closelylinked to change by targeted prevention components

A transdisciplinary approach helps to better understand the lifesituation of high-risk youth as based to some extent on both constitutionaland environmental factors (Fuqua et al 2004 Rutter et al 1997 Wills etal 1996b) From the transactional perspective their situation is in partconstitutional they may have temperamental characteristics that arepartly heritable and that have set the stage at earlier ages for decrements inself-control ability and academic performance that then increase risk for

2002 Sussman et al

ORDER REPRINTS

drug use However their situation is also part environmental based in parton family socialization and in part on the types of peers they have as well asthe type and quality of the physical and cultural environment-at-largeThere are many points at which a potential chain of failures can beinterrupted and the individualrsquos trajectory turned in a better directionProblems are not inevitable from starting level (Tarter and Vanyukov1994) and environmental modifications to support good self-controlability can help to avert an adverse impact from earlier experiences orcurrent difficulties (Brody et al 2002 Novak and Clayton 2001 Patock-Peckham et al 2001 Rutter et al 1997 Wills et al 2002)

The problems and needs of high-risk youth in our nationrsquos highschools demand our attention for designing and rigorously testingtargeted prevention approaches Substantial evidence shows that theseyouth are at greater risk for drug involvement and co-occurring problemssuch as aggression depression and suicidal behaviors as we previouslydiscussed It is hoped that the information presented in this article willstimulate others to join in extending this work including testing othermodels of targeted prevention

GLOSSARY

Universal programs Programs that aim to influence all subjects in acontext

Selective drug-abuse prevention programs Programs that servegroups at greater risk of ATOD usemdashfor example children of alcoholicparents They are at psychosocial risk for drug use and abuse

Indicated drug-abuse prevention programs Programs that attemptto benefit individuals who already show signs of drug involvement orrelated risk factors In indicated prevention programs the primary goal isto stem the progression of ATOD use or reduce drug involvementamong the high-risk youth

Targeted programming Programming that subsumes selective andindicated programming sometimes the other two types of programs thattarget specific groups lsquolsquoat riskrsquorsquo are considered together

ACKNOWLEDGMENTS

This research was supported by grants from the National Institute onDrug Abuse (DA01070 DA07601 DA13814 and DA16094) and by aResearch Scientist Development Award K02 DA00252 from theNational Institute on Drug Abuse

Motivation Skills and Decision Making 2003

ORDER REPRINTS

REFERENCES

Alexander J F Barton C Schiaro R S Parsons B V (1976)

Systems-behavioral intervention with families of delinquents

therapist characteristics family behavior and outcome Journal of

Consulting and Clinical Psychology 44(4)656ndash664Alexander J F Parsons B V (1973) Short-term behavioral interven-

tion with delinquent families impact on family process and

recidivism Journal of Abnormal Psychology 3219ndash225American psychiatric association (APA) (1994) Diagnostic and

Statistical Manual of Mental Disorders 4th edn (DSM-IV)

Washington DC American Psychiatric AssociationAmes S L Sussman S Dent C W (1999) Pro-drug-use myths and

competing constructs in the prediction of substance use among

youth at continuation high schools a one-year prospective study

Personality and Individual Differences 26987ndash1003Bachman S G Wadsworth K N OrsquoMalley P M Johnston L D

Schulenberg J E (1997) Smoking drinking and drug use in young

adulthood Mahwah NJ Lawrence Erlbaum Associates 8ndash25

153ndash190Bandura A (1986) Social Foundations of Thought and Action A Social

Cognitive Theory Englewood Cliffs NJ Prentice HallBarton C Alexander J F Waldron H Turner C W Warburton J

(1985) Generalizing treatment effects of functional family therapy

Three replications The American Journal of Family Therapy

13(3)16ndash26Battin-Pearson S R Newcomb M D Abbott R D Hill K G

Catalano R F Hawkins J D (2000) Predicting early high school

dropout Journal of Educational Psychology 92568ndash582Biglan A Brennan P A Foster S L Holder H D Miller T L

Cunningham P B et al (in press) Helping Adolescents at Risk

Prevention of Multiple Problem Behaviors New York NY Guilford

PressBindra D Stewart J (1996) Motivation Baltimore MD Penguin

BooksBlanton H Gibbons F X Gerrard M Conger K J Smith G E

(1998) The role of family and peers in the development of

prototypes associated with substance use Journal of Family

Psychology 11271ndash288

2004 Sussman et al

ORDER REPRINTS

Botvin G J (1993) School-based drug abuse prevention Long-termfollow-up results In First Annual Meeting of the Society forPrevention Research Kentuck Lexington Society for PreventionResearch

Botvin G J Baker E Dusenbury L Botvin E M Diaz T (1995)Long-term follow-up results of a randomized drug abuse preven-tion trial in a white middle-class population Journal of theAmerican Medical Association 2731106ndash1012

Brody G H Dorsey S Forehand R Armistead L (2002) Uniquecontributions of parenting and classroom processes to the self-control of AfricanndashAmerican children Child Development73274ndash286

Carroll M E (1996) Reducing drug abuse by enriching the environmentwith alternative nondrug reinforcers In Green L Kagel J Heds Advances in Behavioral Economics Norwood NJ NorwoodPublishing Corp 37ndash68

Carver C S Scheier M F (1998) On the Self-Regulation of BehaviorNew York Cambridge University Press

Catalano R F Hawkins J D (1996) The social developmental modela theory of antisocial behavior In Hawkins J D ed Delinquencyand Crime Current Theories New York Cambridge UniversityPress

Centers for Disease Control (CDC) (October 1999) Youth risk BehaviorSurveillancemdashNational Alternative High School Youth RiskBehavior Survey 1998 Morbidity and Mortality Weekly Report48 No SS-7

Chamberlain P (1994) Family connections A treatment foster caremodel for adolescents with delinquency Eugene OR CastaliaPublishing Company

Chamberlain P Reid J B (1998) Comparison of two communityalternatives to incarceration for chronic juvenile offenders Journalof Consulting and Clinical Psychology 66(4)624ndash633

Chassin L A Presson C C Sherman S J (1985) Stepping backwardin order to step forward an acquisition-oriented approach toprimary prevention Journal of Consulting and Clinical Psychology53612ndash622

Chou C-P Montgomery S Pentz M A Rohrbach L A JohnsonC A Flay B R MacKinnon D P (1998) Effects of acommunity-based prevention program on decreasing drug use inhigh-risk adolescentsAmerican Journal of Public Health 88944ndash948

Conducts Problems Prevention Research Group (CPPRG) (1999) Initialimpact of the fast track prevention trial for conduct problems I

Motivation Skills and Decision Making 2005

ORDER REPRINTS

The high-risk sample Journal of Consulting and Clinical Psychology

67631ndash647Conducts Problems Prevention Research Group (CPPRG) (2000)

Merging universal and indicated prevention programs the fast

track model Addictive Behaviors 25913ndash927Council of Philosophical Studies (1981) Psychology and the Philosophy

of Mind in the Philosophy Curriculum San Francisco San Francisco

State UniversityCummings K M Hellmann R Emont S L (1988) Correlates of

participation in a worksite stop smoking program Journal of

Behavioral Medicine 11267ndash277Curry S Wagner E H Gothaus L C (1990) Intrinsic and extrinsic

motivation for smoking cessation Journal of Consulting and

Clinical Psychology 58310ndash316Dent C W Sussman S McCuller W J Stacy A W (2001) Drug

abuse prevention among youth at comprehensive high schools

Preventive Medicine 32514ndash520Dewey J (1886) Psychology New York HarperDishion T J French D C Patterson G R (1995) The development

and ecology of antisocial behavior In Cicchetti D Cohen D

eds Manual of developmental psychopathology New York John

Wiley 421ndash471Eggert L L Herting J R (1991) Preventing teenage drug abuse

exploratory effects of network social support Youth and Society

22482ndash534 [Reprinted National Prevention Evaluation Research

CollectionRockville MD Aspen 1993]Eggert L L Herting J R Thompson E A Nicholas L J Dicker

B G (1994) Preventing adolescent drug abuse and high school

dropout through an intensive school-based social network devel-

opment program American Journal of Health Promotion

8202ndash214Eggert L L Thompson E A Herting J R Nicholas L J (1995)

Reducing suicide potential among high-risk youth tests of a school-

based prevention program Suicide amp Life-Threatening Behavior

25276ndash296Ellickson P L Bell R M (1990) Drug prevention in junior high a

multi-site longitudinal test Science 2471299ndash1305Elliott D S (Series ed) (2003) Blueprints for violence prevention

Boulder CO Institute of Behavioral Science Regents of the

University of Colorado wwwcoloradoeducspvblueprints

2006 Sussman et al

ORDER REPRINTS

Farrell A D Danish S J (1993) Peer drug associations and emotionalrestraint Causes or consequences of adolescent drug use Journal ofConsulting and Clinical Psychology 61327ndash334

Festinger L A (1957) A Theory of Cognitive Dissonance New YorkHarper amp Row

Fuqua J Stokols D Gress J Phillips K Harvey R (2004)Transdisciplinary collaboration as a basis for enhancing the scienceand prevention of substance use and abuse Substance Use ampMisuse

Giuliano J D (1994) A peer education program to promote the use ofconflict resolution skills among at-risk school-age males PublicHealth Reports 109158ndash169

Glynn K Levanthal H Hirschman R (1985) A cognitivedevelopmental approach to smoking prevention In Bell C SBattjes R eds Prevention research Deterring Drug Abuse AmongChildren and Adolescents Rockville MD NIDA ResearchMonograph 63

Glynn T J (1989) Essential elements of school-based smokingprevention programs Journal of School Health 59181ndash188

Goodman R M Burdine J N Meehan E McLeroy K R eds(1993) Community coalitions for health promotion Special issue ofHealth Education Research Theory and Practice 8309ndash453

Goodyear R D Newcomb M D Locke T F (2002) PregnantLatina teenagers psychosocial and developmental determinants ofhow they select and perceive the men who father their childrenJournal of Counseling Psychology 49187ndash201

Gordon R (1987) An operational classification of disease preventionIn Steinberg J A Silverman M M eds Preventing MentalDisorders Rockville MD DHHS 20ndash26

Graham J W Johnson C A Hansen W B Flay B R Gee M(1990) Drug use prevention programs gender and ethnicityevaluation of three seventh-grade project SMART cohortsPreventive Medicine 19305ndash313

Griffin K W Botvin G J Nichols T R Doyal M M (2003)Effectiveness of a universal drug abuse prevention approach foryouth at high risk for substance use initiation Preventive Medicine36(1)1ndash7

Hamilton S (August 20 2000) Views slowly changing on alternativeschools The Sacramento Bee 1ndash3

Hansen W B (1992) School-based substance abuse prevention a reviewof the state of the art in curriculum 1980ndash1990 Health EducationResearch 7403ndash430

Motivation Skills and Decision Making 2007

ORDER REPRINTS

Hansen W B Johnson C A Flay B R Graham J W Sobel J(1988) Affective and social influences approaches to the preventionof multiple substance abuse among seventh grade students resultsfrom project SMART Preventive Medicine 17135ndash154

Hansen W B Graham J W (1991) Preventing alcohol marijuanaand cigarette use among adolescents peer pressure and resistancetraining versus establishing conservative norms PreventiveMedicine 20414ndash430

Hawkins D H Catalano R F Miller J Y (1992) Risk andprotective factors for alcohol and other drug problems inadolescence and early adulthood Implications for substanceabuse prevention Psychological Bulletin 11254ndash105

Hawkins J D Catalano R F Kosterman R Abbott R Hill K G(1999) Preventing adolescent health-risk behaviors by strengthen-ing protection during childhood Archives of Pediatric amp AdolescentMedicine 153226ndash234

Heider F (1958) The Psychology of Interpersonal Relations New YorkWiley

Henggeler S W Pickrel S G Brondino M J Crouch J L (1996)Eliminating (almost) treatment dropout of substance abusing ordependent delinquents through home-based multisystemic therapyAmerican Journal of Psychiatry 153(3)427ndash428

Henggeler S W Melton G B Brondino M J Scherer D GHanley J H (1997) Multisystemic therapy with violent andchronic juvenile offenders and their families the role of treatmentfidelity in successful dissemination Journal of Consulting andClinical Psychology 65(5)821ndash833

Henggeler S W Schoenwald S K Borduin C M Rowland M DCunningham P B (1998) Multisystemic treatment of antisocialbehavior in children and adolescents New York The Guilford Press

Henggeler S W Pickrel S G Brondino M J (1999) Multisystemictreatment of substance-abusing and dependent delinquents out-comes treatment fidelity and transportability Mental HealthServices Residual 1(3)171ndash84

Johnson C A Pentz M A Weber M D Dwyer J H Baer NMacKinnon D P Hansen W B Flay B R (1990) Relativeeffectiveness of comprehensive community programming for drugabuse prevention with high-risk and low-risk adolescents Journalof Consulting and Clinical Psychology 58447ndash456

Kaftarian S J Hansen W B eds (1994) CSAP special issuecommunity partnership program Journal of Community Psychologypages 205

2008 Sussman et al

ORDER REPRINTS

Karoly P (1993) Mechanisms in self-regulation A systems view AnnualReview of Psychology 4423ndash51

Karoly P (1980) Person variables in therapeutic change and develop-ment In Karoly P Steffen J J eds Improving the Long-TermEffects of Psychotherapy New York Gardner Press 195ndash261

Kendall P C Braswell L (1982) Cognitive-behavioral self-controltherapy for children a components analysis Journal of Consultingand Clinical Psychology 50672ndash689

Kerr M Tremblay R E Pagani L Vitaro F (1997) Boysrsquobehavioral inhibition and the risk of later delinquency Archivesof General Psychiatry 54809ndash816

Klein N C Alexander J F Parsons B V (1977) Impact of familysystems intervention on recidivism and sibling delinquency a modelof primary prevention and program evaluation Journal ofConsulting and Clinical Psychology 45(3)469ndash474

Kumpfer K L (1999) Outcomes measures of interventions in the studyof children of substance-abusing parents Pediatrics 1031128ndash1144

Lau R R Hartman K A Ware J E (1986) Health as a valuemethodological and theoretical considerations Health Psychology525ndash43

Lichtenstein E L Glasgow R E (1997) A pragmatic framework forsmoking cessation implications for clinical and public healthprograms Psychology of Addictive Behaviors 11142ndash151

Locke T F Newcomb M D (in press) Childhood maltreatmentparent drug problems polydrug problems and parenting practicesa test of gender differences and four theoretical perspectivesJournal of Family Psychology

McCreary D R Newcomb M D Sadava S W (1999) The male rolealcohol use and alcohol problems a structural modeling examina-tion in adult women and men Journal of Counseling Psychology46109ndash124

McGee L Newcomb M D (1992) General deviance syndromeexpanded hierarchical evaluations at four ages from earlyadolescence to adulthood Journal of Consulting amp ClinicalPsychology 60766ndash776

Miller W R Brown J M (1991) Self-regulation as a conceptual basisfor the prevention of addictive behaviours In Heather N MillerW R Greeley J eds Self-control and the Addictive BehavioursSydney Australia Maxwell Macmillan 3ndash79

Miller W R Leckman A L Delaney H D Tinkcom M (1993)Long-term follow-up of behavioral self-control training forproblem drinkers Journal of Studies on Alcohol 53249ndash261

Motivation Skills and Decision Making 2009

ORDER REPRINTS

Miller W R Rollnick S (1991) Motivational InterviewingPreparing People to Change Addictive Behavior New YorkGuilford Press

Moffitt T E Caspi A Harrington H Milne B J (2002) Males onthe life-course-persistent and adolescence-limited antisocial path-ways follow-up at age 26 years Development and Psychopathology14(1)179ndash207

National Institute on Drug Abuse (NIDA) (1997) Drug abuseprevention What works NIH Publication 97-4110 DHHSNational Institutes of Health National Institute on Drug AbuseOffice of Science Policy and Communications Rockville MD

Newcomb M D (1992a) Substance abuse and control in the UnitedStates ethical and legal issues Social Science and Medicine35471ndash479

Newcomb M D (1992b) Understanding the multidimensional nature ofdrug use and abuse The role of consumption risk factors andprotective factors In Glantz M D Pickens R eds Vulnerabilityto Drug Abuse Washington DC American PsychologicalAssociation 255ndash298

Newcomb M D (1996a) Pseudomaturity among adolescents constructvalidation sex differences and associations in adulthood Journalof Drug Issues 26477ndash504

Newcomb M D (1996b) Adolescence Pathologizing a normal processThe Counseling Psychologist 24482ndash490

Newcomb M D (1997) Psychosocial predictors and consequences ofdrug use a developmental perspective within a prospective studyJournal of Addictive Diseases 1651ndash89

Newcomb M D Bentler P M (1988) Consequences of Adolescent DrugUse Impact on the Lives of Young Adults Beverly Hills CA Sage

Newcomb M D Bentler P M (1989) Substance use and abuse amongchildren and teenagers American Psychologist 44242ndash248

Newcomb M D Harlow L L (1986) Life events and substance useamong adolescents Mediating effects of perceived loss of controland meaninglessness in life Journal of Personality and SocialPsychology 51564ndash577

Newcomb M D Chou C-P Bentler P M Huba G J (1988)Cognitive motivations for drug use among adolescents longitudinaltests of gender differences and predictors of change in drug useJournal of Counseling Psychology 35426ndash438

Newcomb M D Abbott R D Catalano R F Hawkins J DBattin-Pearson S R Hill K (2002) Mediational and deviancetheories of late high school failure Process roles of structural

2010 Sussman et al

ORDER REPRINTS

strains academic competence and general versus specific problem

behaviors Journal of Counseling Psychology 49172ndash186Nezami E Sussman S Pentz M A (2003) Motivation in tobacco use

cessation research Substance Use amp Misuse 3825ndash5Novak S P Clayton R R (2001) The influence of school environment

and self-regulation on transitions between stages of cigarette

smoking Health Psychology 20196ndash207Offord D R (2000) Selection of levels of prevention Addictive

Behaviors 25833ndash842Palinkas L A Atkins C J Miller C Ferreira D (1996) Social skills

training for drug prevention in high-risk female adolescents

Preventive Medicine 25692ndash701Patock-Peckham J A Cheong J-W Balhorn M E Nagoshi C T

(2001) A model of parenting styles self-regulation perceived

drinking control and alcohol use and problems Alcoholism

Experimental and Clinical Research 251284ndash1292Pentz M A (1994) Directions for future research in drug abuse

prevention Preventive Medicine 23646ndash652Pentz M A Dwyer J H MacKinnon D Flay B R Hansen W B

Wang E Y I Johnson C A (1989) A multi-community trial for

primary prevention of adolescent drug abuse effects on drug use

prevalence JAMA 2623259ndash3266Pentz M A Mares D Schinke S Rohrbach L (in press) Political

science public policy and drug abuse prevention Substance Use amp

MisuseProchaska J O DiClemente C C (1982) Transtheoretical therapy

toward a more integrative model of change Psychotherapy Theory

Research and Practice 19275ndash288Pulkkinen L Pitkanen T (1994) A prospective study of the precursors

to problem drinking in young adulthood Journal of Studies on

Alcohol 55578ndash587Rathus S A Nevid J S (1977) Behavior Therapy Strategies for

Solving Problems in Living New York Doubleday and Company

IncResnicow K Botvin G (1993) School-based substance use prevention

programs why do effects decay Preventive Medicine 22484ndash490Rutter M Dunn J Plomin R Simonoff E Pickles A Maughan

B Ormel J Meyer J Eaves L (1997) Integrating nature and

nurture implications of person-environment interactions for

developmental psychopathology Development and Psychopathology

9335ndash364

Motivation Skills and Decision Making 2011

ORDER REPRINTS

Salomon G Stein Y Eisenberg S Klein L (1984) Adolescent

smokers and nonsmokers profiles and their changing structure

Preventive Medicine 13446ndash461Sambrano S (1999) National cross-site evaluation of high risk youth

programs In Interim findings Bulletin Washington DC CSAP

SAMSHA US DHHS May 1ndash16Schinke S P Gilchrist L D (1985) Preventing substance abuse with

children and adolescents Journal of Consulting and Clinical

Psychology 53596ndash602Skara S N Sussman S (2003) A review of 25 long-term adolescent

tobacco and other drug use prevention program evaluations

Preventive MedicineSmith C Lizotte A J Thornberry T P Krohn M D (1995)

Resilient youth identifying factors that prevent high-risk youth

from engaging in delinquency and drug use Delinquency and

Disrepute in the Life Course Greenwich CT John Hagan JAI

press 217ndash247Sommers P V (1972) The Biology of Behavior Australia Pty ltd

Sydney John Wiley amp SonsSt Pierre T L Kaltreider D L Mark M M Aikin K J (1992)

Drug prevention in a community setting a longitudinal study of the

relative effectiveness of a three-year primary prevention program in

boys and girls clubs across the nation American Journal of

Community Psychology 20673ndash706Stein J A Newcomb M D Bentler P M (1987) An eight year study

of multiple influences on drug use and drug use consequences

Journal of Personality and Social Psychology 531094ndash1105Sully J (1884) Outlines of Psychology New York D Appleton amp CoSussman S (1989) Two social influence perspectives of tobacco use

development and prevention Health Education Research Theory

and Practice 4213ndash223Sussman S (1991) Curriculum development in school-based prevention

research Health Education Research Theory and Practice

6339ndash351Sussman S (1996) Development of a school-based drug abuse

prevention curriculum for high risk youth Journal of

Psychoactive Drugs 28169ndash182Sussman S Ames S L (2001) The social psychology of drug abuse

Buckingham GB Open University PressSussman S Unger J (2004) A drug abuse theoretical integration a

transdisciplinary speculation Substance Use amp Misuse

2012 Sussman et al

ORDER REPRINTS

Sussman S Dent C W Burton D Stacy A W Flay B R (1995a)

Developing school-based tobacco use prevention and cessation

programs Thousand Oaks CA Sage Publications IncSussman S Dent C W Simon T R Stacy A W Galaif E R

Moss M A Craig S Johnson C A (1995b) Effectiveness of

social influence substance abuse prevention curricula in compre-

hensive and continuation high schools Drugs and Society 865ndash81Sussman S Dent C W Galaif E R (1997) The correlates of

substance abuse and dependence among adolescents at high risk

for drug abuse Journal of Substance Abuse 9241ndash255Sussman S Dent C W Stacy A W (1996) The relation of pro-drug

use myths with self-reported drug use among youth at continuation

high schools Journal of Applied Social Psychology 26214ndash267Sussman S Dent C W Stacy A Craig S (1998) One-year outcomes

of project towards no drug abuse Preventive Medicine 27632ndash642

(erratum 766)Sussman S Dent C W Stacy S (2002) Project towards no drug

abuse a review of the findings and future directions American

Journal of Health Behavior 26354ndash365Sussman S McCuller W J Dent C W (2003) The associations of

social self-control personality disorders and demographics with

drug use among high risk youth Addictive Behaviors 281159ndash1166Sussman S Rohrbach L Patel R Holiday K (2003) A look at an

interactive classroom-based drug abuse prevention program

Interactive contents and suggestions for research Journal of Drug

Education 33355ndash368Sussman S Sun P McCuller W J Dent C W (2003) Project

towards no drug abuse two year outcomes of a trial that compares

health educator delivery to self-instruction Preventive Medicine

37155ndash162Tarter R E Vanyukov M (1994) Alcoholism a developmental disorder

Journal of Consulting and Clinical Psychology 621096ndash1107Thornton T N Craft C A Dahlberg L L Lynch B S Baer K

(2000) Best Practices of Youth Violence Prevention A Sourcebook

for Community Action Atlanta GA Division of Violence

Prevention Centers for Disease Control and PreventionTobler N S (1986) Meta-analysis of 143 adolescent drug prevention

programs quantitative outcome of program participants compared to

a control or comparison group Journal of Drug Issues 16537ndash567Tobler N S Roona M R Ochshorn P Marshall D G Streke

A V Stackpole K M (2000) School-based adolescent drug

Motivation Skills and Decision Making 2013

ORDER REPRINTS

prevention programs 1998 Meta-analysis The Journal of Primary

Prevention 20275ndash336US Department of Health and Human Services (USDHHS) (2003)

Substance Abuse andMental Health Services Administration Center

for Substance Abuse Prevention Science-based prevention programs and

principles 2002 Rockville MD US DHHS (SMA)03-3764 Also

see httpmodelprogramssamhsagovUnger J Baezconde-Garbanati L Shakib S Palmer P H Nezami

E Mora J (2004) What are the implications of structuralcultural

theory for drug abuse prevention Substance Use amp MisuseUpshaw H S Ostrom T M (1984) Psychological perspective in

attitude research In Eiser J R ed Attitudinal Judgment New

York Springer-Verlag 23ndash42Valente T W Gallaher P Mouttapa M (2004) Using social network

theory to understand and prevent substance use a transdisciplinary

perspective Substance Use amp MisuseVorrath H Brendtro L (1985) Positive peer culture 2nd edn Aldine

ChicagoWaldron H B Slesnick N Brody J L Turner C W Peterson T R

(2001) Treatment outcomes for adolescent substance abuse at 4-

and 7-month assessments Journal of Consulting amp Clinical

Psychology 69(5)802ndash813Watson D L Tharp R G (2002) Self-directed behavior Self-

modification for personal adjustment 8th edn Belmont CA

WadsworthWeissberg R P Caplan M Z Sivo P J (1989) A new conceptual

framework for establishing school-based social competence promo-

tion programs In Bond L A Compas B E eds Primary

Prevention amp Promotion in the Schools Newbury Park CA Sage

255ndash296Wills T A (1986) Stress and coping in early adolescence relationships

to substance use in urban school samples Health Psychology

5503ndash529Wills T A Cleary S D (1995) Stress-coping model for alcohol-

tobacco interactions in adolescence In Fertig J B Allen J P

eds Alcohol and Tobacco From Basic Science to Clinical Practice

Bethesda MD National Institute on Alcohol Abuse and

Alcoholism 107ndash128Wills T A Cleary S D (1999) Peer and adolescent substance use

among 6thndash9th graders Latent growth analyses of influence versus

selection mechanisms Health Psychology 18453ndash463

2014 Sussman et al

ORDER REPRINTS

Wills T A Hirky A E (1996) Coping and substance abuse InZeidner M Endler N S eds Handbook of Coping TheoryResearch and Applications New York Wiley 279ndash302

Wills T A Stoolmiller M (2002) The role of self-control in earlyescalation of substance use a time-varying analysis Journal ofConsulting and Clinical Psychology 70986ndash997

Wills T A Baker E Botvin G J (1989) Dimensions of assertivenessdifferential relationships to substance use in early adolescenceJournal of Consulting and Clinical Psychology 57(4)473ndash478

Wills T A Vaccaro D McNamara G (1994) Novelty seeking risktaking and related constructs as predictors of adolescent substanceuse an application of Cloningerrsquos theory Journal of SubstanceAbuse 61ndash20

Wills T A McNamara G Vaccaro D Hirky A E (1996a)Escalated substance use a longitudinal grouping analysis fromearly to middle adolescence Journal of Abnormal Psychology105166ndash180

Wills T A Pierce J P Evans R I (1996b) Large-scale environmentalrisk factors for substance use American Behavioral Scientist39808ndash822

Wills T A Windle M Cleary S D (1998) Role of temperamentnovelty-seeking and self-control in adolescent substance useJournal of Personality and Social Psychology 74387ndash406

Wills T A Sandy J M Shinar O (1999) Substance use level andproblems in late adolescence a mediational model based on self-control and coping motives Experimental and ClinicalPsychopharmacology 7122ndash134

Wills T A Cleary S D Filer M Shinar O Mariani J Spera K(2001) Temperament and self-control related to early-onsetsubstance use test of a developmental model Prevention Science2145ndash163

Wills T A Sandy J M Yaeger A (2002) Moderators of therelationship between substance use level and problems test of aself-regulation model in adolescence Journal of AbnormalPsychology 1113ndash21

Wills T A Gibbons F X Gerrard M Murry V Brody G (in press-a) Family communication and religiosity related to substance useand sexual behavior in early adolescence Psychology of AddictiveBehaviors

Wills T A Resko J Ainette M Mendoza D (in press-b) The role ofparent and peer support in adolescent substance use a test ofmediated effects Psychology of Addictive Behaviors

Motivation Skills and Decision Making 2015

ORDER REPRINTS

Young P T (1936) Motivation of Behavior New York John Wiley andSons

Zimmerman B J (2000) Attaining self-regulation a social cognitivemodel In Boekaerts M Pintrich P R eds Handbook of Self-Regulation San Diego Academic Press 13ndash39

2016 Sussman et al

Request PermissionOrder Reprints

Reprints of this article can also be ordered at

httpwwwdekkercomservletproductDOI101081JA200034769

Request Permission or Order Reprints Instantly

Interested in copying and sharing this article In most cases US Copyright Law requires that you get permission from the articlersquos rightsholder before using copyrighted content

All information and materials found in this article including but not limited to text trademarks patents logos graphics and images (the Materials) are the copyrighted works and other forms of intellectual property of Marcel Dekker Inc or its licensors All rights not expressly granted are reserved

Get permission to lawfully reproduce and distribute the Materials or order reprints quickly and painlessly Simply click on the Request Permission Order Reprints link below and follow the instructions Visit the US Copyright Office for information on Fair Use limitations of US copyright law Please refer to The Association of American Publishersrsquo (AAP) website for guidelines on Fair Use in the Classroom

The Materials are for your personal use only and cannot be reformatted reposted resold or distributed by electronic means or otherwise without permission from Marcel Dekker Inc Marcel Dekker Inc grants you the limited right to display the Materials only on your personal computer or personal wireless device and to copy and download single copies of such Materials provided that any copyright trademark or other notice appearing on such Materials is also retained by displayed copied or downloaded as part of the Materials and is not removed or obscured and provided you do not edit modify alter or enhance the Materials Please refer to our Website User Agreement for more details

ORDER REPRINTS

consumption They may prove more likely to adopt a new goal ofdecreased drug use especially if they believe that they could achieve thegoal as self-efficacy theory suggests

Teens may exert energy to reduce discrepancies between currentstates and desired states They may learn new life or social skills whichcan lead them to become involved in rewarding but nondrug-usingactivities (Carroll 1996) In addition they may become involved in newtypes of social networks containing low-risk rather than high-risk peers(Valente et al 2004 Wills et al in press-b) Finally attaining a healthiergoal can create a positive optimal set point and the motivation systemprovides more positive feedback Over time through experience ofdifferent life events youth may alter the set point and begin a new goal-searching process (Sussman and Unger 2004) One may experience atraumatic life event for example and again consider drug use as a meansto return to an optimal set point or repeatedly get into trouble because ofassociating with deviant peers and realize that there is a need to turn todifferent types of associations

Research and theory from several disciplines suggest many motiva-tion strategies for a successful prevention program These motivationstrategies include myth correction stereotyping valuing life andachievement of health goals

Myth Correction

The recovery movement often refers to substance use and abuse as aproblem of perception Another closely related expression drug use mythsdescribes questionable or dysfunctional expectancies or beliefs that serveto justify drug use Myths involve more than expectancies or beliefs aboutpositive or negative outcomes they include inaccurate expectancies orbeliefs about the characteristics (or norms) of drugs and drug use and arelikely to confuse drug effects with drug experiences

Some common myths include inflated expectancies of positiveoutcomes from drug use or underestimates of negative outcomes fromdrug use Teens may believe that substance use will create peer groupacceptance or help them cope with family and school problems when infact the drug use only diverts them from actively coping with these socialand academic issues Thus in the long run drug use makes things worsenot better (Wills and Hirky 1996) Other myths include endorsement ofmisleading beliefs For example many adolescents believe that learningto manage drug intake without getting sick is a positive sign that theirbodies are growing tolerant to the drug rather than signaling the

Motivation Skills and Decision Making 1989

ORDER REPRINTS

beginnings of drug dependence or addiction In addition misperceptionsregarding physical consequences of drug use operate For example usersmistakenly believe that if they are able to regulate subjective effects of adrug they have gained control over use In reality warning systems maybe deteriorating as addiction begins (Glynn et al 1985 Sussman et al1995b) Challenging drug myths undoubtedly helps prevent drug abuse

These challenges can prove especially useful with high-risk popula-tions particularly if social influence programs are less effective in thesegroups Several prevention researchers have adopted a similar taxonomyof drug myths when attempting to prevent drug use Sussman Dent andStacy (1996) examined the internal consistency and discriminant validityof a measure of drug-related myths in 362 continuation (alternative) highschool youth They found good internal consistency and discriminantvalidity for the measure Controlling for its relations with socialdesirability perceived friendsrsquo drug use (a social influence measure)ethnicity and gender the myth measure remained significantly associatedwith four drug use measures Ames Sussman Dent and Stacy (1999)found a myth measure to be a relatively strong psychosocial predictor ofdrug use one-year later Cognitive perceptions obviously play a role indrug abuse prevention (Stein et al 1987) These findings suggest thatcontinued research on drug use myths should prove fruitful forprevention efforts (Sussman et al 1998 2003)

Some cognitive restructuring corrects faulty or self-defeatingcognitive structures (myths) In particular elaborating on the logicalsteps involved in the construction of a drug use myth may help to destroyits impact on behavior For example a common myth suggests thathaving trouble finding onersquos car after getting drunk is a funny event Ifone asks (a) lsquolsquoDid you want to find your carrsquorsquo (b) lsquolsquoWere you too drunk tofind it for a long timersquorsquo and (c) lsquolsquoAnd thatrsquos funnyrsquorsquo the apparent humorin the story may dissipate Further one may delineate the kernel of truthin the myth (not finding onersquos car is an odd event) from the falseaspects of the myth (not finding onersquos car indicates failure of functioningwhich is sad worrisome anxiety provoking not funny)

Stereotyping

Lower risk peers tend to perceive lsquolsquoat riskrsquorsquo others (eg alternativehigh school students) as being more deviant than they actually areUnderstandably youth so-labeled students resent this stereotypeAddressing this stereotype may help prevent drug abuse If lsquolsquoat riskrsquorsquoyouth begin to view themselves as being more deviant than they actually

1990 Sussman et al

ORDER REPRINTS

are the situation could lead to self-fulfilling prophesy as if they weregiving in to the stereotype However lowering the estimates of drug useamong their peers can correct this giving in This version of a prevalence-overestimation reduction lesson which includes a motivational featurehas appeared in successful prevention programs (Sussman et al 2002) Astereotype-oriented lesson may also accomplish a second goal If high-risk youth do not view themselves as being deviant as they assumedothers had judged them possibly reactions against this stereotype mayenergize an effort to avoid drug use as well as portray oneself morefavorably (Hamilton August 20 2000)

Valuing Life and Health Goals

Letrsquos consider the example of older teens Most youth report thatthey plan to graduate from high school and continue their educations orfind a job They do not view hanging out as a desirable option They alsosee that drug use could interfere with achieving their goals A lessonexplaining the negative consequences of drug use particularly oneconsistent with data (Newcomb and Bentler 1988) could reveal howearly involvement with drugs creates symptoms of abuse and dependenceand alters job opportunities marriage and family functioning These lifegoals can seem more valuable as students perceive them as attainableEnhancing the value of life goals can increase motivation for learningadaptive coping (Lau et al 1986) Youth have reported that drug usecould interfere with obtaining desired life goals In theme and componentstudies youth positively evaluated a lesson that taught that drug usecould interfere with obtaining desired goals and that placing animportance on health as a value was consistent with achievement of lifegoals (Sussman 1996) Thus it is important for prevention programs tohelp youth connect the importance of health to obtaining their life goalsand develop a sequenced plan so that they know how to proceed step-by-step (Karoly 1993 Watson and Tharp 2002)

Although modifiable understanding the source of positive life goalsis also important since these may occur earlier in life For instanceNewcomb and Harlow (1986) found that perceived loss of control andmeaninglessness in life mediated the relationship between negative lifeevents and drug use While numerous types of stressful events wereconsidered in this study other studies identify an adverse childhoodfamily environment as a potent precursor to later drug use (Locke andNewcomb in press Palinkas et al 1996) An adverse early homeenvironment a modifiable etiological factor should serve as a focus of

Motivation Skills and Decision Making 1991

ORDER REPRINTS

prevention that addresses child abuse and neglect (see later discussion ofthis topic)

Attitudinal Perspectives

Most youth consider themselves as being moderates They can alsoreliably identify drug use as being a deviant immoderate behaviorPresenting them with the disparity between their self-view as a moderateperson despite their deviant drug use can produce a desired behaviorchange (Sussman 1989 Upshaw and Ostrom 1984) An attitudinalperspective lesson can confront students with the inconsistency betweentheir general self-attitude ratings as moderates vs their more extremespecific behaviors (eg drug use) Adopting a self-perception as amoderate may inoculate youth when social pressures to experiment withdrugs arise A desire for internal consistency a similarity betweenattitudes and behavior may increase motivation to abstain from drugs(Festinger 1957 Heider 1958) Youth received lessons like these quitefavorably in previous work (Salomon et al 1984)

Skills

Direct instruction modeling practice and group reinforcementenhance social learning At least three basic kinds of skills needinstruction self-control communication and resource acquisition

Social Self-control Skills

Good self-control protects against substance use and buffers againstthe impact of risk factors (Bandura 1986 Catalano and Hawkins 1996Weissberg et al 1989 Wills et al 1998) Poor self-control involvesbehavioral affective and cognitive deficits Poor behavioral self-controlis associated with a need to regulate and stabilize mood possiblypreceding uncontrolled behavior or stemming from the consequences ofuncontrolled behavior Poor self-control behavior along with difficultiesin mood stabilization increases risk for substance use and rapidescalation to high levels of use which then can lead to physiologicaldependence (Wills and Stoolmiller 2002)

Self-control strategies cross physiological and personality boundariesbecause self-control also relates to coping motives for substance use a

1992 Sussman et al

ORDER REPRINTS

strong predictor of substance use problems (Wills et al 1999) Self-control includes cognition because developing self-control is the substratefor personality organization including not only behavioral and affectivecontrol but also attitudes values and views of the world as accepting orhostile and social perceptions about substance use as being attractive vsunattractive For example studies find poor self-control correlated withattitudinal tolerance for deviance and more favorable perceptions oftobacco and alcohol users whereas good self-control is related tofavorable perceptions of teens that abstain from drug use (Wills et alin press-a) Self-control approaches can be useful for preventionprograms by improving self and other perceptions academic perfor-mance and the impact or facilitation of negative life events goals that aresalient to teenagers and their parents (Wills and Stoolmiller 2002)

Youth often lack adequate coping skills they tend to lack restraint orplanfulness (Farrell and Danish 1993 Rutter et al 1997) Coping skillsinstruction may help increase self-control (Kendall and Braswell 1982)Coping skills instruction receives little attention in typical social influencesprogramming (Hansen 1992) although this material appears in life skillstraining (Botvin 1993 Botvin et al 1995 Wills 1986) In self-controlprogramming youth learn to assess their self-control particularly in socialcontexts (Sussman et al 2003) They learn the importance of thinkingahead and anticipating problem situations so that they are preparedbeforehand to deal with problems that may arise They also learn theimportance of context (eg not laughing at a funeral) Finally they learnassertiveness and anger management to help them better control theirreactions in social settings (Sambrano May 1999 Sussman et al 2002)

Listening and Communication Skills

Youth genuinely benefit from listening to information with an openmind and asking open-ended questions to keep a conversation goingThey can improve social skills by learning how to ask open-endedquestions establish eye contact appropriately nodding and orientingtheir body toward the other speaker (CPPRG 1999 Eggert and Herting1991 Hawkins et al 1999 Sussman et al 2002 2003) Neverthelesssocial skills training can create problems for nondrug using high-riskteens (Palinkas et al 1996 Sussman et al 1995b Wills et al in press-b)Training in drug refusal may create reactance in some samples (Sussmanet al 1996) Among high-risk youth enhancing assertiveness and datingskills may increase the scope of social entertainment options andinadvertently improve a teenrsquos ability to acquire drugs from new sources

Motivation Skills and Decision Making 1993

ORDER REPRINTS

(Wills et al 1989) Also there are cultural variations on what constitutesgood social skill (Unger et al 2004) There are good arguments forplacing high-risk teens together in activities with well-controlled teens sothat they can model adaptive social skills and problem solvingAdditionally utilizing motivation methods prior to instructing thespecific skill channels canalizes health-directed use of social skillsmastered Overall increasing social competence will have protectiveeffects for high-risk teens (Wills et al 1994) This idea is consistent withthe studies that have shown social withdrawal to increase risk for druguse (Kerr et al 1997) though there may be gender differences in theseeffects (Pulkkinen and Pitkanen 1994) Still it is most wise to includesocial skills training in conjunction with material addressing motivationand decision making Motivations regarding drug use need to beaddressed so behaviors learned are not misdirected

Resource Acquisition

Adults often assume that teens can access community services withlittle effort In fact few teens understand the availability of healthservices or other assistance Simple information including phonenumbers and locations can assist teens immensely (Carroll 1996Sussman et al 2002) Coaching teens on techniques for receivingassistance can prove productive Public assistance for drug use-relatedproblems and other life problems can help tremendously but negotiatingthe bureaucratic difficulties inherent in many of these systems can requireconsiderable skill (Eggert and Herting 1991 Sambrano May 1999Sussman et al 2002) Direct instruction modeling and structuredpractice in resource acquisition skills may help youth to increase theirknowledge and self-efficacy on how to acquire resources and to readilyaccess resources when needed (eg use of the bus system) These skillsmay generalize to comparable tasks later in life

Decision-Making

Prevention programs have employed several decision-making strate-gies For example the protocol from Project Reconnecting Youth(Project RY) is STEPS The acronym stands for Stop Think ofoptions Evaluate options Perform or take action on the chosen optionand then Self-praise for using steps for making healthy choices (Eggertand Herting 1991) The participants help set the agenda and take turns

1994 Sussman et al

ORDER REPRINTS

illustrating it on a flip chart This task helps share the leadership andfocuses the group work and time The lesson STEPS to Drug UseControl follows skills training sessions that cover understandingSTEPS as a decision-making model

Project Towards No Drug Abuse (TND)rsquos decision-making sessioninvolves four steps These steps are

1 Brainstorming (making a list of ideas without judging them)2 Weigh the pros and cons (the benefits and costs of each idea)3 Select the best option4 Follow through (try that option and reevaluate the decision)

(Sussman et al 2002)

These decision-making strategies are similar across different pro-grams except that they include some different emphases For exampleSTEPS includes a self-instruction to begin decision making and self-praise whereas the TND sequence includes more of an emphasis onfollowing through with the decision Generally each program requiresgenerating options evaluating them choosing the best and evaluatingthe outcome in an effort to make the next decision Teens tend to enjoypracticing decision making in bogus problem situations Youth soonlearn to engage in steps like these with considerable skill Training indecision making operates on variables that are intermediate in the causalprocess and thereby strengthen individual profiles of self-controlabilities so that they are more resilient in the face of proximal riskfactors for drug use such as life stresses and peer pressures

Modalities of Programming

Both school and nonschool prevention modalities have a rich andimportant history in substance abuse prevention research (Pentz 1994Pentz et al 2004) Schools provide a captive audience for educationalmaterial Youth spend 25 of their waking lives at school so thisenvironment has considerable potential Furthermore the school contextprovides a rich research history for building new studies and evaluatingtheir efficacy (Sussman et al 1995a) Community programs also offerconsiderable opportunity

Community programs often involve local leaders and organizations(eg coalitions community boards) (Goodman et al 1993 Kaftarianand Hansen 1994) that help mobilize numerous community unitsCommunity units include businesses media the family and governmental

Motivation Skills and Decision Making 1995

ORDER REPRINTS

agencies like the police or recreational departments as well as schoolsystems A network of community units working together to developpromote and implement educational programming could increase youthsrsquobonding to others across a wide variety of social contexts (Hawkins et al1992 Pentz 1994) Community units can provide numerous types ofspecific extra-classroom prevention opportunities (Pentz 1994)

Parent-or-family targeted prevention programs include offering earlychildhood education social support for parents managing crisesparenting skills training parent-child communication skills and resourceacquisition instruction or networking Mass media targeted programsinvolve programs or public service announcements with novel fastand unconventional messages (eg the American Legacy FoundationTRUTH campaign) use of the Internet and interactive CDs (eg videogames) Alternative means to involve youth include involvement in hikingclubs drug-free dances or other after-school events with prosocial adultmentors and with means to involve youth outside of school includingentry into different environments (ie outward bound) (Tobler 1986) Inaddition policy implementation and enforcement may contribute toother prevention programs (Pentz et al 1989) Indeed simultaneousprograms within and outside of schools over long periods might maintainthe positive effects that sometimes dissipate when school programsappear alone (Pentz 1994)

The Difference Between Targeted Prevention and Cessation

Targeted (secondary) prevention attempts to keep persons fromcrossing the invisible line where they funnel into a cycle of addiction andaccumulation of negative consequences Cessation programs (sometimesreferred to as tertiary prevention) take the stance that a behavior hasoccurred with definite and perhaps irreversible negative consequencesThe goal is to stop the behavior permit recovery from the damage learnhow to prevent relapse and learn how to live with permanent changes(eg neurotransmitter function drug use-related injury) It is not clearexactly where indicated prevention ends however and where cessationbegins For example an early version of the Project TND curriculum didnot achieve effects on cigarette smoking possibly because 46 of thesample already smoked cigarettes daily (while not engaging often in someother drug use) In a revised curriculum a smoking cessation componentwas added to the program and then an effect on cigarette smoking wasachieved Cessation material can appear with prevention material to

1996 Sussman et al

ORDER REPRINTS

maximize program effectiveness Careful program development can helpdetermine the best mix (Sussman et al 2002)

Summary of Evidence-based Targeted Drug Abuse Prevention

At present approximately 29 drug-use prevention programs havebeen evaluated favorably for their effects on drug use or other problembehavior (see Table 1) These 29 programs have been identified throughtwo sources Blueprints for Violence Prevention (Elliott 2003) and theSubstance Abuse and Mental Health Services Administrationrsquos(SAMSHA) science-based prevention programsrsquo guide (USDHHS2003) PsycINFO and MEDLINE searches of drug abuse preventionstudies since 1970 supplemented searches through these two guides (seeTable 1) Nine definitions of high-risk were used across these programsEleven programs focused on economic deprivation as the definition Sixprograms focused on delinquent behavior as the identifying characteristicto target Two programs each identified single-parent homes drug use orexposure to drug use family problems alternative high school attendanceor being at risk for dropout at a regular high school as the characteristicsto target subjects Finally one program each identified new immigrantstatus or residential facility placement as the defining characteristic ofbeing at high risk for drug use

Among these programs eight focused on preteens For example theEarly Risers program defined its high-risk youth as those 6ndash10 year-oldsthat suffered economic deprivation and exhibited aggressive or opposi-tional behavior Another five programs focused on a young teen agegroup For example Preventive Intervention defined its high-risk youthas those seventh to eighth graders who exhibited poor school andacademic discipline and reported family problems Another sevenprograms focused on an older teen age group For example ProjectTND defined its high-risk youth as those youth that attended alternativehigh schools Finally nine programs encompassed wide age ranges Forinstance Big Brothers Big Sisters of America defined its high-risk youthas 6ndash18 year-olds that lived in single-parent homes

Of these programs 10 involved multiple often flexible settings ofimplementation Another 13 programs focused on the school settingFour programs focused on the home setting Finally two programsfocused on a community agency setting In general these programsinvolved implementation by highly trained personnel Eighteen of theseprograms involved some motivation aspect generally motivationenhancement but sometimes including extrinsic reinforcement strategies

Motivation Skills and Decision Making 1997

ORDER REPRINTS

Twenty-six of these programs provided skills training Finally 18programs provided instruction in decision making Thus the MSDmodel tends to appear in a majority of these programs however all threecomponents were included together in only nine of these programs

Twenty of these programs involved at least one replication of theprogram and 14 involved three or more replications Further 14 of theseprograms were tested through use of experimental designs and nineinvolved use of only quasi-experimental designs Effects on drug use wereassessed and found in 22 of these programs For example theReconnecting Youth program was implemented to youth at risk fordropout This program involved 90 sessions within a comprehensive highschool class delivered generally over a semester with small studentgroups and a highly trained teacher Instruction included use of groupsupport and providing life skills training (norm setting self-esteem moodmanagement communication skills self-monitoring monitoring goalsschool bonding and social activities) with feedback to parents Programgoals were achieved through use of a quasi-experimental design showingeffects for school performance (18 improvement in grades) drug use(54 decrease in hard drug use) and suicide risk (32 decline inperceived stress) This programrsquos results have been replicated numeroustimes in numerous locations This program involved all three componentsof the MSD model except that motivation was provided through peergroup support not through provision motivation enhancement strate-gies These targeted programs present an optimistic picture for drug-useprevention that is focused on at-risk youth (see Table 1)

Not all targeted prevention programs have been found to beeffective One published program that failed to find positive effects wasProject PALS (Palinkas et al 1996) This project was developed for teengirls who were pregnant or at risk for pregnancy and drug use Theprogram consisted of school-based delivery of 16 sessions once a weekin a class The goal was to decrease drug use The PALS Skills TrainingProgram involved instruction in assertiveness providing and receivingfeedback social conversation handling requests and asking for help andmood management This program was tested against a normativeeducation program (called Facts of Life or FOL) which instructedvalues and decision making sexuality issues and contraception sexuallytransmitted diseases (STDs) drug use risks sexual assault prevalenceand norms material An experimental evaluation with a seven-monthspost-baseline was used The results indicated that the PALS programsubjects reported 29 times greater marijuana use than FOL amongbaseline nonusers No other differences were found It is possible that theprogram was not targeted to the right population that the mix of skills

1998 Sussman et al

ORDER REPRINTS

instructed was not appropriate or that skill training alone (withoutappropriate motivation material) may not be effective in drug useprevention Researchers should examine these possibilities and others tofurther understand program failures as well as program successes

Potential Limitations of Targeted Prevention

Dishion and colleagues (1995) suggest from various findings thatgrouping high-risk youth may lead to increased drug use This outcomecan result if youth come to learn deviant behavior from each other Theycan learn deviant behavior from each other in a program if they haveunstructured or unsupervised time together An essential feature ofseveral targeted programs (eg the RY and TND programs) is building apositive peer culture with group norms that decrease drug involvementand drug-use control problems The RYrsquos findings suggest that a positivepeer group component carefully fostered by a well-trained and competentRY group leader can direct the group toward lower risk behaviorSimilarly classroom management in Project TND involves developmentof positive norms of classroom behavior Further interaction betweenyouth is encouraged but is primarily teacher-directed and highlystructured (Sussman et al 2003) In both RY and Project TND theteacherrsquos role is to actively develop and maintain peer group support inthe class by modeling support positively reinforcing it among groupmembers and negatively reinforcing deviant peer bonds and activities(Eggert and Herting 1991 Vorrath and Brendtro 1985) The teachercreates and structures interactions among youth in prosocial directions(Sussman et al 2003)

Multiple Problem Behaviors of Adolescents

Acknowledging the relationship of drug use to other commonadolescent problems may facilitate identification of effective methods ofreducing drug use Researchers on tobacco alcohol and other drug useantisocial behavior high-risk sexual behavior and depression increas-ingly recognize that these problems are interrelated (McGee andNewcomb 1992) and stem to a large extent from the same environ-mental and biological factors (Biglan et al in press Eggert et al 1995Sussman and Ames 2001 Wills and Cleary 1995) Clearly it is necessaryto have strategies that address the entire range of problems and thecontext that influences those problems Indeed further reductions in

Motivation Skills and Decision Making 1999

ORDER REPRINTS

many problems require that we comprehensively target youth withmultiple problem behaviors

Biglan and colleagues (in press) provide a comprehensive review ofthe relationships among antisocial behavior tobacco alcohol and otherdrug use and high-risk sexual behavior It is clear that the same youngpeople are prone to the development of the entire range of problems In arecent review Moffitt and colleagues (2002) found that antisocialbehavior in early adolescence (rather than late adolescence) is a greaterrisk factor for developing multiple problems These findings point to theimportance of early intervention before youth develop serious problemsMoreover these different problems largely result from the same set ofenvironmental and biological factors

One implication is that disciplines dealing with these problemsother than drug abuse may contribute to dealing with the problem ofdrug use (Newcomb 1996b 1997) In particular research by dev-elopmental psychologists family social workers and sociologists onthe influence of parents on adolescent problem development and oninterventions to alter parenting practices contributes to our understandingof how to prevent or ameliorate drug abuse and other problems Onealso should note that nonsubstance use is not a guarantee for problemimmunity for the entire age range of people whatever their genderethnicity religiosity socioeconomic status (SEC) domicility etc It maybe argued that the most promising programs are those targeting thesemultiple levels of influence Several multidisciplinary programs haveachieved promising results We describe three of these empiricallyevaluated programs tested in various settings

Functional Family Therapy (FFT)FFT is an indicated intervention involving family treatment designed

for delinquent teenagers (also see Table 1) Developed in the early 1970sby Alexander and colleagues (1973) FFT focuses on family commu-nication and the establishment of rules and consequences Several studiesprovide encouraging reports of the programrsquos effectiveness (Alexander etal 1976 Barton et al 1985 Klein et al 1977 Waldron et al 2001) Inthe Waldron et al (2001) study researchers used FFT and anintervention with cognitive behavior therapy on teens referred formarijuana use Each of the interventions produced significant resultson marijuana use by the teens at four months but only the twointerventions combined maintained these results at seven months Theearlier studies found a greater number of results For example in the twoAlexander studies (1973 1976) improvement in family communicationposttreatment led to reduced delinquency Note that all the teens in these

2000 Sussman et al

ORDER REPRINTS

studies had histories of serious antisocial or delinquent behavior Thusachieving positive outcomes even if only short-term should encouragefurther research into the efficacy of FFT

Multisystemic Therapy (MST)As its name suggestsMST targets individual family peer school and

community influences of those youth offenders with serious problems thatmay include violence substance use and severe emotional problems (alsosee Table 1) Numerous researchers have published the results ofrandomized trials of MST (Henggeler et al 1996 1997 1998 Thorntonet al 2000) The most consistent findings across studies are decreased (1)drug use (2) re-arrest (3) self-reported criminal offense and (4) days inout-of-home placements Other consistent findings are improved familyrelations school attendance and psychiatric functioning One cautionarynote the programrsquos effectiveness lowers considerably if not implementedwith fidelity (Hengler et al 1997 1999) In other words all or key lessonsneed to be delivered as written by educators who are well-trained in usingthe strategies employed and youth need to be able to receive all material inan atmosphere conducive to learning the material The programdevelopers have instituted training strategies that address these fidelityissues thus shaping MST to be a very promising program for at-riskyouth

Multidimensional Treatment Foster Care (MTFC)MTFC targets family and peer factors influencing adolescents with a

pattern of repeat criminal offending (see Table 1) (Chamberlain 1994)This intervention includes placement of the youth into a foster homewith a foster parent trained in behavior management who receivessupport from intervention staff After the adolescent has begun torespond to the intervention in the foster home and after the parents havereceived the same training and support as the foster parents did theadolescent returns home Chamberlain and Reid (1998) tested theintervention with 85 boys with felony and other criminal histories andfound substantial benefits of the program Following treatment the boysassigned to MTFC (compared to those receiving community-based groupcare) showed fewer days in detention or lock-up twice as much timeliving with parents fewer misdemeanor and felony arrests and fewer self-reported index crimes felony arrests and general delinquency TheMTFC is a cost-effective alternative to incarceration however staffrequirements are extensive which may influence the ability of some

Motivation Skills and Decision Making 2001

ORDER REPRINTS

groups to apply the program with fidelity However as with each of theprograms described here the results of the randomized trials areencouraging

Future Research Needs in Targeted Prevention

Future research can help discern when and where targeted preventionprogramming will tend to work rather than produce potentiallydeleterious negative group effects or results that are irrelevant for pro-social healthy adaptation as well as what the critical necessary conditionsare for their effective operation within given de facto realities Comparedto the breadth of evaluated universal drug use prevention programs(Tobler et al 2000) relatively few targeted prevention programs havereceived empirical support Yet previous research suggests that universalschool-based drug use prevention programs implemented in junior highschool have relatively less chance of long-term success especially for thoseyouth that began using drugs before the prevention program wasimplemented Of course there are notable exceptions (eg effects lastedfor one and a half years effects lasted for six years) (Chou et al 1998Griffin et al 2003 Skara and Sussman 2003) Almost no research existsregarding maximization of booster programming with high-risk youthMore research on booster programs would help the field

While continuing to engage in this work there will be numerousissues to manage that go well beyond the scope of this article There willbe a need to avoid producing negative labeling effects while providingprogramming for those who are at risk for drug use It is possible thatcessation information needs to be included in the mix with preventionmaterial to provide better targeted-prevention effects There may be aneed to develop a teacher selection instrument to help select out teacherswho can deliver drug abuse prevention programming adequatelyCertainly definition of outcome variables needs continued explorationincluding analysis to ascertain the effects of programming on drug abusevs drug use and identification of the variables that are most closelylinked to change by targeted prevention components

A transdisciplinary approach helps to better understand the lifesituation of high-risk youth as based to some extent on both constitutionaland environmental factors (Fuqua et al 2004 Rutter et al 1997 Wills etal 1996b) From the transactional perspective their situation is in partconstitutional they may have temperamental characteristics that arepartly heritable and that have set the stage at earlier ages for decrements inself-control ability and academic performance that then increase risk for

2002 Sussman et al

ORDER REPRINTS

drug use However their situation is also part environmental based in parton family socialization and in part on the types of peers they have as well asthe type and quality of the physical and cultural environment-at-largeThere are many points at which a potential chain of failures can beinterrupted and the individualrsquos trajectory turned in a better directionProblems are not inevitable from starting level (Tarter and Vanyukov1994) and environmental modifications to support good self-controlability can help to avert an adverse impact from earlier experiences orcurrent difficulties (Brody et al 2002 Novak and Clayton 2001 Patock-Peckham et al 2001 Rutter et al 1997 Wills et al 2002)

The problems and needs of high-risk youth in our nationrsquos highschools demand our attention for designing and rigorously testingtargeted prevention approaches Substantial evidence shows that theseyouth are at greater risk for drug involvement and co-occurring problemssuch as aggression depression and suicidal behaviors as we previouslydiscussed It is hoped that the information presented in this article willstimulate others to join in extending this work including testing othermodels of targeted prevention

GLOSSARY

Universal programs Programs that aim to influence all subjects in acontext

Selective drug-abuse prevention programs Programs that servegroups at greater risk of ATOD usemdashfor example children of alcoholicparents They are at psychosocial risk for drug use and abuse

Indicated drug-abuse prevention programs Programs that attemptto benefit individuals who already show signs of drug involvement orrelated risk factors In indicated prevention programs the primary goal isto stem the progression of ATOD use or reduce drug involvementamong the high-risk youth

Targeted programming Programming that subsumes selective andindicated programming sometimes the other two types of programs thattarget specific groups lsquolsquoat riskrsquorsquo are considered together

ACKNOWLEDGMENTS

This research was supported by grants from the National Institute onDrug Abuse (DA01070 DA07601 DA13814 and DA16094) and by aResearch Scientist Development Award K02 DA00252 from theNational Institute on Drug Abuse

Motivation Skills and Decision Making 2003

ORDER REPRINTS

REFERENCES

Alexander J F Barton C Schiaro R S Parsons B V (1976)

Systems-behavioral intervention with families of delinquents

therapist characteristics family behavior and outcome Journal of

Consulting and Clinical Psychology 44(4)656ndash664Alexander J F Parsons B V (1973) Short-term behavioral interven-

tion with delinquent families impact on family process and

recidivism Journal of Abnormal Psychology 3219ndash225American psychiatric association (APA) (1994) Diagnostic and

Statistical Manual of Mental Disorders 4th edn (DSM-IV)

Washington DC American Psychiatric AssociationAmes S L Sussman S Dent C W (1999) Pro-drug-use myths and

competing constructs in the prediction of substance use among

youth at continuation high schools a one-year prospective study

Personality and Individual Differences 26987ndash1003Bachman S G Wadsworth K N OrsquoMalley P M Johnston L D

Schulenberg J E (1997) Smoking drinking and drug use in young

adulthood Mahwah NJ Lawrence Erlbaum Associates 8ndash25

153ndash190Bandura A (1986) Social Foundations of Thought and Action A Social

Cognitive Theory Englewood Cliffs NJ Prentice HallBarton C Alexander J F Waldron H Turner C W Warburton J

(1985) Generalizing treatment effects of functional family therapy

Three replications The American Journal of Family Therapy

13(3)16ndash26Battin-Pearson S R Newcomb M D Abbott R D Hill K G

Catalano R F Hawkins J D (2000) Predicting early high school

dropout Journal of Educational Psychology 92568ndash582Biglan A Brennan P A Foster S L Holder H D Miller T L

Cunningham P B et al (in press) Helping Adolescents at Risk

Prevention of Multiple Problem Behaviors New York NY Guilford

PressBindra D Stewart J (1996) Motivation Baltimore MD Penguin

BooksBlanton H Gibbons F X Gerrard M Conger K J Smith G E

(1998) The role of family and peers in the development of

prototypes associated with substance use Journal of Family

Psychology 11271ndash288

2004 Sussman et al

ORDER REPRINTS

Botvin G J (1993) School-based drug abuse prevention Long-termfollow-up results In First Annual Meeting of the Society forPrevention Research Kentuck Lexington Society for PreventionResearch

Botvin G J Baker E Dusenbury L Botvin E M Diaz T (1995)Long-term follow-up results of a randomized drug abuse preven-tion trial in a white middle-class population Journal of theAmerican Medical Association 2731106ndash1012

Brody G H Dorsey S Forehand R Armistead L (2002) Uniquecontributions of parenting and classroom processes to the self-control of AfricanndashAmerican children Child Development73274ndash286

Carroll M E (1996) Reducing drug abuse by enriching the environmentwith alternative nondrug reinforcers In Green L Kagel J Heds Advances in Behavioral Economics Norwood NJ NorwoodPublishing Corp 37ndash68

Carver C S Scheier M F (1998) On the Self-Regulation of BehaviorNew York Cambridge University Press

Catalano R F Hawkins J D (1996) The social developmental modela theory of antisocial behavior In Hawkins J D ed Delinquencyand Crime Current Theories New York Cambridge UniversityPress

Centers for Disease Control (CDC) (October 1999) Youth risk BehaviorSurveillancemdashNational Alternative High School Youth RiskBehavior Survey 1998 Morbidity and Mortality Weekly Report48 No SS-7

Chamberlain P (1994) Family connections A treatment foster caremodel for adolescents with delinquency Eugene OR CastaliaPublishing Company

Chamberlain P Reid J B (1998) Comparison of two communityalternatives to incarceration for chronic juvenile offenders Journalof Consulting and Clinical Psychology 66(4)624ndash633

Chassin L A Presson C C Sherman S J (1985) Stepping backwardin order to step forward an acquisition-oriented approach toprimary prevention Journal of Consulting and Clinical Psychology53612ndash622

Chou C-P Montgomery S Pentz M A Rohrbach L A JohnsonC A Flay B R MacKinnon D P (1998) Effects of acommunity-based prevention program on decreasing drug use inhigh-risk adolescentsAmerican Journal of Public Health 88944ndash948

Conducts Problems Prevention Research Group (CPPRG) (1999) Initialimpact of the fast track prevention trial for conduct problems I

Motivation Skills and Decision Making 2005

ORDER REPRINTS

The high-risk sample Journal of Consulting and Clinical Psychology

67631ndash647Conducts Problems Prevention Research Group (CPPRG) (2000)

Merging universal and indicated prevention programs the fast

track model Addictive Behaviors 25913ndash927Council of Philosophical Studies (1981) Psychology and the Philosophy

of Mind in the Philosophy Curriculum San Francisco San Francisco

State UniversityCummings K M Hellmann R Emont S L (1988) Correlates of

participation in a worksite stop smoking program Journal of

Behavioral Medicine 11267ndash277Curry S Wagner E H Gothaus L C (1990) Intrinsic and extrinsic

motivation for smoking cessation Journal of Consulting and

Clinical Psychology 58310ndash316Dent C W Sussman S McCuller W J Stacy A W (2001) Drug

abuse prevention among youth at comprehensive high schools

Preventive Medicine 32514ndash520Dewey J (1886) Psychology New York HarperDishion T J French D C Patterson G R (1995) The development

and ecology of antisocial behavior In Cicchetti D Cohen D

eds Manual of developmental psychopathology New York John

Wiley 421ndash471Eggert L L Herting J R (1991) Preventing teenage drug abuse

exploratory effects of network social support Youth and Society

22482ndash534 [Reprinted National Prevention Evaluation Research

CollectionRockville MD Aspen 1993]Eggert L L Herting J R Thompson E A Nicholas L J Dicker

B G (1994) Preventing adolescent drug abuse and high school

dropout through an intensive school-based social network devel-

opment program American Journal of Health Promotion

8202ndash214Eggert L L Thompson E A Herting J R Nicholas L J (1995)

Reducing suicide potential among high-risk youth tests of a school-

based prevention program Suicide amp Life-Threatening Behavior

25276ndash296Ellickson P L Bell R M (1990) Drug prevention in junior high a

multi-site longitudinal test Science 2471299ndash1305Elliott D S (Series ed) (2003) Blueprints for violence prevention

Boulder CO Institute of Behavioral Science Regents of the

University of Colorado wwwcoloradoeducspvblueprints

2006 Sussman et al

ORDER REPRINTS

Farrell A D Danish S J (1993) Peer drug associations and emotionalrestraint Causes or consequences of adolescent drug use Journal ofConsulting and Clinical Psychology 61327ndash334

Festinger L A (1957) A Theory of Cognitive Dissonance New YorkHarper amp Row

Fuqua J Stokols D Gress J Phillips K Harvey R (2004)Transdisciplinary collaboration as a basis for enhancing the scienceand prevention of substance use and abuse Substance Use ampMisuse

Giuliano J D (1994) A peer education program to promote the use ofconflict resolution skills among at-risk school-age males PublicHealth Reports 109158ndash169

Glynn K Levanthal H Hirschman R (1985) A cognitivedevelopmental approach to smoking prevention In Bell C SBattjes R eds Prevention research Deterring Drug Abuse AmongChildren and Adolescents Rockville MD NIDA ResearchMonograph 63

Glynn T J (1989) Essential elements of school-based smokingprevention programs Journal of School Health 59181ndash188

Goodman R M Burdine J N Meehan E McLeroy K R eds(1993) Community coalitions for health promotion Special issue ofHealth Education Research Theory and Practice 8309ndash453

Goodyear R D Newcomb M D Locke T F (2002) PregnantLatina teenagers psychosocial and developmental determinants ofhow they select and perceive the men who father their childrenJournal of Counseling Psychology 49187ndash201

Gordon R (1987) An operational classification of disease preventionIn Steinberg J A Silverman M M eds Preventing MentalDisorders Rockville MD DHHS 20ndash26

Graham J W Johnson C A Hansen W B Flay B R Gee M(1990) Drug use prevention programs gender and ethnicityevaluation of three seventh-grade project SMART cohortsPreventive Medicine 19305ndash313

Griffin K W Botvin G J Nichols T R Doyal M M (2003)Effectiveness of a universal drug abuse prevention approach foryouth at high risk for substance use initiation Preventive Medicine36(1)1ndash7

Hamilton S (August 20 2000) Views slowly changing on alternativeschools The Sacramento Bee 1ndash3

Hansen W B (1992) School-based substance abuse prevention a reviewof the state of the art in curriculum 1980ndash1990 Health EducationResearch 7403ndash430

Motivation Skills and Decision Making 2007

ORDER REPRINTS

Hansen W B Johnson C A Flay B R Graham J W Sobel J(1988) Affective and social influences approaches to the preventionof multiple substance abuse among seventh grade students resultsfrom project SMART Preventive Medicine 17135ndash154

Hansen W B Graham J W (1991) Preventing alcohol marijuanaand cigarette use among adolescents peer pressure and resistancetraining versus establishing conservative norms PreventiveMedicine 20414ndash430

Hawkins D H Catalano R F Miller J Y (1992) Risk andprotective factors for alcohol and other drug problems inadolescence and early adulthood Implications for substanceabuse prevention Psychological Bulletin 11254ndash105

Hawkins J D Catalano R F Kosterman R Abbott R Hill K G(1999) Preventing adolescent health-risk behaviors by strengthen-ing protection during childhood Archives of Pediatric amp AdolescentMedicine 153226ndash234

Heider F (1958) The Psychology of Interpersonal Relations New YorkWiley

Henggeler S W Pickrel S G Brondino M J Crouch J L (1996)Eliminating (almost) treatment dropout of substance abusing ordependent delinquents through home-based multisystemic therapyAmerican Journal of Psychiatry 153(3)427ndash428

Henggeler S W Melton G B Brondino M J Scherer D GHanley J H (1997) Multisystemic therapy with violent andchronic juvenile offenders and their families the role of treatmentfidelity in successful dissemination Journal of Consulting andClinical Psychology 65(5)821ndash833

Henggeler S W Schoenwald S K Borduin C M Rowland M DCunningham P B (1998) Multisystemic treatment of antisocialbehavior in children and adolescents New York The Guilford Press

Henggeler S W Pickrel S G Brondino M J (1999) Multisystemictreatment of substance-abusing and dependent delinquents out-comes treatment fidelity and transportability Mental HealthServices Residual 1(3)171ndash84

Johnson C A Pentz M A Weber M D Dwyer J H Baer NMacKinnon D P Hansen W B Flay B R (1990) Relativeeffectiveness of comprehensive community programming for drugabuse prevention with high-risk and low-risk adolescents Journalof Consulting and Clinical Psychology 58447ndash456

Kaftarian S J Hansen W B eds (1994) CSAP special issuecommunity partnership program Journal of Community Psychologypages 205

2008 Sussman et al

ORDER REPRINTS

Karoly P (1993) Mechanisms in self-regulation A systems view AnnualReview of Psychology 4423ndash51

Karoly P (1980) Person variables in therapeutic change and develop-ment In Karoly P Steffen J J eds Improving the Long-TermEffects of Psychotherapy New York Gardner Press 195ndash261

Kendall P C Braswell L (1982) Cognitive-behavioral self-controltherapy for children a components analysis Journal of Consultingand Clinical Psychology 50672ndash689

Kerr M Tremblay R E Pagani L Vitaro F (1997) Boysrsquobehavioral inhibition and the risk of later delinquency Archivesof General Psychiatry 54809ndash816

Klein N C Alexander J F Parsons B V (1977) Impact of familysystems intervention on recidivism and sibling delinquency a modelof primary prevention and program evaluation Journal ofConsulting and Clinical Psychology 45(3)469ndash474

Kumpfer K L (1999) Outcomes measures of interventions in the studyof children of substance-abusing parents Pediatrics 1031128ndash1144

Lau R R Hartman K A Ware J E (1986) Health as a valuemethodological and theoretical considerations Health Psychology525ndash43

Lichtenstein E L Glasgow R E (1997) A pragmatic framework forsmoking cessation implications for clinical and public healthprograms Psychology of Addictive Behaviors 11142ndash151

Locke T F Newcomb M D (in press) Childhood maltreatmentparent drug problems polydrug problems and parenting practicesa test of gender differences and four theoretical perspectivesJournal of Family Psychology

McCreary D R Newcomb M D Sadava S W (1999) The male rolealcohol use and alcohol problems a structural modeling examina-tion in adult women and men Journal of Counseling Psychology46109ndash124

McGee L Newcomb M D (1992) General deviance syndromeexpanded hierarchical evaluations at four ages from earlyadolescence to adulthood Journal of Consulting amp ClinicalPsychology 60766ndash776

Miller W R Brown J M (1991) Self-regulation as a conceptual basisfor the prevention of addictive behaviours In Heather N MillerW R Greeley J eds Self-control and the Addictive BehavioursSydney Australia Maxwell Macmillan 3ndash79

Miller W R Leckman A L Delaney H D Tinkcom M (1993)Long-term follow-up of behavioral self-control training forproblem drinkers Journal of Studies on Alcohol 53249ndash261

Motivation Skills and Decision Making 2009

ORDER REPRINTS

Miller W R Rollnick S (1991) Motivational InterviewingPreparing People to Change Addictive Behavior New YorkGuilford Press

Moffitt T E Caspi A Harrington H Milne B J (2002) Males onthe life-course-persistent and adolescence-limited antisocial path-ways follow-up at age 26 years Development and Psychopathology14(1)179ndash207

National Institute on Drug Abuse (NIDA) (1997) Drug abuseprevention What works NIH Publication 97-4110 DHHSNational Institutes of Health National Institute on Drug AbuseOffice of Science Policy and Communications Rockville MD

Newcomb M D (1992a) Substance abuse and control in the UnitedStates ethical and legal issues Social Science and Medicine35471ndash479

Newcomb M D (1992b) Understanding the multidimensional nature ofdrug use and abuse The role of consumption risk factors andprotective factors In Glantz M D Pickens R eds Vulnerabilityto Drug Abuse Washington DC American PsychologicalAssociation 255ndash298

Newcomb M D (1996a) Pseudomaturity among adolescents constructvalidation sex differences and associations in adulthood Journalof Drug Issues 26477ndash504

Newcomb M D (1996b) Adolescence Pathologizing a normal processThe Counseling Psychologist 24482ndash490

Newcomb M D (1997) Psychosocial predictors and consequences ofdrug use a developmental perspective within a prospective studyJournal of Addictive Diseases 1651ndash89

Newcomb M D Bentler P M (1988) Consequences of Adolescent DrugUse Impact on the Lives of Young Adults Beverly Hills CA Sage

Newcomb M D Bentler P M (1989) Substance use and abuse amongchildren and teenagers American Psychologist 44242ndash248

Newcomb M D Harlow L L (1986) Life events and substance useamong adolescents Mediating effects of perceived loss of controland meaninglessness in life Journal of Personality and SocialPsychology 51564ndash577

Newcomb M D Chou C-P Bentler P M Huba G J (1988)Cognitive motivations for drug use among adolescents longitudinaltests of gender differences and predictors of change in drug useJournal of Counseling Psychology 35426ndash438

Newcomb M D Abbott R D Catalano R F Hawkins J DBattin-Pearson S R Hill K (2002) Mediational and deviancetheories of late high school failure Process roles of structural

2010 Sussman et al

ORDER REPRINTS

strains academic competence and general versus specific problem

behaviors Journal of Counseling Psychology 49172ndash186Nezami E Sussman S Pentz M A (2003) Motivation in tobacco use

cessation research Substance Use amp Misuse 3825ndash5Novak S P Clayton R R (2001) The influence of school environment

and self-regulation on transitions between stages of cigarette

smoking Health Psychology 20196ndash207Offord D R (2000) Selection of levels of prevention Addictive

Behaviors 25833ndash842Palinkas L A Atkins C J Miller C Ferreira D (1996) Social skills

training for drug prevention in high-risk female adolescents

Preventive Medicine 25692ndash701Patock-Peckham J A Cheong J-W Balhorn M E Nagoshi C T

(2001) A model of parenting styles self-regulation perceived

drinking control and alcohol use and problems Alcoholism

Experimental and Clinical Research 251284ndash1292Pentz M A (1994) Directions for future research in drug abuse

prevention Preventive Medicine 23646ndash652Pentz M A Dwyer J H MacKinnon D Flay B R Hansen W B

Wang E Y I Johnson C A (1989) A multi-community trial for

primary prevention of adolescent drug abuse effects on drug use

prevalence JAMA 2623259ndash3266Pentz M A Mares D Schinke S Rohrbach L (in press) Political

science public policy and drug abuse prevention Substance Use amp

MisuseProchaska J O DiClemente C C (1982) Transtheoretical therapy

toward a more integrative model of change Psychotherapy Theory

Research and Practice 19275ndash288Pulkkinen L Pitkanen T (1994) A prospective study of the precursors

to problem drinking in young adulthood Journal of Studies on

Alcohol 55578ndash587Rathus S A Nevid J S (1977) Behavior Therapy Strategies for

Solving Problems in Living New York Doubleday and Company

IncResnicow K Botvin G (1993) School-based substance use prevention

programs why do effects decay Preventive Medicine 22484ndash490Rutter M Dunn J Plomin R Simonoff E Pickles A Maughan

B Ormel J Meyer J Eaves L (1997) Integrating nature and

nurture implications of person-environment interactions for

developmental psychopathology Development and Psychopathology

9335ndash364

Motivation Skills and Decision Making 2011

ORDER REPRINTS

Salomon G Stein Y Eisenberg S Klein L (1984) Adolescent

smokers and nonsmokers profiles and their changing structure

Preventive Medicine 13446ndash461Sambrano S (1999) National cross-site evaluation of high risk youth

programs In Interim findings Bulletin Washington DC CSAP

SAMSHA US DHHS May 1ndash16Schinke S P Gilchrist L D (1985) Preventing substance abuse with

children and adolescents Journal of Consulting and Clinical

Psychology 53596ndash602Skara S N Sussman S (2003) A review of 25 long-term adolescent

tobacco and other drug use prevention program evaluations

Preventive MedicineSmith C Lizotte A J Thornberry T P Krohn M D (1995)

Resilient youth identifying factors that prevent high-risk youth

from engaging in delinquency and drug use Delinquency and

Disrepute in the Life Course Greenwich CT John Hagan JAI

press 217ndash247Sommers P V (1972) The Biology of Behavior Australia Pty ltd

Sydney John Wiley amp SonsSt Pierre T L Kaltreider D L Mark M M Aikin K J (1992)

Drug prevention in a community setting a longitudinal study of the

relative effectiveness of a three-year primary prevention program in

boys and girls clubs across the nation American Journal of

Community Psychology 20673ndash706Stein J A Newcomb M D Bentler P M (1987) An eight year study

of multiple influences on drug use and drug use consequences

Journal of Personality and Social Psychology 531094ndash1105Sully J (1884) Outlines of Psychology New York D Appleton amp CoSussman S (1989) Two social influence perspectives of tobacco use

development and prevention Health Education Research Theory

and Practice 4213ndash223Sussman S (1991) Curriculum development in school-based prevention

research Health Education Research Theory and Practice

6339ndash351Sussman S (1996) Development of a school-based drug abuse

prevention curriculum for high risk youth Journal of

Psychoactive Drugs 28169ndash182Sussman S Ames S L (2001) The social psychology of drug abuse

Buckingham GB Open University PressSussman S Unger J (2004) A drug abuse theoretical integration a

transdisciplinary speculation Substance Use amp Misuse

2012 Sussman et al

ORDER REPRINTS

Sussman S Dent C W Burton D Stacy A W Flay B R (1995a)

Developing school-based tobacco use prevention and cessation

programs Thousand Oaks CA Sage Publications IncSussman S Dent C W Simon T R Stacy A W Galaif E R

Moss M A Craig S Johnson C A (1995b) Effectiveness of

social influence substance abuse prevention curricula in compre-

hensive and continuation high schools Drugs and Society 865ndash81Sussman S Dent C W Galaif E R (1997) The correlates of

substance abuse and dependence among adolescents at high risk

for drug abuse Journal of Substance Abuse 9241ndash255Sussman S Dent C W Stacy A W (1996) The relation of pro-drug

use myths with self-reported drug use among youth at continuation

high schools Journal of Applied Social Psychology 26214ndash267Sussman S Dent C W Stacy A Craig S (1998) One-year outcomes

of project towards no drug abuse Preventive Medicine 27632ndash642

(erratum 766)Sussman S Dent C W Stacy S (2002) Project towards no drug

abuse a review of the findings and future directions American

Journal of Health Behavior 26354ndash365Sussman S McCuller W J Dent C W (2003) The associations of

social self-control personality disorders and demographics with

drug use among high risk youth Addictive Behaviors 281159ndash1166Sussman S Rohrbach L Patel R Holiday K (2003) A look at an

interactive classroom-based drug abuse prevention program

Interactive contents and suggestions for research Journal of Drug

Education 33355ndash368Sussman S Sun P McCuller W J Dent C W (2003) Project

towards no drug abuse two year outcomes of a trial that compares

health educator delivery to self-instruction Preventive Medicine

37155ndash162Tarter R E Vanyukov M (1994) Alcoholism a developmental disorder

Journal of Consulting and Clinical Psychology 621096ndash1107Thornton T N Craft C A Dahlberg L L Lynch B S Baer K

(2000) Best Practices of Youth Violence Prevention A Sourcebook

for Community Action Atlanta GA Division of Violence

Prevention Centers for Disease Control and PreventionTobler N S (1986) Meta-analysis of 143 adolescent drug prevention

programs quantitative outcome of program participants compared to

a control or comparison group Journal of Drug Issues 16537ndash567Tobler N S Roona M R Ochshorn P Marshall D G Streke

A V Stackpole K M (2000) School-based adolescent drug

Motivation Skills and Decision Making 2013

ORDER REPRINTS

prevention programs 1998 Meta-analysis The Journal of Primary

Prevention 20275ndash336US Department of Health and Human Services (USDHHS) (2003)

Substance Abuse andMental Health Services Administration Center

for Substance Abuse Prevention Science-based prevention programs and

principles 2002 Rockville MD US DHHS (SMA)03-3764 Also

see httpmodelprogramssamhsagovUnger J Baezconde-Garbanati L Shakib S Palmer P H Nezami

E Mora J (2004) What are the implications of structuralcultural

theory for drug abuse prevention Substance Use amp MisuseUpshaw H S Ostrom T M (1984) Psychological perspective in

attitude research In Eiser J R ed Attitudinal Judgment New

York Springer-Verlag 23ndash42Valente T W Gallaher P Mouttapa M (2004) Using social network

theory to understand and prevent substance use a transdisciplinary

perspective Substance Use amp MisuseVorrath H Brendtro L (1985) Positive peer culture 2nd edn Aldine

ChicagoWaldron H B Slesnick N Brody J L Turner C W Peterson T R

(2001) Treatment outcomes for adolescent substance abuse at 4-

and 7-month assessments Journal of Consulting amp Clinical

Psychology 69(5)802ndash813Watson D L Tharp R G (2002) Self-directed behavior Self-

modification for personal adjustment 8th edn Belmont CA

WadsworthWeissberg R P Caplan M Z Sivo P J (1989) A new conceptual

framework for establishing school-based social competence promo-

tion programs In Bond L A Compas B E eds Primary

Prevention amp Promotion in the Schools Newbury Park CA Sage

255ndash296Wills T A (1986) Stress and coping in early adolescence relationships

to substance use in urban school samples Health Psychology

5503ndash529Wills T A Cleary S D (1995) Stress-coping model for alcohol-

tobacco interactions in adolescence In Fertig J B Allen J P

eds Alcohol and Tobacco From Basic Science to Clinical Practice

Bethesda MD National Institute on Alcohol Abuse and

Alcoholism 107ndash128Wills T A Cleary S D (1999) Peer and adolescent substance use

among 6thndash9th graders Latent growth analyses of influence versus

selection mechanisms Health Psychology 18453ndash463

2014 Sussman et al

ORDER REPRINTS

Wills T A Hirky A E (1996) Coping and substance abuse InZeidner M Endler N S eds Handbook of Coping TheoryResearch and Applications New York Wiley 279ndash302

Wills T A Stoolmiller M (2002) The role of self-control in earlyescalation of substance use a time-varying analysis Journal ofConsulting and Clinical Psychology 70986ndash997

Wills T A Baker E Botvin G J (1989) Dimensions of assertivenessdifferential relationships to substance use in early adolescenceJournal of Consulting and Clinical Psychology 57(4)473ndash478

Wills T A Vaccaro D McNamara G (1994) Novelty seeking risktaking and related constructs as predictors of adolescent substanceuse an application of Cloningerrsquos theory Journal of SubstanceAbuse 61ndash20

Wills T A McNamara G Vaccaro D Hirky A E (1996a)Escalated substance use a longitudinal grouping analysis fromearly to middle adolescence Journal of Abnormal Psychology105166ndash180

Wills T A Pierce J P Evans R I (1996b) Large-scale environmentalrisk factors for substance use American Behavioral Scientist39808ndash822

Wills T A Windle M Cleary S D (1998) Role of temperamentnovelty-seeking and self-control in adolescent substance useJournal of Personality and Social Psychology 74387ndash406

Wills T A Sandy J M Shinar O (1999) Substance use level andproblems in late adolescence a mediational model based on self-control and coping motives Experimental and ClinicalPsychopharmacology 7122ndash134

Wills T A Cleary S D Filer M Shinar O Mariani J Spera K(2001) Temperament and self-control related to early-onsetsubstance use test of a developmental model Prevention Science2145ndash163

Wills T A Sandy J M Yaeger A (2002) Moderators of therelationship between substance use level and problems test of aself-regulation model in adolescence Journal of AbnormalPsychology 1113ndash21

Wills T A Gibbons F X Gerrard M Murry V Brody G (in press-a) Family communication and religiosity related to substance useand sexual behavior in early adolescence Psychology of AddictiveBehaviors

Wills T A Resko J Ainette M Mendoza D (in press-b) The role ofparent and peer support in adolescent substance use a test ofmediated effects Psychology of Addictive Behaviors

Motivation Skills and Decision Making 2015

ORDER REPRINTS

Young P T (1936) Motivation of Behavior New York John Wiley andSons

Zimmerman B J (2000) Attaining self-regulation a social cognitivemodel In Boekaerts M Pintrich P R eds Handbook of Self-Regulation San Diego Academic Press 13ndash39

2016 Sussman et al

Request PermissionOrder Reprints

Reprints of this article can also be ordered at

httpwwwdekkercomservletproductDOI101081JA200034769

Request Permission or Order Reprints Instantly

Interested in copying and sharing this article In most cases US Copyright Law requires that you get permission from the articlersquos rightsholder before using copyrighted content

All information and materials found in this article including but not limited to text trademarks patents logos graphics and images (the Materials) are the copyrighted works and other forms of intellectual property of Marcel Dekker Inc or its licensors All rights not expressly granted are reserved

Get permission to lawfully reproduce and distribute the Materials or order reprints quickly and painlessly Simply click on the Request Permission Order Reprints link below and follow the instructions Visit the US Copyright Office for information on Fair Use limitations of US copyright law Please refer to The Association of American Publishersrsquo (AAP) website for guidelines on Fair Use in the Classroom

The Materials are for your personal use only and cannot be reformatted reposted resold or distributed by electronic means or otherwise without permission from Marcel Dekker Inc Marcel Dekker Inc grants you the limited right to display the Materials only on your personal computer or personal wireless device and to copy and download single copies of such Materials provided that any copyright trademark or other notice appearing on such Materials is also retained by displayed copied or downloaded as part of the Materials and is not removed or obscured and provided you do not edit modify alter or enhance the Materials Please refer to our Website User Agreement for more details

ORDER REPRINTS

beginnings of drug dependence or addiction In addition misperceptionsregarding physical consequences of drug use operate For example usersmistakenly believe that if they are able to regulate subjective effects of adrug they have gained control over use In reality warning systems maybe deteriorating as addiction begins (Glynn et al 1985 Sussman et al1995b) Challenging drug myths undoubtedly helps prevent drug abuse

These challenges can prove especially useful with high-risk popula-tions particularly if social influence programs are less effective in thesegroups Several prevention researchers have adopted a similar taxonomyof drug myths when attempting to prevent drug use Sussman Dent andStacy (1996) examined the internal consistency and discriminant validityof a measure of drug-related myths in 362 continuation (alternative) highschool youth They found good internal consistency and discriminantvalidity for the measure Controlling for its relations with socialdesirability perceived friendsrsquo drug use (a social influence measure)ethnicity and gender the myth measure remained significantly associatedwith four drug use measures Ames Sussman Dent and Stacy (1999)found a myth measure to be a relatively strong psychosocial predictor ofdrug use one-year later Cognitive perceptions obviously play a role indrug abuse prevention (Stein et al 1987) These findings suggest thatcontinued research on drug use myths should prove fruitful forprevention efforts (Sussman et al 1998 2003)

Some cognitive restructuring corrects faulty or self-defeatingcognitive structures (myths) In particular elaborating on the logicalsteps involved in the construction of a drug use myth may help to destroyits impact on behavior For example a common myth suggests thathaving trouble finding onersquos car after getting drunk is a funny event Ifone asks (a) lsquolsquoDid you want to find your carrsquorsquo (b) lsquolsquoWere you too drunk tofind it for a long timersquorsquo and (c) lsquolsquoAnd thatrsquos funnyrsquorsquo the apparent humorin the story may dissipate Further one may delineate the kernel of truthin the myth (not finding onersquos car is an odd event) from the falseaspects of the myth (not finding onersquos car indicates failure of functioningwhich is sad worrisome anxiety provoking not funny)

Stereotyping

Lower risk peers tend to perceive lsquolsquoat riskrsquorsquo others (eg alternativehigh school students) as being more deviant than they actually areUnderstandably youth so-labeled students resent this stereotypeAddressing this stereotype may help prevent drug abuse If lsquolsquoat riskrsquorsquoyouth begin to view themselves as being more deviant than they actually

1990 Sussman et al

ORDER REPRINTS

are the situation could lead to self-fulfilling prophesy as if they weregiving in to the stereotype However lowering the estimates of drug useamong their peers can correct this giving in This version of a prevalence-overestimation reduction lesson which includes a motivational featurehas appeared in successful prevention programs (Sussman et al 2002) Astereotype-oriented lesson may also accomplish a second goal If high-risk youth do not view themselves as being deviant as they assumedothers had judged them possibly reactions against this stereotype mayenergize an effort to avoid drug use as well as portray oneself morefavorably (Hamilton August 20 2000)

Valuing Life and Health Goals

Letrsquos consider the example of older teens Most youth report thatthey plan to graduate from high school and continue their educations orfind a job They do not view hanging out as a desirable option They alsosee that drug use could interfere with achieving their goals A lessonexplaining the negative consequences of drug use particularly oneconsistent with data (Newcomb and Bentler 1988) could reveal howearly involvement with drugs creates symptoms of abuse and dependenceand alters job opportunities marriage and family functioning These lifegoals can seem more valuable as students perceive them as attainableEnhancing the value of life goals can increase motivation for learningadaptive coping (Lau et al 1986) Youth have reported that drug usecould interfere with obtaining desired life goals In theme and componentstudies youth positively evaluated a lesson that taught that drug usecould interfere with obtaining desired goals and that placing animportance on health as a value was consistent with achievement of lifegoals (Sussman 1996) Thus it is important for prevention programs tohelp youth connect the importance of health to obtaining their life goalsand develop a sequenced plan so that they know how to proceed step-by-step (Karoly 1993 Watson and Tharp 2002)

Although modifiable understanding the source of positive life goalsis also important since these may occur earlier in life For instanceNewcomb and Harlow (1986) found that perceived loss of control andmeaninglessness in life mediated the relationship between negative lifeevents and drug use While numerous types of stressful events wereconsidered in this study other studies identify an adverse childhoodfamily environment as a potent precursor to later drug use (Locke andNewcomb in press Palinkas et al 1996) An adverse early homeenvironment a modifiable etiological factor should serve as a focus of

Motivation Skills and Decision Making 1991

ORDER REPRINTS

prevention that addresses child abuse and neglect (see later discussion ofthis topic)

Attitudinal Perspectives

Most youth consider themselves as being moderates They can alsoreliably identify drug use as being a deviant immoderate behaviorPresenting them with the disparity between their self-view as a moderateperson despite their deviant drug use can produce a desired behaviorchange (Sussman 1989 Upshaw and Ostrom 1984) An attitudinalperspective lesson can confront students with the inconsistency betweentheir general self-attitude ratings as moderates vs their more extremespecific behaviors (eg drug use) Adopting a self-perception as amoderate may inoculate youth when social pressures to experiment withdrugs arise A desire for internal consistency a similarity betweenattitudes and behavior may increase motivation to abstain from drugs(Festinger 1957 Heider 1958) Youth received lessons like these quitefavorably in previous work (Salomon et al 1984)

Skills

Direct instruction modeling practice and group reinforcementenhance social learning At least three basic kinds of skills needinstruction self-control communication and resource acquisition

Social Self-control Skills

Good self-control protects against substance use and buffers againstthe impact of risk factors (Bandura 1986 Catalano and Hawkins 1996Weissberg et al 1989 Wills et al 1998) Poor self-control involvesbehavioral affective and cognitive deficits Poor behavioral self-controlis associated with a need to regulate and stabilize mood possiblypreceding uncontrolled behavior or stemming from the consequences ofuncontrolled behavior Poor self-control behavior along with difficultiesin mood stabilization increases risk for substance use and rapidescalation to high levels of use which then can lead to physiologicaldependence (Wills and Stoolmiller 2002)

Self-control strategies cross physiological and personality boundariesbecause self-control also relates to coping motives for substance use a

1992 Sussman et al

ORDER REPRINTS

strong predictor of substance use problems (Wills et al 1999) Self-control includes cognition because developing self-control is the substratefor personality organization including not only behavioral and affectivecontrol but also attitudes values and views of the world as accepting orhostile and social perceptions about substance use as being attractive vsunattractive For example studies find poor self-control correlated withattitudinal tolerance for deviance and more favorable perceptions oftobacco and alcohol users whereas good self-control is related tofavorable perceptions of teens that abstain from drug use (Wills et alin press-a) Self-control approaches can be useful for preventionprograms by improving self and other perceptions academic perfor-mance and the impact or facilitation of negative life events goals that aresalient to teenagers and their parents (Wills and Stoolmiller 2002)

Youth often lack adequate coping skills they tend to lack restraint orplanfulness (Farrell and Danish 1993 Rutter et al 1997) Coping skillsinstruction may help increase self-control (Kendall and Braswell 1982)Coping skills instruction receives little attention in typical social influencesprogramming (Hansen 1992) although this material appears in life skillstraining (Botvin 1993 Botvin et al 1995 Wills 1986) In self-controlprogramming youth learn to assess their self-control particularly in socialcontexts (Sussman et al 2003) They learn the importance of thinkingahead and anticipating problem situations so that they are preparedbeforehand to deal with problems that may arise They also learn theimportance of context (eg not laughing at a funeral) Finally they learnassertiveness and anger management to help them better control theirreactions in social settings (Sambrano May 1999 Sussman et al 2002)

Listening and Communication Skills

Youth genuinely benefit from listening to information with an openmind and asking open-ended questions to keep a conversation goingThey can improve social skills by learning how to ask open-endedquestions establish eye contact appropriately nodding and orientingtheir body toward the other speaker (CPPRG 1999 Eggert and Herting1991 Hawkins et al 1999 Sussman et al 2002 2003) Neverthelesssocial skills training can create problems for nondrug using high-riskteens (Palinkas et al 1996 Sussman et al 1995b Wills et al in press-b)Training in drug refusal may create reactance in some samples (Sussmanet al 1996) Among high-risk youth enhancing assertiveness and datingskills may increase the scope of social entertainment options andinadvertently improve a teenrsquos ability to acquire drugs from new sources

Motivation Skills and Decision Making 1993

ORDER REPRINTS

(Wills et al 1989) Also there are cultural variations on what constitutesgood social skill (Unger et al 2004) There are good arguments forplacing high-risk teens together in activities with well-controlled teens sothat they can model adaptive social skills and problem solvingAdditionally utilizing motivation methods prior to instructing thespecific skill channels canalizes health-directed use of social skillsmastered Overall increasing social competence will have protectiveeffects for high-risk teens (Wills et al 1994) This idea is consistent withthe studies that have shown social withdrawal to increase risk for druguse (Kerr et al 1997) though there may be gender differences in theseeffects (Pulkkinen and Pitkanen 1994) Still it is most wise to includesocial skills training in conjunction with material addressing motivationand decision making Motivations regarding drug use need to beaddressed so behaviors learned are not misdirected

Resource Acquisition

Adults often assume that teens can access community services withlittle effort In fact few teens understand the availability of healthservices or other assistance Simple information including phonenumbers and locations can assist teens immensely (Carroll 1996Sussman et al 2002) Coaching teens on techniques for receivingassistance can prove productive Public assistance for drug use-relatedproblems and other life problems can help tremendously but negotiatingthe bureaucratic difficulties inherent in many of these systems can requireconsiderable skill (Eggert and Herting 1991 Sambrano May 1999Sussman et al 2002) Direct instruction modeling and structuredpractice in resource acquisition skills may help youth to increase theirknowledge and self-efficacy on how to acquire resources and to readilyaccess resources when needed (eg use of the bus system) These skillsmay generalize to comparable tasks later in life

Decision-Making

Prevention programs have employed several decision-making strate-gies For example the protocol from Project Reconnecting Youth(Project RY) is STEPS The acronym stands for Stop Think ofoptions Evaluate options Perform or take action on the chosen optionand then Self-praise for using steps for making healthy choices (Eggertand Herting 1991) The participants help set the agenda and take turns

1994 Sussman et al

ORDER REPRINTS

illustrating it on a flip chart This task helps share the leadership andfocuses the group work and time The lesson STEPS to Drug UseControl follows skills training sessions that cover understandingSTEPS as a decision-making model

Project Towards No Drug Abuse (TND)rsquos decision-making sessioninvolves four steps These steps are

1 Brainstorming (making a list of ideas without judging them)2 Weigh the pros and cons (the benefits and costs of each idea)3 Select the best option4 Follow through (try that option and reevaluate the decision)

(Sussman et al 2002)

These decision-making strategies are similar across different pro-grams except that they include some different emphases For exampleSTEPS includes a self-instruction to begin decision making and self-praise whereas the TND sequence includes more of an emphasis onfollowing through with the decision Generally each program requiresgenerating options evaluating them choosing the best and evaluatingthe outcome in an effort to make the next decision Teens tend to enjoypracticing decision making in bogus problem situations Youth soonlearn to engage in steps like these with considerable skill Training indecision making operates on variables that are intermediate in the causalprocess and thereby strengthen individual profiles of self-controlabilities so that they are more resilient in the face of proximal riskfactors for drug use such as life stresses and peer pressures

Modalities of Programming

Both school and nonschool prevention modalities have a rich andimportant history in substance abuse prevention research (Pentz 1994Pentz et al 2004) Schools provide a captive audience for educationalmaterial Youth spend 25 of their waking lives at school so thisenvironment has considerable potential Furthermore the school contextprovides a rich research history for building new studies and evaluatingtheir efficacy (Sussman et al 1995a) Community programs also offerconsiderable opportunity

Community programs often involve local leaders and organizations(eg coalitions community boards) (Goodman et al 1993 Kaftarianand Hansen 1994) that help mobilize numerous community unitsCommunity units include businesses media the family and governmental

Motivation Skills and Decision Making 1995

ORDER REPRINTS

agencies like the police or recreational departments as well as schoolsystems A network of community units working together to developpromote and implement educational programming could increase youthsrsquobonding to others across a wide variety of social contexts (Hawkins et al1992 Pentz 1994) Community units can provide numerous types ofspecific extra-classroom prevention opportunities (Pentz 1994)

Parent-or-family targeted prevention programs include offering earlychildhood education social support for parents managing crisesparenting skills training parent-child communication skills and resourceacquisition instruction or networking Mass media targeted programsinvolve programs or public service announcements with novel fastand unconventional messages (eg the American Legacy FoundationTRUTH campaign) use of the Internet and interactive CDs (eg videogames) Alternative means to involve youth include involvement in hikingclubs drug-free dances or other after-school events with prosocial adultmentors and with means to involve youth outside of school includingentry into different environments (ie outward bound) (Tobler 1986) Inaddition policy implementation and enforcement may contribute toother prevention programs (Pentz et al 1989) Indeed simultaneousprograms within and outside of schools over long periods might maintainthe positive effects that sometimes dissipate when school programsappear alone (Pentz 1994)

The Difference Between Targeted Prevention and Cessation

Targeted (secondary) prevention attempts to keep persons fromcrossing the invisible line where they funnel into a cycle of addiction andaccumulation of negative consequences Cessation programs (sometimesreferred to as tertiary prevention) take the stance that a behavior hasoccurred with definite and perhaps irreversible negative consequencesThe goal is to stop the behavior permit recovery from the damage learnhow to prevent relapse and learn how to live with permanent changes(eg neurotransmitter function drug use-related injury) It is not clearexactly where indicated prevention ends however and where cessationbegins For example an early version of the Project TND curriculum didnot achieve effects on cigarette smoking possibly because 46 of thesample already smoked cigarettes daily (while not engaging often in someother drug use) In a revised curriculum a smoking cessation componentwas added to the program and then an effect on cigarette smoking wasachieved Cessation material can appear with prevention material to

1996 Sussman et al

ORDER REPRINTS

maximize program effectiveness Careful program development can helpdetermine the best mix (Sussman et al 2002)

Summary of Evidence-based Targeted Drug Abuse Prevention

At present approximately 29 drug-use prevention programs havebeen evaluated favorably for their effects on drug use or other problembehavior (see Table 1) These 29 programs have been identified throughtwo sources Blueprints for Violence Prevention (Elliott 2003) and theSubstance Abuse and Mental Health Services Administrationrsquos(SAMSHA) science-based prevention programsrsquo guide (USDHHS2003) PsycINFO and MEDLINE searches of drug abuse preventionstudies since 1970 supplemented searches through these two guides (seeTable 1) Nine definitions of high-risk were used across these programsEleven programs focused on economic deprivation as the definition Sixprograms focused on delinquent behavior as the identifying characteristicto target Two programs each identified single-parent homes drug use orexposure to drug use family problems alternative high school attendanceor being at risk for dropout at a regular high school as the characteristicsto target subjects Finally one program each identified new immigrantstatus or residential facility placement as the defining characteristic ofbeing at high risk for drug use

Among these programs eight focused on preteens For example theEarly Risers program defined its high-risk youth as those 6ndash10 year-oldsthat suffered economic deprivation and exhibited aggressive or opposi-tional behavior Another five programs focused on a young teen agegroup For example Preventive Intervention defined its high-risk youthas those seventh to eighth graders who exhibited poor school andacademic discipline and reported family problems Another sevenprograms focused on an older teen age group For example ProjectTND defined its high-risk youth as those youth that attended alternativehigh schools Finally nine programs encompassed wide age ranges Forinstance Big Brothers Big Sisters of America defined its high-risk youthas 6ndash18 year-olds that lived in single-parent homes

Of these programs 10 involved multiple often flexible settings ofimplementation Another 13 programs focused on the school settingFour programs focused on the home setting Finally two programsfocused on a community agency setting In general these programsinvolved implementation by highly trained personnel Eighteen of theseprograms involved some motivation aspect generally motivationenhancement but sometimes including extrinsic reinforcement strategies

Motivation Skills and Decision Making 1997

ORDER REPRINTS

Twenty-six of these programs provided skills training Finally 18programs provided instruction in decision making Thus the MSDmodel tends to appear in a majority of these programs however all threecomponents were included together in only nine of these programs

Twenty of these programs involved at least one replication of theprogram and 14 involved three or more replications Further 14 of theseprograms were tested through use of experimental designs and nineinvolved use of only quasi-experimental designs Effects on drug use wereassessed and found in 22 of these programs For example theReconnecting Youth program was implemented to youth at risk fordropout This program involved 90 sessions within a comprehensive highschool class delivered generally over a semester with small studentgroups and a highly trained teacher Instruction included use of groupsupport and providing life skills training (norm setting self-esteem moodmanagement communication skills self-monitoring monitoring goalsschool bonding and social activities) with feedback to parents Programgoals were achieved through use of a quasi-experimental design showingeffects for school performance (18 improvement in grades) drug use(54 decrease in hard drug use) and suicide risk (32 decline inperceived stress) This programrsquos results have been replicated numeroustimes in numerous locations This program involved all three componentsof the MSD model except that motivation was provided through peergroup support not through provision motivation enhancement strate-gies These targeted programs present an optimistic picture for drug-useprevention that is focused on at-risk youth (see Table 1)

Not all targeted prevention programs have been found to beeffective One published program that failed to find positive effects wasProject PALS (Palinkas et al 1996) This project was developed for teengirls who were pregnant or at risk for pregnancy and drug use Theprogram consisted of school-based delivery of 16 sessions once a weekin a class The goal was to decrease drug use The PALS Skills TrainingProgram involved instruction in assertiveness providing and receivingfeedback social conversation handling requests and asking for help andmood management This program was tested against a normativeeducation program (called Facts of Life or FOL) which instructedvalues and decision making sexuality issues and contraception sexuallytransmitted diseases (STDs) drug use risks sexual assault prevalenceand norms material An experimental evaluation with a seven-monthspost-baseline was used The results indicated that the PALS programsubjects reported 29 times greater marijuana use than FOL amongbaseline nonusers No other differences were found It is possible that theprogram was not targeted to the right population that the mix of skills

1998 Sussman et al

ORDER REPRINTS

instructed was not appropriate or that skill training alone (withoutappropriate motivation material) may not be effective in drug useprevention Researchers should examine these possibilities and others tofurther understand program failures as well as program successes

Potential Limitations of Targeted Prevention

Dishion and colleagues (1995) suggest from various findings thatgrouping high-risk youth may lead to increased drug use This outcomecan result if youth come to learn deviant behavior from each other Theycan learn deviant behavior from each other in a program if they haveunstructured or unsupervised time together An essential feature ofseveral targeted programs (eg the RY and TND programs) is building apositive peer culture with group norms that decrease drug involvementand drug-use control problems The RYrsquos findings suggest that a positivepeer group component carefully fostered by a well-trained and competentRY group leader can direct the group toward lower risk behaviorSimilarly classroom management in Project TND involves developmentof positive norms of classroom behavior Further interaction betweenyouth is encouraged but is primarily teacher-directed and highlystructured (Sussman et al 2003) In both RY and Project TND theteacherrsquos role is to actively develop and maintain peer group support inthe class by modeling support positively reinforcing it among groupmembers and negatively reinforcing deviant peer bonds and activities(Eggert and Herting 1991 Vorrath and Brendtro 1985) The teachercreates and structures interactions among youth in prosocial directions(Sussman et al 2003)

Multiple Problem Behaviors of Adolescents

Acknowledging the relationship of drug use to other commonadolescent problems may facilitate identification of effective methods ofreducing drug use Researchers on tobacco alcohol and other drug useantisocial behavior high-risk sexual behavior and depression increas-ingly recognize that these problems are interrelated (McGee andNewcomb 1992) and stem to a large extent from the same environ-mental and biological factors (Biglan et al in press Eggert et al 1995Sussman and Ames 2001 Wills and Cleary 1995) Clearly it is necessaryto have strategies that address the entire range of problems and thecontext that influences those problems Indeed further reductions in

Motivation Skills and Decision Making 1999

ORDER REPRINTS

many problems require that we comprehensively target youth withmultiple problem behaviors

Biglan and colleagues (in press) provide a comprehensive review ofthe relationships among antisocial behavior tobacco alcohol and otherdrug use and high-risk sexual behavior It is clear that the same youngpeople are prone to the development of the entire range of problems In arecent review Moffitt and colleagues (2002) found that antisocialbehavior in early adolescence (rather than late adolescence) is a greaterrisk factor for developing multiple problems These findings point to theimportance of early intervention before youth develop serious problemsMoreover these different problems largely result from the same set ofenvironmental and biological factors

One implication is that disciplines dealing with these problemsother than drug abuse may contribute to dealing with the problem ofdrug use (Newcomb 1996b 1997) In particular research by dev-elopmental psychologists family social workers and sociologists onthe influence of parents on adolescent problem development and oninterventions to alter parenting practices contributes to our understandingof how to prevent or ameliorate drug abuse and other problems Onealso should note that nonsubstance use is not a guarantee for problemimmunity for the entire age range of people whatever their genderethnicity religiosity socioeconomic status (SEC) domicility etc It maybe argued that the most promising programs are those targeting thesemultiple levels of influence Several multidisciplinary programs haveachieved promising results We describe three of these empiricallyevaluated programs tested in various settings

Functional Family Therapy (FFT)FFT is an indicated intervention involving family treatment designed

for delinquent teenagers (also see Table 1) Developed in the early 1970sby Alexander and colleagues (1973) FFT focuses on family commu-nication and the establishment of rules and consequences Several studiesprovide encouraging reports of the programrsquos effectiveness (Alexander etal 1976 Barton et al 1985 Klein et al 1977 Waldron et al 2001) Inthe Waldron et al (2001) study researchers used FFT and anintervention with cognitive behavior therapy on teens referred formarijuana use Each of the interventions produced significant resultson marijuana use by the teens at four months but only the twointerventions combined maintained these results at seven months Theearlier studies found a greater number of results For example in the twoAlexander studies (1973 1976) improvement in family communicationposttreatment led to reduced delinquency Note that all the teens in these

2000 Sussman et al

ORDER REPRINTS

studies had histories of serious antisocial or delinquent behavior Thusachieving positive outcomes even if only short-term should encouragefurther research into the efficacy of FFT

Multisystemic Therapy (MST)As its name suggestsMST targets individual family peer school and

community influences of those youth offenders with serious problems thatmay include violence substance use and severe emotional problems (alsosee Table 1) Numerous researchers have published the results ofrandomized trials of MST (Henggeler et al 1996 1997 1998 Thorntonet al 2000) The most consistent findings across studies are decreased (1)drug use (2) re-arrest (3) self-reported criminal offense and (4) days inout-of-home placements Other consistent findings are improved familyrelations school attendance and psychiatric functioning One cautionarynote the programrsquos effectiveness lowers considerably if not implementedwith fidelity (Hengler et al 1997 1999) In other words all or key lessonsneed to be delivered as written by educators who are well-trained in usingthe strategies employed and youth need to be able to receive all material inan atmosphere conducive to learning the material The programdevelopers have instituted training strategies that address these fidelityissues thus shaping MST to be a very promising program for at-riskyouth

Multidimensional Treatment Foster Care (MTFC)MTFC targets family and peer factors influencing adolescents with a

pattern of repeat criminal offending (see Table 1) (Chamberlain 1994)This intervention includes placement of the youth into a foster homewith a foster parent trained in behavior management who receivessupport from intervention staff After the adolescent has begun torespond to the intervention in the foster home and after the parents havereceived the same training and support as the foster parents did theadolescent returns home Chamberlain and Reid (1998) tested theintervention with 85 boys with felony and other criminal histories andfound substantial benefits of the program Following treatment the boysassigned to MTFC (compared to those receiving community-based groupcare) showed fewer days in detention or lock-up twice as much timeliving with parents fewer misdemeanor and felony arrests and fewer self-reported index crimes felony arrests and general delinquency TheMTFC is a cost-effective alternative to incarceration however staffrequirements are extensive which may influence the ability of some

Motivation Skills and Decision Making 2001

ORDER REPRINTS

groups to apply the program with fidelity However as with each of theprograms described here the results of the randomized trials areencouraging

Future Research Needs in Targeted Prevention

Future research can help discern when and where targeted preventionprogramming will tend to work rather than produce potentiallydeleterious negative group effects or results that are irrelevant for pro-social healthy adaptation as well as what the critical necessary conditionsare for their effective operation within given de facto realities Comparedto the breadth of evaluated universal drug use prevention programs(Tobler et al 2000) relatively few targeted prevention programs havereceived empirical support Yet previous research suggests that universalschool-based drug use prevention programs implemented in junior highschool have relatively less chance of long-term success especially for thoseyouth that began using drugs before the prevention program wasimplemented Of course there are notable exceptions (eg effects lastedfor one and a half years effects lasted for six years) (Chou et al 1998Griffin et al 2003 Skara and Sussman 2003) Almost no research existsregarding maximization of booster programming with high-risk youthMore research on booster programs would help the field

While continuing to engage in this work there will be numerousissues to manage that go well beyond the scope of this article There willbe a need to avoid producing negative labeling effects while providingprogramming for those who are at risk for drug use It is possible thatcessation information needs to be included in the mix with preventionmaterial to provide better targeted-prevention effects There may be aneed to develop a teacher selection instrument to help select out teacherswho can deliver drug abuse prevention programming adequatelyCertainly definition of outcome variables needs continued explorationincluding analysis to ascertain the effects of programming on drug abusevs drug use and identification of the variables that are most closelylinked to change by targeted prevention components

A transdisciplinary approach helps to better understand the lifesituation of high-risk youth as based to some extent on both constitutionaland environmental factors (Fuqua et al 2004 Rutter et al 1997 Wills etal 1996b) From the transactional perspective their situation is in partconstitutional they may have temperamental characteristics that arepartly heritable and that have set the stage at earlier ages for decrements inself-control ability and academic performance that then increase risk for

2002 Sussman et al

ORDER REPRINTS

drug use However their situation is also part environmental based in parton family socialization and in part on the types of peers they have as well asthe type and quality of the physical and cultural environment-at-largeThere are many points at which a potential chain of failures can beinterrupted and the individualrsquos trajectory turned in a better directionProblems are not inevitable from starting level (Tarter and Vanyukov1994) and environmental modifications to support good self-controlability can help to avert an adverse impact from earlier experiences orcurrent difficulties (Brody et al 2002 Novak and Clayton 2001 Patock-Peckham et al 2001 Rutter et al 1997 Wills et al 2002)

The problems and needs of high-risk youth in our nationrsquos highschools demand our attention for designing and rigorously testingtargeted prevention approaches Substantial evidence shows that theseyouth are at greater risk for drug involvement and co-occurring problemssuch as aggression depression and suicidal behaviors as we previouslydiscussed It is hoped that the information presented in this article willstimulate others to join in extending this work including testing othermodels of targeted prevention

GLOSSARY

Universal programs Programs that aim to influence all subjects in acontext

Selective drug-abuse prevention programs Programs that servegroups at greater risk of ATOD usemdashfor example children of alcoholicparents They are at psychosocial risk for drug use and abuse

Indicated drug-abuse prevention programs Programs that attemptto benefit individuals who already show signs of drug involvement orrelated risk factors In indicated prevention programs the primary goal isto stem the progression of ATOD use or reduce drug involvementamong the high-risk youth

Targeted programming Programming that subsumes selective andindicated programming sometimes the other two types of programs thattarget specific groups lsquolsquoat riskrsquorsquo are considered together

ACKNOWLEDGMENTS

This research was supported by grants from the National Institute onDrug Abuse (DA01070 DA07601 DA13814 and DA16094) and by aResearch Scientist Development Award K02 DA00252 from theNational Institute on Drug Abuse

Motivation Skills and Decision Making 2003

ORDER REPRINTS

REFERENCES

Alexander J F Barton C Schiaro R S Parsons B V (1976)

Systems-behavioral intervention with families of delinquents

therapist characteristics family behavior and outcome Journal of

Consulting and Clinical Psychology 44(4)656ndash664Alexander J F Parsons B V (1973) Short-term behavioral interven-

tion with delinquent families impact on family process and

recidivism Journal of Abnormal Psychology 3219ndash225American psychiatric association (APA) (1994) Diagnostic and

Statistical Manual of Mental Disorders 4th edn (DSM-IV)

Washington DC American Psychiatric AssociationAmes S L Sussman S Dent C W (1999) Pro-drug-use myths and

competing constructs in the prediction of substance use among

youth at continuation high schools a one-year prospective study

Personality and Individual Differences 26987ndash1003Bachman S G Wadsworth K N OrsquoMalley P M Johnston L D

Schulenberg J E (1997) Smoking drinking and drug use in young

adulthood Mahwah NJ Lawrence Erlbaum Associates 8ndash25

153ndash190Bandura A (1986) Social Foundations of Thought and Action A Social

Cognitive Theory Englewood Cliffs NJ Prentice HallBarton C Alexander J F Waldron H Turner C W Warburton J

(1985) Generalizing treatment effects of functional family therapy

Three replications The American Journal of Family Therapy

13(3)16ndash26Battin-Pearson S R Newcomb M D Abbott R D Hill K G

Catalano R F Hawkins J D (2000) Predicting early high school

dropout Journal of Educational Psychology 92568ndash582Biglan A Brennan P A Foster S L Holder H D Miller T L

Cunningham P B et al (in press) Helping Adolescents at Risk

Prevention of Multiple Problem Behaviors New York NY Guilford

PressBindra D Stewart J (1996) Motivation Baltimore MD Penguin

BooksBlanton H Gibbons F X Gerrard M Conger K J Smith G E

(1998) The role of family and peers in the development of

prototypes associated with substance use Journal of Family

Psychology 11271ndash288

2004 Sussman et al

ORDER REPRINTS

Botvin G J (1993) School-based drug abuse prevention Long-termfollow-up results In First Annual Meeting of the Society forPrevention Research Kentuck Lexington Society for PreventionResearch

Botvin G J Baker E Dusenbury L Botvin E M Diaz T (1995)Long-term follow-up results of a randomized drug abuse preven-tion trial in a white middle-class population Journal of theAmerican Medical Association 2731106ndash1012

Brody G H Dorsey S Forehand R Armistead L (2002) Uniquecontributions of parenting and classroom processes to the self-control of AfricanndashAmerican children Child Development73274ndash286

Carroll M E (1996) Reducing drug abuse by enriching the environmentwith alternative nondrug reinforcers In Green L Kagel J Heds Advances in Behavioral Economics Norwood NJ NorwoodPublishing Corp 37ndash68

Carver C S Scheier M F (1998) On the Self-Regulation of BehaviorNew York Cambridge University Press

Catalano R F Hawkins J D (1996) The social developmental modela theory of antisocial behavior In Hawkins J D ed Delinquencyand Crime Current Theories New York Cambridge UniversityPress

Centers for Disease Control (CDC) (October 1999) Youth risk BehaviorSurveillancemdashNational Alternative High School Youth RiskBehavior Survey 1998 Morbidity and Mortality Weekly Report48 No SS-7

Chamberlain P (1994) Family connections A treatment foster caremodel for adolescents with delinquency Eugene OR CastaliaPublishing Company

Chamberlain P Reid J B (1998) Comparison of two communityalternatives to incarceration for chronic juvenile offenders Journalof Consulting and Clinical Psychology 66(4)624ndash633

Chassin L A Presson C C Sherman S J (1985) Stepping backwardin order to step forward an acquisition-oriented approach toprimary prevention Journal of Consulting and Clinical Psychology53612ndash622

Chou C-P Montgomery S Pentz M A Rohrbach L A JohnsonC A Flay B R MacKinnon D P (1998) Effects of acommunity-based prevention program on decreasing drug use inhigh-risk adolescentsAmerican Journal of Public Health 88944ndash948

Conducts Problems Prevention Research Group (CPPRG) (1999) Initialimpact of the fast track prevention trial for conduct problems I

Motivation Skills and Decision Making 2005

ORDER REPRINTS

The high-risk sample Journal of Consulting and Clinical Psychology

67631ndash647Conducts Problems Prevention Research Group (CPPRG) (2000)

Merging universal and indicated prevention programs the fast

track model Addictive Behaviors 25913ndash927Council of Philosophical Studies (1981) Psychology and the Philosophy

of Mind in the Philosophy Curriculum San Francisco San Francisco

State UniversityCummings K M Hellmann R Emont S L (1988) Correlates of

participation in a worksite stop smoking program Journal of

Behavioral Medicine 11267ndash277Curry S Wagner E H Gothaus L C (1990) Intrinsic and extrinsic

motivation for smoking cessation Journal of Consulting and

Clinical Psychology 58310ndash316Dent C W Sussman S McCuller W J Stacy A W (2001) Drug

abuse prevention among youth at comprehensive high schools

Preventive Medicine 32514ndash520Dewey J (1886) Psychology New York HarperDishion T J French D C Patterson G R (1995) The development

and ecology of antisocial behavior In Cicchetti D Cohen D

eds Manual of developmental psychopathology New York John

Wiley 421ndash471Eggert L L Herting J R (1991) Preventing teenage drug abuse

exploratory effects of network social support Youth and Society

22482ndash534 [Reprinted National Prevention Evaluation Research

CollectionRockville MD Aspen 1993]Eggert L L Herting J R Thompson E A Nicholas L J Dicker

B G (1994) Preventing adolescent drug abuse and high school

dropout through an intensive school-based social network devel-

opment program American Journal of Health Promotion

8202ndash214Eggert L L Thompson E A Herting J R Nicholas L J (1995)

Reducing suicide potential among high-risk youth tests of a school-

based prevention program Suicide amp Life-Threatening Behavior

25276ndash296Ellickson P L Bell R M (1990) Drug prevention in junior high a

multi-site longitudinal test Science 2471299ndash1305Elliott D S (Series ed) (2003) Blueprints for violence prevention

Boulder CO Institute of Behavioral Science Regents of the

University of Colorado wwwcoloradoeducspvblueprints

2006 Sussman et al

ORDER REPRINTS

Farrell A D Danish S J (1993) Peer drug associations and emotionalrestraint Causes or consequences of adolescent drug use Journal ofConsulting and Clinical Psychology 61327ndash334

Festinger L A (1957) A Theory of Cognitive Dissonance New YorkHarper amp Row

Fuqua J Stokols D Gress J Phillips K Harvey R (2004)Transdisciplinary collaboration as a basis for enhancing the scienceand prevention of substance use and abuse Substance Use ampMisuse

Giuliano J D (1994) A peer education program to promote the use ofconflict resolution skills among at-risk school-age males PublicHealth Reports 109158ndash169

Glynn K Levanthal H Hirschman R (1985) A cognitivedevelopmental approach to smoking prevention In Bell C SBattjes R eds Prevention research Deterring Drug Abuse AmongChildren and Adolescents Rockville MD NIDA ResearchMonograph 63

Glynn T J (1989) Essential elements of school-based smokingprevention programs Journal of School Health 59181ndash188

Goodman R M Burdine J N Meehan E McLeroy K R eds(1993) Community coalitions for health promotion Special issue ofHealth Education Research Theory and Practice 8309ndash453

Goodyear R D Newcomb M D Locke T F (2002) PregnantLatina teenagers psychosocial and developmental determinants ofhow they select and perceive the men who father their childrenJournal of Counseling Psychology 49187ndash201

Gordon R (1987) An operational classification of disease preventionIn Steinberg J A Silverman M M eds Preventing MentalDisorders Rockville MD DHHS 20ndash26

Graham J W Johnson C A Hansen W B Flay B R Gee M(1990) Drug use prevention programs gender and ethnicityevaluation of three seventh-grade project SMART cohortsPreventive Medicine 19305ndash313

Griffin K W Botvin G J Nichols T R Doyal M M (2003)Effectiveness of a universal drug abuse prevention approach foryouth at high risk for substance use initiation Preventive Medicine36(1)1ndash7

Hamilton S (August 20 2000) Views slowly changing on alternativeschools The Sacramento Bee 1ndash3

Hansen W B (1992) School-based substance abuse prevention a reviewof the state of the art in curriculum 1980ndash1990 Health EducationResearch 7403ndash430

Motivation Skills and Decision Making 2007

ORDER REPRINTS

Hansen W B Johnson C A Flay B R Graham J W Sobel J(1988) Affective and social influences approaches to the preventionof multiple substance abuse among seventh grade students resultsfrom project SMART Preventive Medicine 17135ndash154

Hansen W B Graham J W (1991) Preventing alcohol marijuanaand cigarette use among adolescents peer pressure and resistancetraining versus establishing conservative norms PreventiveMedicine 20414ndash430

Hawkins D H Catalano R F Miller J Y (1992) Risk andprotective factors for alcohol and other drug problems inadolescence and early adulthood Implications for substanceabuse prevention Psychological Bulletin 11254ndash105

Hawkins J D Catalano R F Kosterman R Abbott R Hill K G(1999) Preventing adolescent health-risk behaviors by strengthen-ing protection during childhood Archives of Pediatric amp AdolescentMedicine 153226ndash234

Heider F (1958) The Psychology of Interpersonal Relations New YorkWiley

Henggeler S W Pickrel S G Brondino M J Crouch J L (1996)Eliminating (almost) treatment dropout of substance abusing ordependent delinquents through home-based multisystemic therapyAmerican Journal of Psychiatry 153(3)427ndash428

Henggeler S W Melton G B Brondino M J Scherer D GHanley J H (1997) Multisystemic therapy with violent andchronic juvenile offenders and their families the role of treatmentfidelity in successful dissemination Journal of Consulting andClinical Psychology 65(5)821ndash833

Henggeler S W Schoenwald S K Borduin C M Rowland M DCunningham P B (1998) Multisystemic treatment of antisocialbehavior in children and adolescents New York The Guilford Press

Henggeler S W Pickrel S G Brondino M J (1999) Multisystemictreatment of substance-abusing and dependent delinquents out-comes treatment fidelity and transportability Mental HealthServices Residual 1(3)171ndash84

Johnson C A Pentz M A Weber M D Dwyer J H Baer NMacKinnon D P Hansen W B Flay B R (1990) Relativeeffectiveness of comprehensive community programming for drugabuse prevention with high-risk and low-risk adolescents Journalof Consulting and Clinical Psychology 58447ndash456

Kaftarian S J Hansen W B eds (1994) CSAP special issuecommunity partnership program Journal of Community Psychologypages 205

2008 Sussman et al

ORDER REPRINTS

Karoly P (1993) Mechanisms in self-regulation A systems view AnnualReview of Psychology 4423ndash51

Karoly P (1980) Person variables in therapeutic change and develop-ment In Karoly P Steffen J J eds Improving the Long-TermEffects of Psychotherapy New York Gardner Press 195ndash261

Kendall P C Braswell L (1982) Cognitive-behavioral self-controltherapy for children a components analysis Journal of Consultingand Clinical Psychology 50672ndash689

Kerr M Tremblay R E Pagani L Vitaro F (1997) Boysrsquobehavioral inhibition and the risk of later delinquency Archivesof General Psychiatry 54809ndash816

Klein N C Alexander J F Parsons B V (1977) Impact of familysystems intervention on recidivism and sibling delinquency a modelof primary prevention and program evaluation Journal ofConsulting and Clinical Psychology 45(3)469ndash474

Kumpfer K L (1999) Outcomes measures of interventions in the studyof children of substance-abusing parents Pediatrics 1031128ndash1144

Lau R R Hartman K A Ware J E (1986) Health as a valuemethodological and theoretical considerations Health Psychology525ndash43

Lichtenstein E L Glasgow R E (1997) A pragmatic framework forsmoking cessation implications for clinical and public healthprograms Psychology of Addictive Behaviors 11142ndash151

Locke T F Newcomb M D (in press) Childhood maltreatmentparent drug problems polydrug problems and parenting practicesa test of gender differences and four theoretical perspectivesJournal of Family Psychology

McCreary D R Newcomb M D Sadava S W (1999) The male rolealcohol use and alcohol problems a structural modeling examina-tion in adult women and men Journal of Counseling Psychology46109ndash124

McGee L Newcomb M D (1992) General deviance syndromeexpanded hierarchical evaluations at four ages from earlyadolescence to adulthood Journal of Consulting amp ClinicalPsychology 60766ndash776

Miller W R Brown J M (1991) Self-regulation as a conceptual basisfor the prevention of addictive behaviours In Heather N MillerW R Greeley J eds Self-control and the Addictive BehavioursSydney Australia Maxwell Macmillan 3ndash79

Miller W R Leckman A L Delaney H D Tinkcom M (1993)Long-term follow-up of behavioral self-control training forproblem drinkers Journal of Studies on Alcohol 53249ndash261

Motivation Skills and Decision Making 2009

ORDER REPRINTS

Miller W R Rollnick S (1991) Motivational InterviewingPreparing People to Change Addictive Behavior New YorkGuilford Press

Moffitt T E Caspi A Harrington H Milne B J (2002) Males onthe life-course-persistent and adolescence-limited antisocial path-ways follow-up at age 26 years Development and Psychopathology14(1)179ndash207

National Institute on Drug Abuse (NIDA) (1997) Drug abuseprevention What works NIH Publication 97-4110 DHHSNational Institutes of Health National Institute on Drug AbuseOffice of Science Policy and Communications Rockville MD

Newcomb M D (1992a) Substance abuse and control in the UnitedStates ethical and legal issues Social Science and Medicine35471ndash479

Newcomb M D (1992b) Understanding the multidimensional nature ofdrug use and abuse The role of consumption risk factors andprotective factors In Glantz M D Pickens R eds Vulnerabilityto Drug Abuse Washington DC American PsychologicalAssociation 255ndash298

Newcomb M D (1996a) Pseudomaturity among adolescents constructvalidation sex differences and associations in adulthood Journalof Drug Issues 26477ndash504

Newcomb M D (1996b) Adolescence Pathologizing a normal processThe Counseling Psychologist 24482ndash490

Newcomb M D (1997) Psychosocial predictors and consequences ofdrug use a developmental perspective within a prospective studyJournal of Addictive Diseases 1651ndash89

Newcomb M D Bentler P M (1988) Consequences of Adolescent DrugUse Impact on the Lives of Young Adults Beverly Hills CA Sage

Newcomb M D Bentler P M (1989) Substance use and abuse amongchildren and teenagers American Psychologist 44242ndash248

Newcomb M D Harlow L L (1986) Life events and substance useamong adolescents Mediating effects of perceived loss of controland meaninglessness in life Journal of Personality and SocialPsychology 51564ndash577

Newcomb M D Chou C-P Bentler P M Huba G J (1988)Cognitive motivations for drug use among adolescents longitudinaltests of gender differences and predictors of change in drug useJournal of Counseling Psychology 35426ndash438

Newcomb M D Abbott R D Catalano R F Hawkins J DBattin-Pearson S R Hill K (2002) Mediational and deviancetheories of late high school failure Process roles of structural

2010 Sussman et al

ORDER REPRINTS

strains academic competence and general versus specific problem

behaviors Journal of Counseling Psychology 49172ndash186Nezami E Sussman S Pentz M A (2003) Motivation in tobacco use

cessation research Substance Use amp Misuse 3825ndash5Novak S P Clayton R R (2001) The influence of school environment

and self-regulation on transitions between stages of cigarette

smoking Health Psychology 20196ndash207Offord D R (2000) Selection of levels of prevention Addictive

Behaviors 25833ndash842Palinkas L A Atkins C J Miller C Ferreira D (1996) Social skills

training for drug prevention in high-risk female adolescents

Preventive Medicine 25692ndash701Patock-Peckham J A Cheong J-W Balhorn M E Nagoshi C T

(2001) A model of parenting styles self-regulation perceived

drinking control and alcohol use and problems Alcoholism

Experimental and Clinical Research 251284ndash1292Pentz M A (1994) Directions for future research in drug abuse

prevention Preventive Medicine 23646ndash652Pentz M A Dwyer J H MacKinnon D Flay B R Hansen W B

Wang E Y I Johnson C A (1989) A multi-community trial for

primary prevention of adolescent drug abuse effects on drug use

prevalence JAMA 2623259ndash3266Pentz M A Mares D Schinke S Rohrbach L (in press) Political

science public policy and drug abuse prevention Substance Use amp

MisuseProchaska J O DiClemente C C (1982) Transtheoretical therapy

toward a more integrative model of change Psychotherapy Theory

Research and Practice 19275ndash288Pulkkinen L Pitkanen T (1994) A prospective study of the precursors

to problem drinking in young adulthood Journal of Studies on

Alcohol 55578ndash587Rathus S A Nevid J S (1977) Behavior Therapy Strategies for

Solving Problems in Living New York Doubleday and Company

IncResnicow K Botvin G (1993) School-based substance use prevention

programs why do effects decay Preventive Medicine 22484ndash490Rutter M Dunn J Plomin R Simonoff E Pickles A Maughan

B Ormel J Meyer J Eaves L (1997) Integrating nature and

nurture implications of person-environment interactions for

developmental psychopathology Development and Psychopathology

9335ndash364

Motivation Skills and Decision Making 2011

ORDER REPRINTS

Salomon G Stein Y Eisenberg S Klein L (1984) Adolescent

smokers and nonsmokers profiles and their changing structure

Preventive Medicine 13446ndash461Sambrano S (1999) National cross-site evaluation of high risk youth

programs In Interim findings Bulletin Washington DC CSAP

SAMSHA US DHHS May 1ndash16Schinke S P Gilchrist L D (1985) Preventing substance abuse with

children and adolescents Journal of Consulting and Clinical

Psychology 53596ndash602Skara S N Sussman S (2003) A review of 25 long-term adolescent

tobacco and other drug use prevention program evaluations

Preventive MedicineSmith C Lizotte A J Thornberry T P Krohn M D (1995)

Resilient youth identifying factors that prevent high-risk youth

from engaging in delinquency and drug use Delinquency and

Disrepute in the Life Course Greenwich CT John Hagan JAI

press 217ndash247Sommers P V (1972) The Biology of Behavior Australia Pty ltd

Sydney John Wiley amp SonsSt Pierre T L Kaltreider D L Mark M M Aikin K J (1992)

Drug prevention in a community setting a longitudinal study of the

relative effectiveness of a three-year primary prevention program in

boys and girls clubs across the nation American Journal of

Community Psychology 20673ndash706Stein J A Newcomb M D Bentler P M (1987) An eight year study

of multiple influences on drug use and drug use consequences

Journal of Personality and Social Psychology 531094ndash1105Sully J (1884) Outlines of Psychology New York D Appleton amp CoSussman S (1989) Two social influence perspectives of tobacco use

development and prevention Health Education Research Theory

and Practice 4213ndash223Sussman S (1991) Curriculum development in school-based prevention

research Health Education Research Theory and Practice

6339ndash351Sussman S (1996) Development of a school-based drug abuse

prevention curriculum for high risk youth Journal of

Psychoactive Drugs 28169ndash182Sussman S Ames S L (2001) The social psychology of drug abuse

Buckingham GB Open University PressSussman S Unger J (2004) A drug abuse theoretical integration a

transdisciplinary speculation Substance Use amp Misuse

2012 Sussman et al

ORDER REPRINTS

Sussman S Dent C W Burton D Stacy A W Flay B R (1995a)

Developing school-based tobacco use prevention and cessation

programs Thousand Oaks CA Sage Publications IncSussman S Dent C W Simon T R Stacy A W Galaif E R

Moss M A Craig S Johnson C A (1995b) Effectiveness of

social influence substance abuse prevention curricula in compre-

hensive and continuation high schools Drugs and Society 865ndash81Sussman S Dent C W Galaif E R (1997) The correlates of

substance abuse and dependence among adolescents at high risk

for drug abuse Journal of Substance Abuse 9241ndash255Sussman S Dent C W Stacy A W (1996) The relation of pro-drug

use myths with self-reported drug use among youth at continuation

high schools Journal of Applied Social Psychology 26214ndash267Sussman S Dent C W Stacy A Craig S (1998) One-year outcomes

of project towards no drug abuse Preventive Medicine 27632ndash642

(erratum 766)Sussman S Dent C W Stacy S (2002) Project towards no drug

abuse a review of the findings and future directions American

Journal of Health Behavior 26354ndash365Sussman S McCuller W J Dent C W (2003) The associations of

social self-control personality disorders and demographics with

drug use among high risk youth Addictive Behaviors 281159ndash1166Sussman S Rohrbach L Patel R Holiday K (2003) A look at an

interactive classroom-based drug abuse prevention program

Interactive contents and suggestions for research Journal of Drug

Education 33355ndash368Sussman S Sun P McCuller W J Dent C W (2003) Project

towards no drug abuse two year outcomes of a trial that compares

health educator delivery to self-instruction Preventive Medicine

37155ndash162Tarter R E Vanyukov M (1994) Alcoholism a developmental disorder

Journal of Consulting and Clinical Psychology 621096ndash1107Thornton T N Craft C A Dahlberg L L Lynch B S Baer K

(2000) Best Practices of Youth Violence Prevention A Sourcebook

for Community Action Atlanta GA Division of Violence

Prevention Centers for Disease Control and PreventionTobler N S (1986) Meta-analysis of 143 adolescent drug prevention

programs quantitative outcome of program participants compared to

a control or comparison group Journal of Drug Issues 16537ndash567Tobler N S Roona M R Ochshorn P Marshall D G Streke

A V Stackpole K M (2000) School-based adolescent drug

Motivation Skills and Decision Making 2013

ORDER REPRINTS

prevention programs 1998 Meta-analysis The Journal of Primary

Prevention 20275ndash336US Department of Health and Human Services (USDHHS) (2003)

Substance Abuse andMental Health Services Administration Center

for Substance Abuse Prevention Science-based prevention programs and

principles 2002 Rockville MD US DHHS (SMA)03-3764 Also

see httpmodelprogramssamhsagovUnger J Baezconde-Garbanati L Shakib S Palmer P H Nezami

E Mora J (2004) What are the implications of structuralcultural

theory for drug abuse prevention Substance Use amp MisuseUpshaw H S Ostrom T M (1984) Psychological perspective in

attitude research In Eiser J R ed Attitudinal Judgment New

York Springer-Verlag 23ndash42Valente T W Gallaher P Mouttapa M (2004) Using social network

theory to understand and prevent substance use a transdisciplinary

perspective Substance Use amp MisuseVorrath H Brendtro L (1985) Positive peer culture 2nd edn Aldine

ChicagoWaldron H B Slesnick N Brody J L Turner C W Peterson T R

(2001) Treatment outcomes for adolescent substance abuse at 4-

and 7-month assessments Journal of Consulting amp Clinical

Psychology 69(5)802ndash813Watson D L Tharp R G (2002) Self-directed behavior Self-

modification for personal adjustment 8th edn Belmont CA

WadsworthWeissberg R P Caplan M Z Sivo P J (1989) A new conceptual

framework for establishing school-based social competence promo-

tion programs In Bond L A Compas B E eds Primary

Prevention amp Promotion in the Schools Newbury Park CA Sage

255ndash296Wills T A (1986) Stress and coping in early adolescence relationships

to substance use in urban school samples Health Psychology

5503ndash529Wills T A Cleary S D (1995) Stress-coping model for alcohol-

tobacco interactions in adolescence In Fertig J B Allen J P

eds Alcohol and Tobacco From Basic Science to Clinical Practice

Bethesda MD National Institute on Alcohol Abuse and

Alcoholism 107ndash128Wills T A Cleary S D (1999) Peer and adolescent substance use

among 6thndash9th graders Latent growth analyses of influence versus

selection mechanisms Health Psychology 18453ndash463

2014 Sussman et al

ORDER REPRINTS

Wills T A Hirky A E (1996) Coping and substance abuse InZeidner M Endler N S eds Handbook of Coping TheoryResearch and Applications New York Wiley 279ndash302

Wills T A Stoolmiller M (2002) The role of self-control in earlyescalation of substance use a time-varying analysis Journal ofConsulting and Clinical Psychology 70986ndash997

Wills T A Baker E Botvin G J (1989) Dimensions of assertivenessdifferential relationships to substance use in early adolescenceJournal of Consulting and Clinical Psychology 57(4)473ndash478

Wills T A Vaccaro D McNamara G (1994) Novelty seeking risktaking and related constructs as predictors of adolescent substanceuse an application of Cloningerrsquos theory Journal of SubstanceAbuse 61ndash20

Wills T A McNamara G Vaccaro D Hirky A E (1996a)Escalated substance use a longitudinal grouping analysis fromearly to middle adolescence Journal of Abnormal Psychology105166ndash180

Wills T A Pierce J P Evans R I (1996b) Large-scale environmentalrisk factors for substance use American Behavioral Scientist39808ndash822

Wills T A Windle M Cleary S D (1998) Role of temperamentnovelty-seeking and self-control in adolescent substance useJournal of Personality and Social Psychology 74387ndash406

Wills T A Sandy J M Shinar O (1999) Substance use level andproblems in late adolescence a mediational model based on self-control and coping motives Experimental and ClinicalPsychopharmacology 7122ndash134

Wills T A Cleary S D Filer M Shinar O Mariani J Spera K(2001) Temperament and self-control related to early-onsetsubstance use test of a developmental model Prevention Science2145ndash163

Wills T A Sandy J M Yaeger A (2002) Moderators of therelationship between substance use level and problems test of aself-regulation model in adolescence Journal of AbnormalPsychology 1113ndash21

Wills T A Gibbons F X Gerrard M Murry V Brody G (in press-a) Family communication and religiosity related to substance useand sexual behavior in early adolescence Psychology of AddictiveBehaviors

Wills T A Resko J Ainette M Mendoza D (in press-b) The role ofparent and peer support in adolescent substance use a test ofmediated effects Psychology of Addictive Behaviors

Motivation Skills and Decision Making 2015

ORDER REPRINTS

Young P T (1936) Motivation of Behavior New York John Wiley andSons

Zimmerman B J (2000) Attaining self-regulation a social cognitivemodel In Boekaerts M Pintrich P R eds Handbook of Self-Regulation San Diego Academic Press 13ndash39

2016 Sussman et al

Request PermissionOrder Reprints

Reprints of this article can also be ordered at

httpwwwdekkercomservletproductDOI101081JA200034769

Request Permission or Order Reprints Instantly

Interested in copying and sharing this article In most cases US Copyright Law requires that you get permission from the articlersquos rightsholder before using copyrighted content

All information and materials found in this article including but not limited to text trademarks patents logos graphics and images (the Materials) are the copyrighted works and other forms of intellectual property of Marcel Dekker Inc or its licensors All rights not expressly granted are reserved

Get permission to lawfully reproduce and distribute the Materials or order reprints quickly and painlessly Simply click on the Request Permission Order Reprints link below and follow the instructions Visit the US Copyright Office for information on Fair Use limitations of US copyright law Please refer to The Association of American Publishersrsquo (AAP) website for guidelines on Fair Use in the Classroom

The Materials are for your personal use only and cannot be reformatted reposted resold or distributed by electronic means or otherwise without permission from Marcel Dekker Inc Marcel Dekker Inc grants you the limited right to display the Materials only on your personal computer or personal wireless device and to copy and download single copies of such Materials provided that any copyright trademark or other notice appearing on such Materials is also retained by displayed copied or downloaded as part of the Materials and is not removed or obscured and provided you do not edit modify alter or enhance the Materials Please refer to our Website User Agreement for more details

ORDER REPRINTS

are the situation could lead to self-fulfilling prophesy as if they weregiving in to the stereotype However lowering the estimates of drug useamong their peers can correct this giving in This version of a prevalence-overestimation reduction lesson which includes a motivational featurehas appeared in successful prevention programs (Sussman et al 2002) Astereotype-oriented lesson may also accomplish a second goal If high-risk youth do not view themselves as being deviant as they assumedothers had judged them possibly reactions against this stereotype mayenergize an effort to avoid drug use as well as portray oneself morefavorably (Hamilton August 20 2000)

Valuing Life and Health Goals

Letrsquos consider the example of older teens Most youth report thatthey plan to graduate from high school and continue their educations orfind a job They do not view hanging out as a desirable option They alsosee that drug use could interfere with achieving their goals A lessonexplaining the negative consequences of drug use particularly oneconsistent with data (Newcomb and Bentler 1988) could reveal howearly involvement with drugs creates symptoms of abuse and dependenceand alters job opportunities marriage and family functioning These lifegoals can seem more valuable as students perceive them as attainableEnhancing the value of life goals can increase motivation for learningadaptive coping (Lau et al 1986) Youth have reported that drug usecould interfere with obtaining desired life goals In theme and componentstudies youth positively evaluated a lesson that taught that drug usecould interfere with obtaining desired goals and that placing animportance on health as a value was consistent with achievement of lifegoals (Sussman 1996) Thus it is important for prevention programs tohelp youth connect the importance of health to obtaining their life goalsand develop a sequenced plan so that they know how to proceed step-by-step (Karoly 1993 Watson and Tharp 2002)

Although modifiable understanding the source of positive life goalsis also important since these may occur earlier in life For instanceNewcomb and Harlow (1986) found that perceived loss of control andmeaninglessness in life mediated the relationship between negative lifeevents and drug use While numerous types of stressful events wereconsidered in this study other studies identify an adverse childhoodfamily environment as a potent precursor to later drug use (Locke andNewcomb in press Palinkas et al 1996) An adverse early homeenvironment a modifiable etiological factor should serve as a focus of

Motivation Skills and Decision Making 1991

ORDER REPRINTS

prevention that addresses child abuse and neglect (see later discussion ofthis topic)

Attitudinal Perspectives

Most youth consider themselves as being moderates They can alsoreliably identify drug use as being a deviant immoderate behaviorPresenting them with the disparity between their self-view as a moderateperson despite their deviant drug use can produce a desired behaviorchange (Sussman 1989 Upshaw and Ostrom 1984) An attitudinalperspective lesson can confront students with the inconsistency betweentheir general self-attitude ratings as moderates vs their more extremespecific behaviors (eg drug use) Adopting a self-perception as amoderate may inoculate youth when social pressures to experiment withdrugs arise A desire for internal consistency a similarity betweenattitudes and behavior may increase motivation to abstain from drugs(Festinger 1957 Heider 1958) Youth received lessons like these quitefavorably in previous work (Salomon et al 1984)

Skills

Direct instruction modeling practice and group reinforcementenhance social learning At least three basic kinds of skills needinstruction self-control communication and resource acquisition

Social Self-control Skills

Good self-control protects against substance use and buffers againstthe impact of risk factors (Bandura 1986 Catalano and Hawkins 1996Weissberg et al 1989 Wills et al 1998) Poor self-control involvesbehavioral affective and cognitive deficits Poor behavioral self-controlis associated with a need to regulate and stabilize mood possiblypreceding uncontrolled behavior or stemming from the consequences ofuncontrolled behavior Poor self-control behavior along with difficultiesin mood stabilization increases risk for substance use and rapidescalation to high levels of use which then can lead to physiologicaldependence (Wills and Stoolmiller 2002)

Self-control strategies cross physiological and personality boundariesbecause self-control also relates to coping motives for substance use a

1992 Sussman et al

ORDER REPRINTS

strong predictor of substance use problems (Wills et al 1999) Self-control includes cognition because developing self-control is the substratefor personality organization including not only behavioral and affectivecontrol but also attitudes values and views of the world as accepting orhostile and social perceptions about substance use as being attractive vsunattractive For example studies find poor self-control correlated withattitudinal tolerance for deviance and more favorable perceptions oftobacco and alcohol users whereas good self-control is related tofavorable perceptions of teens that abstain from drug use (Wills et alin press-a) Self-control approaches can be useful for preventionprograms by improving self and other perceptions academic perfor-mance and the impact or facilitation of negative life events goals that aresalient to teenagers and their parents (Wills and Stoolmiller 2002)

Youth often lack adequate coping skills they tend to lack restraint orplanfulness (Farrell and Danish 1993 Rutter et al 1997) Coping skillsinstruction may help increase self-control (Kendall and Braswell 1982)Coping skills instruction receives little attention in typical social influencesprogramming (Hansen 1992) although this material appears in life skillstraining (Botvin 1993 Botvin et al 1995 Wills 1986) In self-controlprogramming youth learn to assess their self-control particularly in socialcontexts (Sussman et al 2003) They learn the importance of thinkingahead and anticipating problem situations so that they are preparedbeforehand to deal with problems that may arise They also learn theimportance of context (eg not laughing at a funeral) Finally they learnassertiveness and anger management to help them better control theirreactions in social settings (Sambrano May 1999 Sussman et al 2002)

Listening and Communication Skills

Youth genuinely benefit from listening to information with an openmind and asking open-ended questions to keep a conversation goingThey can improve social skills by learning how to ask open-endedquestions establish eye contact appropriately nodding and orientingtheir body toward the other speaker (CPPRG 1999 Eggert and Herting1991 Hawkins et al 1999 Sussman et al 2002 2003) Neverthelesssocial skills training can create problems for nondrug using high-riskteens (Palinkas et al 1996 Sussman et al 1995b Wills et al in press-b)Training in drug refusal may create reactance in some samples (Sussmanet al 1996) Among high-risk youth enhancing assertiveness and datingskills may increase the scope of social entertainment options andinadvertently improve a teenrsquos ability to acquire drugs from new sources

Motivation Skills and Decision Making 1993

ORDER REPRINTS

(Wills et al 1989) Also there are cultural variations on what constitutesgood social skill (Unger et al 2004) There are good arguments forplacing high-risk teens together in activities with well-controlled teens sothat they can model adaptive social skills and problem solvingAdditionally utilizing motivation methods prior to instructing thespecific skill channels canalizes health-directed use of social skillsmastered Overall increasing social competence will have protectiveeffects for high-risk teens (Wills et al 1994) This idea is consistent withthe studies that have shown social withdrawal to increase risk for druguse (Kerr et al 1997) though there may be gender differences in theseeffects (Pulkkinen and Pitkanen 1994) Still it is most wise to includesocial skills training in conjunction with material addressing motivationand decision making Motivations regarding drug use need to beaddressed so behaviors learned are not misdirected

Resource Acquisition

Adults often assume that teens can access community services withlittle effort In fact few teens understand the availability of healthservices or other assistance Simple information including phonenumbers and locations can assist teens immensely (Carroll 1996Sussman et al 2002) Coaching teens on techniques for receivingassistance can prove productive Public assistance for drug use-relatedproblems and other life problems can help tremendously but negotiatingthe bureaucratic difficulties inherent in many of these systems can requireconsiderable skill (Eggert and Herting 1991 Sambrano May 1999Sussman et al 2002) Direct instruction modeling and structuredpractice in resource acquisition skills may help youth to increase theirknowledge and self-efficacy on how to acquire resources and to readilyaccess resources when needed (eg use of the bus system) These skillsmay generalize to comparable tasks later in life

Decision-Making

Prevention programs have employed several decision-making strate-gies For example the protocol from Project Reconnecting Youth(Project RY) is STEPS The acronym stands for Stop Think ofoptions Evaluate options Perform or take action on the chosen optionand then Self-praise for using steps for making healthy choices (Eggertand Herting 1991) The participants help set the agenda and take turns

1994 Sussman et al

ORDER REPRINTS

illustrating it on a flip chart This task helps share the leadership andfocuses the group work and time The lesson STEPS to Drug UseControl follows skills training sessions that cover understandingSTEPS as a decision-making model

Project Towards No Drug Abuse (TND)rsquos decision-making sessioninvolves four steps These steps are

1 Brainstorming (making a list of ideas without judging them)2 Weigh the pros and cons (the benefits and costs of each idea)3 Select the best option4 Follow through (try that option and reevaluate the decision)

(Sussman et al 2002)

These decision-making strategies are similar across different pro-grams except that they include some different emphases For exampleSTEPS includes a self-instruction to begin decision making and self-praise whereas the TND sequence includes more of an emphasis onfollowing through with the decision Generally each program requiresgenerating options evaluating them choosing the best and evaluatingthe outcome in an effort to make the next decision Teens tend to enjoypracticing decision making in bogus problem situations Youth soonlearn to engage in steps like these with considerable skill Training indecision making operates on variables that are intermediate in the causalprocess and thereby strengthen individual profiles of self-controlabilities so that they are more resilient in the face of proximal riskfactors for drug use such as life stresses and peer pressures

Modalities of Programming

Both school and nonschool prevention modalities have a rich andimportant history in substance abuse prevention research (Pentz 1994Pentz et al 2004) Schools provide a captive audience for educationalmaterial Youth spend 25 of their waking lives at school so thisenvironment has considerable potential Furthermore the school contextprovides a rich research history for building new studies and evaluatingtheir efficacy (Sussman et al 1995a) Community programs also offerconsiderable opportunity

Community programs often involve local leaders and organizations(eg coalitions community boards) (Goodman et al 1993 Kaftarianand Hansen 1994) that help mobilize numerous community unitsCommunity units include businesses media the family and governmental

Motivation Skills and Decision Making 1995

ORDER REPRINTS

agencies like the police or recreational departments as well as schoolsystems A network of community units working together to developpromote and implement educational programming could increase youthsrsquobonding to others across a wide variety of social contexts (Hawkins et al1992 Pentz 1994) Community units can provide numerous types ofspecific extra-classroom prevention opportunities (Pentz 1994)

Parent-or-family targeted prevention programs include offering earlychildhood education social support for parents managing crisesparenting skills training parent-child communication skills and resourceacquisition instruction or networking Mass media targeted programsinvolve programs or public service announcements with novel fastand unconventional messages (eg the American Legacy FoundationTRUTH campaign) use of the Internet and interactive CDs (eg videogames) Alternative means to involve youth include involvement in hikingclubs drug-free dances or other after-school events with prosocial adultmentors and with means to involve youth outside of school includingentry into different environments (ie outward bound) (Tobler 1986) Inaddition policy implementation and enforcement may contribute toother prevention programs (Pentz et al 1989) Indeed simultaneousprograms within and outside of schools over long periods might maintainthe positive effects that sometimes dissipate when school programsappear alone (Pentz 1994)

The Difference Between Targeted Prevention and Cessation

Targeted (secondary) prevention attempts to keep persons fromcrossing the invisible line where they funnel into a cycle of addiction andaccumulation of negative consequences Cessation programs (sometimesreferred to as tertiary prevention) take the stance that a behavior hasoccurred with definite and perhaps irreversible negative consequencesThe goal is to stop the behavior permit recovery from the damage learnhow to prevent relapse and learn how to live with permanent changes(eg neurotransmitter function drug use-related injury) It is not clearexactly where indicated prevention ends however and where cessationbegins For example an early version of the Project TND curriculum didnot achieve effects on cigarette smoking possibly because 46 of thesample already smoked cigarettes daily (while not engaging often in someother drug use) In a revised curriculum a smoking cessation componentwas added to the program and then an effect on cigarette smoking wasachieved Cessation material can appear with prevention material to

1996 Sussman et al

ORDER REPRINTS

maximize program effectiveness Careful program development can helpdetermine the best mix (Sussman et al 2002)

Summary of Evidence-based Targeted Drug Abuse Prevention

At present approximately 29 drug-use prevention programs havebeen evaluated favorably for their effects on drug use or other problembehavior (see Table 1) These 29 programs have been identified throughtwo sources Blueprints for Violence Prevention (Elliott 2003) and theSubstance Abuse and Mental Health Services Administrationrsquos(SAMSHA) science-based prevention programsrsquo guide (USDHHS2003) PsycINFO and MEDLINE searches of drug abuse preventionstudies since 1970 supplemented searches through these two guides (seeTable 1) Nine definitions of high-risk were used across these programsEleven programs focused on economic deprivation as the definition Sixprograms focused on delinquent behavior as the identifying characteristicto target Two programs each identified single-parent homes drug use orexposure to drug use family problems alternative high school attendanceor being at risk for dropout at a regular high school as the characteristicsto target subjects Finally one program each identified new immigrantstatus or residential facility placement as the defining characteristic ofbeing at high risk for drug use

Among these programs eight focused on preteens For example theEarly Risers program defined its high-risk youth as those 6ndash10 year-oldsthat suffered economic deprivation and exhibited aggressive or opposi-tional behavior Another five programs focused on a young teen agegroup For example Preventive Intervention defined its high-risk youthas those seventh to eighth graders who exhibited poor school andacademic discipline and reported family problems Another sevenprograms focused on an older teen age group For example ProjectTND defined its high-risk youth as those youth that attended alternativehigh schools Finally nine programs encompassed wide age ranges Forinstance Big Brothers Big Sisters of America defined its high-risk youthas 6ndash18 year-olds that lived in single-parent homes

Of these programs 10 involved multiple often flexible settings ofimplementation Another 13 programs focused on the school settingFour programs focused on the home setting Finally two programsfocused on a community agency setting In general these programsinvolved implementation by highly trained personnel Eighteen of theseprograms involved some motivation aspect generally motivationenhancement but sometimes including extrinsic reinforcement strategies

Motivation Skills and Decision Making 1997

ORDER REPRINTS

Twenty-six of these programs provided skills training Finally 18programs provided instruction in decision making Thus the MSDmodel tends to appear in a majority of these programs however all threecomponents were included together in only nine of these programs

Twenty of these programs involved at least one replication of theprogram and 14 involved three or more replications Further 14 of theseprograms were tested through use of experimental designs and nineinvolved use of only quasi-experimental designs Effects on drug use wereassessed and found in 22 of these programs For example theReconnecting Youth program was implemented to youth at risk fordropout This program involved 90 sessions within a comprehensive highschool class delivered generally over a semester with small studentgroups and a highly trained teacher Instruction included use of groupsupport and providing life skills training (norm setting self-esteem moodmanagement communication skills self-monitoring monitoring goalsschool bonding and social activities) with feedback to parents Programgoals were achieved through use of a quasi-experimental design showingeffects for school performance (18 improvement in grades) drug use(54 decrease in hard drug use) and suicide risk (32 decline inperceived stress) This programrsquos results have been replicated numeroustimes in numerous locations This program involved all three componentsof the MSD model except that motivation was provided through peergroup support not through provision motivation enhancement strate-gies These targeted programs present an optimistic picture for drug-useprevention that is focused on at-risk youth (see Table 1)

Not all targeted prevention programs have been found to beeffective One published program that failed to find positive effects wasProject PALS (Palinkas et al 1996) This project was developed for teengirls who were pregnant or at risk for pregnancy and drug use Theprogram consisted of school-based delivery of 16 sessions once a weekin a class The goal was to decrease drug use The PALS Skills TrainingProgram involved instruction in assertiveness providing and receivingfeedback social conversation handling requests and asking for help andmood management This program was tested against a normativeeducation program (called Facts of Life or FOL) which instructedvalues and decision making sexuality issues and contraception sexuallytransmitted diseases (STDs) drug use risks sexual assault prevalenceand norms material An experimental evaluation with a seven-monthspost-baseline was used The results indicated that the PALS programsubjects reported 29 times greater marijuana use than FOL amongbaseline nonusers No other differences were found It is possible that theprogram was not targeted to the right population that the mix of skills

1998 Sussman et al

ORDER REPRINTS

instructed was not appropriate or that skill training alone (withoutappropriate motivation material) may not be effective in drug useprevention Researchers should examine these possibilities and others tofurther understand program failures as well as program successes

Potential Limitations of Targeted Prevention

Dishion and colleagues (1995) suggest from various findings thatgrouping high-risk youth may lead to increased drug use This outcomecan result if youth come to learn deviant behavior from each other Theycan learn deviant behavior from each other in a program if they haveunstructured or unsupervised time together An essential feature ofseveral targeted programs (eg the RY and TND programs) is building apositive peer culture with group norms that decrease drug involvementand drug-use control problems The RYrsquos findings suggest that a positivepeer group component carefully fostered by a well-trained and competentRY group leader can direct the group toward lower risk behaviorSimilarly classroom management in Project TND involves developmentof positive norms of classroom behavior Further interaction betweenyouth is encouraged but is primarily teacher-directed and highlystructured (Sussman et al 2003) In both RY and Project TND theteacherrsquos role is to actively develop and maintain peer group support inthe class by modeling support positively reinforcing it among groupmembers and negatively reinforcing deviant peer bonds and activities(Eggert and Herting 1991 Vorrath and Brendtro 1985) The teachercreates and structures interactions among youth in prosocial directions(Sussman et al 2003)

Multiple Problem Behaviors of Adolescents

Acknowledging the relationship of drug use to other commonadolescent problems may facilitate identification of effective methods ofreducing drug use Researchers on tobacco alcohol and other drug useantisocial behavior high-risk sexual behavior and depression increas-ingly recognize that these problems are interrelated (McGee andNewcomb 1992) and stem to a large extent from the same environ-mental and biological factors (Biglan et al in press Eggert et al 1995Sussman and Ames 2001 Wills and Cleary 1995) Clearly it is necessaryto have strategies that address the entire range of problems and thecontext that influences those problems Indeed further reductions in

Motivation Skills and Decision Making 1999

ORDER REPRINTS

many problems require that we comprehensively target youth withmultiple problem behaviors

Biglan and colleagues (in press) provide a comprehensive review ofthe relationships among antisocial behavior tobacco alcohol and otherdrug use and high-risk sexual behavior It is clear that the same youngpeople are prone to the development of the entire range of problems In arecent review Moffitt and colleagues (2002) found that antisocialbehavior in early adolescence (rather than late adolescence) is a greaterrisk factor for developing multiple problems These findings point to theimportance of early intervention before youth develop serious problemsMoreover these different problems largely result from the same set ofenvironmental and biological factors

One implication is that disciplines dealing with these problemsother than drug abuse may contribute to dealing with the problem ofdrug use (Newcomb 1996b 1997) In particular research by dev-elopmental psychologists family social workers and sociologists onthe influence of parents on adolescent problem development and oninterventions to alter parenting practices contributes to our understandingof how to prevent or ameliorate drug abuse and other problems Onealso should note that nonsubstance use is not a guarantee for problemimmunity for the entire age range of people whatever their genderethnicity religiosity socioeconomic status (SEC) domicility etc It maybe argued that the most promising programs are those targeting thesemultiple levels of influence Several multidisciplinary programs haveachieved promising results We describe three of these empiricallyevaluated programs tested in various settings

Functional Family Therapy (FFT)FFT is an indicated intervention involving family treatment designed

for delinquent teenagers (also see Table 1) Developed in the early 1970sby Alexander and colleagues (1973) FFT focuses on family commu-nication and the establishment of rules and consequences Several studiesprovide encouraging reports of the programrsquos effectiveness (Alexander etal 1976 Barton et al 1985 Klein et al 1977 Waldron et al 2001) Inthe Waldron et al (2001) study researchers used FFT and anintervention with cognitive behavior therapy on teens referred formarijuana use Each of the interventions produced significant resultson marijuana use by the teens at four months but only the twointerventions combined maintained these results at seven months Theearlier studies found a greater number of results For example in the twoAlexander studies (1973 1976) improvement in family communicationposttreatment led to reduced delinquency Note that all the teens in these

2000 Sussman et al

ORDER REPRINTS

studies had histories of serious antisocial or delinquent behavior Thusachieving positive outcomes even if only short-term should encouragefurther research into the efficacy of FFT

Multisystemic Therapy (MST)As its name suggestsMST targets individual family peer school and

community influences of those youth offenders with serious problems thatmay include violence substance use and severe emotional problems (alsosee Table 1) Numerous researchers have published the results ofrandomized trials of MST (Henggeler et al 1996 1997 1998 Thorntonet al 2000) The most consistent findings across studies are decreased (1)drug use (2) re-arrest (3) self-reported criminal offense and (4) days inout-of-home placements Other consistent findings are improved familyrelations school attendance and psychiatric functioning One cautionarynote the programrsquos effectiveness lowers considerably if not implementedwith fidelity (Hengler et al 1997 1999) In other words all or key lessonsneed to be delivered as written by educators who are well-trained in usingthe strategies employed and youth need to be able to receive all material inan atmosphere conducive to learning the material The programdevelopers have instituted training strategies that address these fidelityissues thus shaping MST to be a very promising program for at-riskyouth

Multidimensional Treatment Foster Care (MTFC)MTFC targets family and peer factors influencing adolescents with a

pattern of repeat criminal offending (see Table 1) (Chamberlain 1994)This intervention includes placement of the youth into a foster homewith a foster parent trained in behavior management who receivessupport from intervention staff After the adolescent has begun torespond to the intervention in the foster home and after the parents havereceived the same training and support as the foster parents did theadolescent returns home Chamberlain and Reid (1998) tested theintervention with 85 boys with felony and other criminal histories andfound substantial benefits of the program Following treatment the boysassigned to MTFC (compared to those receiving community-based groupcare) showed fewer days in detention or lock-up twice as much timeliving with parents fewer misdemeanor and felony arrests and fewer self-reported index crimes felony arrests and general delinquency TheMTFC is a cost-effective alternative to incarceration however staffrequirements are extensive which may influence the ability of some

Motivation Skills and Decision Making 2001

ORDER REPRINTS

groups to apply the program with fidelity However as with each of theprograms described here the results of the randomized trials areencouraging

Future Research Needs in Targeted Prevention

Future research can help discern when and where targeted preventionprogramming will tend to work rather than produce potentiallydeleterious negative group effects or results that are irrelevant for pro-social healthy adaptation as well as what the critical necessary conditionsare for their effective operation within given de facto realities Comparedto the breadth of evaluated universal drug use prevention programs(Tobler et al 2000) relatively few targeted prevention programs havereceived empirical support Yet previous research suggests that universalschool-based drug use prevention programs implemented in junior highschool have relatively less chance of long-term success especially for thoseyouth that began using drugs before the prevention program wasimplemented Of course there are notable exceptions (eg effects lastedfor one and a half years effects lasted for six years) (Chou et al 1998Griffin et al 2003 Skara and Sussman 2003) Almost no research existsregarding maximization of booster programming with high-risk youthMore research on booster programs would help the field

While continuing to engage in this work there will be numerousissues to manage that go well beyond the scope of this article There willbe a need to avoid producing negative labeling effects while providingprogramming for those who are at risk for drug use It is possible thatcessation information needs to be included in the mix with preventionmaterial to provide better targeted-prevention effects There may be aneed to develop a teacher selection instrument to help select out teacherswho can deliver drug abuse prevention programming adequatelyCertainly definition of outcome variables needs continued explorationincluding analysis to ascertain the effects of programming on drug abusevs drug use and identification of the variables that are most closelylinked to change by targeted prevention components

A transdisciplinary approach helps to better understand the lifesituation of high-risk youth as based to some extent on both constitutionaland environmental factors (Fuqua et al 2004 Rutter et al 1997 Wills etal 1996b) From the transactional perspective their situation is in partconstitutional they may have temperamental characteristics that arepartly heritable and that have set the stage at earlier ages for decrements inself-control ability and academic performance that then increase risk for

2002 Sussman et al

ORDER REPRINTS

drug use However their situation is also part environmental based in parton family socialization and in part on the types of peers they have as well asthe type and quality of the physical and cultural environment-at-largeThere are many points at which a potential chain of failures can beinterrupted and the individualrsquos trajectory turned in a better directionProblems are not inevitable from starting level (Tarter and Vanyukov1994) and environmental modifications to support good self-controlability can help to avert an adverse impact from earlier experiences orcurrent difficulties (Brody et al 2002 Novak and Clayton 2001 Patock-Peckham et al 2001 Rutter et al 1997 Wills et al 2002)

The problems and needs of high-risk youth in our nationrsquos highschools demand our attention for designing and rigorously testingtargeted prevention approaches Substantial evidence shows that theseyouth are at greater risk for drug involvement and co-occurring problemssuch as aggression depression and suicidal behaviors as we previouslydiscussed It is hoped that the information presented in this article willstimulate others to join in extending this work including testing othermodels of targeted prevention

GLOSSARY

Universal programs Programs that aim to influence all subjects in acontext

Selective drug-abuse prevention programs Programs that servegroups at greater risk of ATOD usemdashfor example children of alcoholicparents They are at psychosocial risk for drug use and abuse

Indicated drug-abuse prevention programs Programs that attemptto benefit individuals who already show signs of drug involvement orrelated risk factors In indicated prevention programs the primary goal isto stem the progression of ATOD use or reduce drug involvementamong the high-risk youth

Targeted programming Programming that subsumes selective andindicated programming sometimes the other two types of programs thattarget specific groups lsquolsquoat riskrsquorsquo are considered together

ACKNOWLEDGMENTS

This research was supported by grants from the National Institute onDrug Abuse (DA01070 DA07601 DA13814 and DA16094) and by aResearch Scientist Development Award K02 DA00252 from theNational Institute on Drug Abuse

Motivation Skills and Decision Making 2003

ORDER REPRINTS

REFERENCES

Alexander J F Barton C Schiaro R S Parsons B V (1976)

Systems-behavioral intervention with families of delinquents

therapist characteristics family behavior and outcome Journal of

Consulting and Clinical Psychology 44(4)656ndash664Alexander J F Parsons B V (1973) Short-term behavioral interven-

tion with delinquent families impact on family process and

recidivism Journal of Abnormal Psychology 3219ndash225American psychiatric association (APA) (1994) Diagnostic and

Statistical Manual of Mental Disorders 4th edn (DSM-IV)

Washington DC American Psychiatric AssociationAmes S L Sussman S Dent C W (1999) Pro-drug-use myths and

competing constructs in the prediction of substance use among

youth at continuation high schools a one-year prospective study

Personality and Individual Differences 26987ndash1003Bachman S G Wadsworth K N OrsquoMalley P M Johnston L D

Schulenberg J E (1997) Smoking drinking and drug use in young

adulthood Mahwah NJ Lawrence Erlbaum Associates 8ndash25

153ndash190Bandura A (1986) Social Foundations of Thought and Action A Social

Cognitive Theory Englewood Cliffs NJ Prentice HallBarton C Alexander J F Waldron H Turner C W Warburton J

(1985) Generalizing treatment effects of functional family therapy

Three replications The American Journal of Family Therapy

13(3)16ndash26Battin-Pearson S R Newcomb M D Abbott R D Hill K G

Catalano R F Hawkins J D (2000) Predicting early high school

dropout Journal of Educational Psychology 92568ndash582Biglan A Brennan P A Foster S L Holder H D Miller T L

Cunningham P B et al (in press) Helping Adolescents at Risk

Prevention of Multiple Problem Behaviors New York NY Guilford

PressBindra D Stewart J (1996) Motivation Baltimore MD Penguin

BooksBlanton H Gibbons F X Gerrard M Conger K J Smith G E

(1998) The role of family and peers in the development of

prototypes associated with substance use Journal of Family

Psychology 11271ndash288

2004 Sussman et al

ORDER REPRINTS

Botvin G J (1993) School-based drug abuse prevention Long-termfollow-up results In First Annual Meeting of the Society forPrevention Research Kentuck Lexington Society for PreventionResearch

Botvin G J Baker E Dusenbury L Botvin E M Diaz T (1995)Long-term follow-up results of a randomized drug abuse preven-tion trial in a white middle-class population Journal of theAmerican Medical Association 2731106ndash1012

Brody G H Dorsey S Forehand R Armistead L (2002) Uniquecontributions of parenting and classroom processes to the self-control of AfricanndashAmerican children Child Development73274ndash286

Carroll M E (1996) Reducing drug abuse by enriching the environmentwith alternative nondrug reinforcers In Green L Kagel J Heds Advances in Behavioral Economics Norwood NJ NorwoodPublishing Corp 37ndash68

Carver C S Scheier M F (1998) On the Self-Regulation of BehaviorNew York Cambridge University Press

Catalano R F Hawkins J D (1996) The social developmental modela theory of antisocial behavior In Hawkins J D ed Delinquencyand Crime Current Theories New York Cambridge UniversityPress

Centers for Disease Control (CDC) (October 1999) Youth risk BehaviorSurveillancemdashNational Alternative High School Youth RiskBehavior Survey 1998 Morbidity and Mortality Weekly Report48 No SS-7

Chamberlain P (1994) Family connections A treatment foster caremodel for adolescents with delinquency Eugene OR CastaliaPublishing Company

Chamberlain P Reid J B (1998) Comparison of two communityalternatives to incarceration for chronic juvenile offenders Journalof Consulting and Clinical Psychology 66(4)624ndash633

Chassin L A Presson C C Sherman S J (1985) Stepping backwardin order to step forward an acquisition-oriented approach toprimary prevention Journal of Consulting and Clinical Psychology53612ndash622

Chou C-P Montgomery S Pentz M A Rohrbach L A JohnsonC A Flay B R MacKinnon D P (1998) Effects of acommunity-based prevention program on decreasing drug use inhigh-risk adolescentsAmerican Journal of Public Health 88944ndash948

Conducts Problems Prevention Research Group (CPPRG) (1999) Initialimpact of the fast track prevention trial for conduct problems I

Motivation Skills and Decision Making 2005

ORDER REPRINTS

The high-risk sample Journal of Consulting and Clinical Psychology

67631ndash647Conducts Problems Prevention Research Group (CPPRG) (2000)

Merging universal and indicated prevention programs the fast

track model Addictive Behaviors 25913ndash927Council of Philosophical Studies (1981) Psychology and the Philosophy

of Mind in the Philosophy Curriculum San Francisco San Francisco

State UniversityCummings K M Hellmann R Emont S L (1988) Correlates of

participation in a worksite stop smoking program Journal of

Behavioral Medicine 11267ndash277Curry S Wagner E H Gothaus L C (1990) Intrinsic and extrinsic

motivation for smoking cessation Journal of Consulting and

Clinical Psychology 58310ndash316Dent C W Sussman S McCuller W J Stacy A W (2001) Drug

abuse prevention among youth at comprehensive high schools

Preventive Medicine 32514ndash520Dewey J (1886) Psychology New York HarperDishion T J French D C Patterson G R (1995) The development

and ecology of antisocial behavior In Cicchetti D Cohen D

eds Manual of developmental psychopathology New York John

Wiley 421ndash471Eggert L L Herting J R (1991) Preventing teenage drug abuse

exploratory effects of network social support Youth and Society

22482ndash534 [Reprinted National Prevention Evaluation Research

CollectionRockville MD Aspen 1993]Eggert L L Herting J R Thompson E A Nicholas L J Dicker

B G (1994) Preventing adolescent drug abuse and high school

dropout through an intensive school-based social network devel-

opment program American Journal of Health Promotion

8202ndash214Eggert L L Thompson E A Herting J R Nicholas L J (1995)

Reducing suicide potential among high-risk youth tests of a school-

based prevention program Suicide amp Life-Threatening Behavior

25276ndash296Ellickson P L Bell R M (1990) Drug prevention in junior high a

multi-site longitudinal test Science 2471299ndash1305Elliott D S (Series ed) (2003) Blueprints for violence prevention

Boulder CO Institute of Behavioral Science Regents of the

University of Colorado wwwcoloradoeducspvblueprints

2006 Sussman et al

ORDER REPRINTS

Farrell A D Danish S J (1993) Peer drug associations and emotionalrestraint Causes or consequences of adolescent drug use Journal ofConsulting and Clinical Psychology 61327ndash334

Festinger L A (1957) A Theory of Cognitive Dissonance New YorkHarper amp Row

Fuqua J Stokols D Gress J Phillips K Harvey R (2004)Transdisciplinary collaboration as a basis for enhancing the scienceand prevention of substance use and abuse Substance Use ampMisuse

Giuliano J D (1994) A peer education program to promote the use ofconflict resolution skills among at-risk school-age males PublicHealth Reports 109158ndash169

Glynn K Levanthal H Hirschman R (1985) A cognitivedevelopmental approach to smoking prevention In Bell C SBattjes R eds Prevention research Deterring Drug Abuse AmongChildren and Adolescents Rockville MD NIDA ResearchMonograph 63

Glynn T J (1989) Essential elements of school-based smokingprevention programs Journal of School Health 59181ndash188

Goodman R M Burdine J N Meehan E McLeroy K R eds(1993) Community coalitions for health promotion Special issue ofHealth Education Research Theory and Practice 8309ndash453

Goodyear R D Newcomb M D Locke T F (2002) PregnantLatina teenagers psychosocial and developmental determinants ofhow they select and perceive the men who father their childrenJournal of Counseling Psychology 49187ndash201

Gordon R (1987) An operational classification of disease preventionIn Steinberg J A Silverman M M eds Preventing MentalDisorders Rockville MD DHHS 20ndash26

Graham J W Johnson C A Hansen W B Flay B R Gee M(1990) Drug use prevention programs gender and ethnicityevaluation of three seventh-grade project SMART cohortsPreventive Medicine 19305ndash313

Griffin K W Botvin G J Nichols T R Doyal M M (2003)Effectiveness of a universal drug abuse prevention approach foryouth at high risk for substance use initiation Preventive Medicine36(1)1ndash7

Hamilton S (August 20 2000) Views slowly changing on alternativeschools The Sacramento Bee 1ndash3

Hansen W B (1992) School-based substance abuse prevention a reviewof the state of the art in curriculum 1980ndash1990 Health EducationResearch 7403ndash430

Motivation Skills and Decision Making 2007

ORDER REPRINTS

Hansen W B Johnson C A Flay B R Graham J W Sobel J(1988) Affective and social influences approaches to the preventionof multiple substance abuse among seventh grade students resultsfrom project SMART Preventive Medicine 17135ndash154

Hansen W B Graham J W (1991) Preventing alcohol marijuanaand cigarette use among adolescents peer pressure and resistancetraining versus establishing conservative norms PreventiveMedicine 20414ndash430

Hawkins D H Catalano R F Miller J Y (1992) Risk andprotective factors for alcohol and other drug problems inadolescence and early adulthood Implications for substanceabuse prevention Psychological Bulletin 11254ndash105

Hawkins J D Catalano R F Kosterman R Abbott R Hill K G(1999) Preventing adolescent health-risk behaviors by strengthen-ing protection during childhood Archives of Pediatric amp AdolescentMedicine 153226ndash234

Heider F (1958) The Psychology of Interpersonal Relations New YorkWiley

Henggeler S W Pickrel S G Brondino M J Crouch J L (1996)Eliminating (almost) treatment dropout of substance abusing ordependent delinquents through home-based multisystemic therapyAmerican Journal of Psychiatry 153(3)427ndash428

Henggeler S W Melton G B Brondino M J Scherer D GHanley J H (1997) Multisystemic therapy with violent andchronic juvenile offenders and their families the role of treatmentfidelity in successful dissemination Journal of Consulting andClinical Psychology 65(5)821ndash833

Henggeler S W Schoenwald S K Borduin C M Rowland M DCunningham P B (1998) Multisystemic treatment of antisocialbehavior in children and adolescents New York The Guilford Press

Henggeler S W Pickrel S G Brondino M J (1999) Multisystemictreatment of substance-abusing and dependent delinquents out-comes treatment fidelity and transportability Mental HealthServices Residual 1(3)171ndash84

Johnson C A Pentz M A Weber M D Dwyer J H Baer NMacKinnon D P Hansen W B Flay B R (1990) Relativeeffectiveness of comprehensive community programming for drugabuse prevention with high-risk and low-risk adolescents Journalof Consulting and Clinical Psychology 58447ndash456

Kaftarian S J Hansen W B eds (1994) CSAP special issuecommunity partnership program Journal of Community Psychologypages 205

2008 Sussman et al

ORDER REPRINTS

Karoly P (1993) Mechanisms in self-regulation A systems view AnnualReview of Psychology 4423ndash51

Karoly P (1980) Person variables in therapeutic change and develop-ment In Karoly P Steffen J J eds Improving the Long-TermEffects of Psychotherapy New York Gardner Press 195ndash261

Kendall P C Braswell L (1982) Cognitive-behavioral self-controltherapy for children a components analysis Journal of Consultingand Clinical Psychology 50672ndash689

Kerr M Tremblay R E Pagani L Vitaro F (1997) Boysrsquobehavioral inhibition and the risk of later delinquency Archivesof General Psychiatry 54809ndash816

Klein N C Alexander J F Parsons B V (1977) Impact of familysystems intervention on recidivism and sibling delinquency a modelof primary prevention and program evaluation Journal ofConsulting and Clinical Psychology 45(3)469ndash474

Kumpfer K L (1999) Outcomes measures of interventions in the studyof children of substance-abusing parents Pediatrics 1031128ndash1144

Lau R R Hartman K A Ware J E (1986) Health as a valuemethodological and theoretical considerations Health Psychology525ndash43

Lichtenstein E L Glasgow R E (1997) A pragmatic framework forsmoking cessation implications for clinical and public healthprograms Psychology of Addictive Behaviors 11142ndash151

Locke T F Newcomb M D (in press) Childhood maltreatmentparent drug problems polydrug problems and parenting practicesa test of gender differences and four theoretical perspectivesJournal of Family Psychology

McCreary D R Newcomb M D Sadava S W (1999) The male rolealcohol use and alcohol problems a structural modeling examina-tion in adult women and men Journal of Counseling Psychology46109ndash124

McGee L Newcomb M D (1992) General deviance syndromeexpanded hierarchical evaluations at four ages from earlyadolescence to adulthood Journal of Consulting amp ClinicalPsychology 60766ndash776

Miller W R Brown J M (1991) Self-regulation as a conceptual basisfor the prevention of addictive behaviours In Heather N MillerW R Greeley J eds Self-control and the Addictive BehavioursSydney Australia Maxwell Macmillan 3ndash79

Miller W R Leckman A L Delaney H D Tinkcom M (1993)Long-term follow-up of behavioral self-control training forproblem drinkers Journal of Studies on Alcohol 53249ndash261

Motivation Skills and Decision Making 2009

ORDER REPRINTS

Miller W R Rollnick S (1991) Motivational InterviewingPreparing People to Change Addictive Behavior New YorkGuilford Press

Moffitt T E Caspi A Harrington H Milne B J (2002) Males onthe life-course-persistent and adolescence-limited antisocial path-ways follow-up at age 26 years Development and Psychopathology14(1)179ndash207

National Institute on Drug Abuse (NIDA) (1997) Drug abuseprevention What works NIH Publication 97-4110 DHHSNational Institutes of Health National Institute on Drug AbuseOffice of Science Policy and Communications Rockville MD

Newcomb M D (1992a) Substance abuse and control in the UnitedStates ethical and legal issues Social Science and Medicine35471ndash479

Newcomb M D (1992b) Understanding the multidimensional nature ofdrug use and abuse The role of consumption risk factors andprotective factors In Glantz M D Pickens R eds Vulnerabilityto Drug Abuse Washington DC American PsychologicalAssociation 255ndash298

Newcomb M D (1996a) Pseudomaturity among adolescents constructvalidation sex differences and associations in adulthood Journalof Drug Issues 26477ndash504

Newcomb M D (1996b) Adolescence Pathologizing a normal processThe Counseling Psychologist 24482ndash490

Newcomb M D (1997) Psychosocial predictors and consequences ofdrug use a developmental perspective within a prospective studyJournal of Addictive Diseases 1651ndash89

Newcomb M D Bentler P M (1988) Consequences of Adolescent DrugUse Impact on the Lives of Young Adults Beverly Hills CA Sage

Newcomb M D Bentler P M (1989) Substance use and abuse amongchildren and teenagers American Psychologist 44242ndash248

Newcomb M D Harlow L L (1986) Life events and substance useamong adolescents Mediating effects of perceived loss of controland meaninglessness in life Journal of Personality and SocialPsychology 51564ndash577

Newcomb M D Chou C-P Bentler P M Huba G J (1988)Cognitive motivations for drug use among adolescents longitudinaltests of gender differences and predictors of change in drug useJournal of Counseling Psychology 35426ndash438

Newcomb M D Abbott R D Catalano R F Hawkins J DBattin-Pearson S R Hill K (2002) Mediational and deviancetheories of late high school failure Process roles of structural

2010 Sussman et al

ORDER REPRINTS

strains academic competence and general versus specific problem

behaviors Journal of Counseling Psychology 49172ndash186Nezami E Sussman S Pentz M A (2003) Motivation in tobacco use

cessation research Substance Use amp Misuse 3825ndash5Novak S P Clayton R R (2001) The influence of school environment

and self-regulation on transitions between stages of cigarette

smoking Health Psychology 20196ndash207Offord D R (2000) Selection of levels of prevention Addictive

Behaviors 25833ndash842Palinkas L A Atkins C J Miller C Ferreira D (1996) Social skills

training for drug prevention in high-risk female adolescents

Preventive Medicine 25692ndash701Patock-Peckham J A Cheong J-W Balhorn M E Nagoshi C T

(2001) A model of parenting styles self-regulation perceived

drinking control and alcohol use and problems Alcoholism

Experimental and Clinical Research 251284ndash1292Pentz M A (1994) Directions for future research in drug abuse

prevention Preventive Medicine 23646ndash652Pentz M A Dwyer J H MacKinnon D Flay B R Hansen W B

Wang E Y I Johnson C A (1989) A multi-community trial for

primary prevention of adolescent drug abuse effects on drug use

prevalence JAMA 2623259ndash3266Pentz M A Mares D Schinke S Rohrbach L (in press) Political

science public policy and drug abuse prevention Substance Use amp

MisuseProchaska J O DiClemente C C (1982) Transtheoretical therapy

toward a more integrative model of change Psychotherapy Theory

Research and Practice 19275ndash288Pulkkinen L Pitkanen T (1994) A prospective study of the precursors

to problem drinking in young adulthood Journal of Studies on

Alcohol 55578ndash587Rathus S A Nevid J S (1977) Behavior Therapy Strategies for

Solving Problems in Living New York Doubleday and Company

IncResnicow K Botvin G (1993) School-based substance use prevention

programs why do effects decay Preventive Medicine 22484ndash490Rutter M Dunn J Plomin R Simonoff E Pickles A Maughan

B Ormel J Meyer J Eaves L (1997) Integrating nature and

nurture implications of person-environment interactions for

developmental psychopathology Development and Psychopathology

9335ndash364

Motivation Skills and Decision Making 2011

ORDER REPRINTS

Salomon G Stein Y Eisenberg S Klein L (1984) Adolescent

smokers and nonsmokers profiles and their changing structure

Preventive Medicine 13446ndash461Sambrano S (1999) National cross-site evaluation of high risk youth

programs In Interim findings Bulletin Washington DC CSAP

SAMSHA US DHHS May 1ndash16Schinke S P Gilchrist L D (1985) Preventing substance abuse with

children and adolescents Journal of Consulting and Clinical

Psychology 53596ndash602Skara S N Sussman S (2003) A review of 25 long-term adolescent

tobacco and other drug use prevention program evaluations

Preventive MedicineSmith C Lizotte A J Thornberry T P Krohn M D (1995)

Resilient youth identifying factors that prevent high-risk youth

from engaging in delinquency and drug use Delinquency and

Disrepute in the Life Course Greenwich CT John Hagan JAI

press 217ndash247Sommers P V (1972) The Biology of Behavior Australia Pty ltd

Sydney John Wiley amp SonsSt Pierre T L Kaltreider D L Mark M M Aikin K J (1992)

Drug prevention in a community setting a longitudinal study of the

relative effectiveness of a three-year primary prevention program in

boys and girls clubs across the nation American Journal of

Community Psychology 20673ndash706Stein J A Newcomb M D Bentler P M (1987) An eight year study

of multiple influences on drug use and drug use consequences

Journal of Personality and Social Psychology 531094ndash1105Sully J (1884) Outlines of Psychology New York D Appleton amp CoSussman S (1989) Two social influence perspectives of tobacco use

development and prevention Health Education Research Theory

and Practice 4213ndash223Sussman S (1991) Curriculum development in school-based prevention

research Health Education Research Theory and Practice

6339ndash351Sussman S (1996) Development of a school-based drug abuse

prevention curriculum for high risk youth Journal of

Psychoactive Drugs 28169ndash182Sussman S Ames S L (2001) The social psychology of drug abuse

Buckingham GB Open University PressSussman S Unger J (2004) A drug abuse theoretical integration a

transdisciplinary speculation Substance Use amp Misuse

2012 Sussman et al

ORDER REPRINTS

Sussman S Dent C W Burton D Stacy A W Flay B R (1995a)

Developing school-based tobacco use prevention and cessation

programs Thousand Oaks CA Sage Publications IncSussman S Dent C W Simon T R Stacy A W Galaif E R

Moss M A Craig S Johnson C A (1995b) Effectiveness of

social influence substance abuse prevention curricula in compre-

hensive and continuation high schools Drugs and Society 865ndash81Sussman S Dent C W Galaif E R (1997) The correlates of

substance abuse and dependence among adolescents at high risk

for drug abuse Journal of Substance Abuse 9241ndash255Sussman S Dent C W Stacy A W (1996) The relation of pro-drug

use myths with self-reported drug use among youth at continuation

high schools Journal of Applied Social Psychology 26214ndash267Sussman S Dent C W Stacy A Craig S (1998) One-year outcomes

of project towards no drug abuse Preventive Medicine 27632ndash642

(erratum 766)Sussman S Dent C W Stacy S (2002) Project towards no drug

abuse a review of the findings and future directions American

Journal of Health Behavior 26354ndash365Sussman S McCuller W J Dent C W (2003) The associations of

social self-control personality disorders and demographics with

drug use among high risk youth Addictive Behaviors 281159ndash1166Sussman S Rohrbach L Patel R Holiday K (2003) A look at an

interactive classroom-based drug abuse prevention program

Interactive contents and suggestions for research Journal of Drug

Education 33355ndash368Sussman S Sun P McCuller W J Dent C W (2003) Project

towards no drug abuse two year outcomes of a trial that compares

health educator delivery to self-instruction Preventive Medicine

37155ndash162Tarter R E Vanyukov M (1994) Alcoholism a developmental disorder

Journal of Consulting and Clinical Psychology 621096ndash1107Thornton T N Craft C A Dahlberg L L Lynch B S Baer K

(2000) Best Practices of Youth Violence Prevention A Sourcebook

for Community Action Atlanta GA Division of Violence

Prevention Centers for Disease Control and PreventionTobler N S (1986) Meta-analysis of 143 adolescent drug prevention

programs quantitative outcome of program participants compared to

a control or comparison group Journal of Drug Issues 16537ndash567Tobler N S Roona M R Ochshorn P Marshall D G Streke

A V Stackpole K M (2000) School-based adolescent drug

Motivation Skills and Decision Making 2013

ORDER REPRINTS

prevention programs 1998 Meta-analysis The Journal of Primary

Prevention 20275ndash336US Department of Health and Human Services (USDHHS) (2003)

Substance Abuse andMental Health Services Administration Center

for Substance Abuse Prevention Science-based prevention programs and

principles 2002 Rockville MD US DHHS (SMA)03-3764 Also

see httpmodelprogramssamhsagovUnger J Baezconde-Garbanati L Shakib S Palmer P H Nezami

E Mora J (2004) What are the implications of structuralcultural

theory for drug abuse prevention Substance Use amp MisuseUpshaw H S Ostrom T M (1984) Psychological perspective in

attitude research In Eiser J R ed Attitudinal Judgment New

York Springer-Verlag 23ndash42Valente T W Gallaher P Mouttapa M (2004) Using social network

theory to understand and prevent substance use a transdisciplinary

perspective Substance Use amp MisuseVorrath H Brendtro L (1985) Positive peer culture 2nd edn Aldine

ChicagoWaldron H B Slesnick N Brody J L Turner C W Peterson T R

(2001) Treatment outcomes for adolescent substance abuse at 4-

and 7-month assessments Journal of Consulting amp Clinical

Psychology 69(5)802ndash813Watson D L Tharp R G (2002) Self-directed behavior Self-

modification for personal adjustment 8th edn Belmont CA

WadsworthWeissberg R P Caplan M Z Sivo P J (1989) A new conceptual

framework for establishing school-based social competence promo-

tion programs In Bond L A Compas B E eds Primary

Prevention amp Promotion in the Schools Newbury Park CA Sage

255ndash296Wills T A (1986) Stress and coping in early adolescence relationships

to substance use in urban school samples Health Psychology

5503ndash529Wills T A Cleary S D (1995) Stress-coping model for alcohol-

tobacco interactions in adolescence In Fertig J B Allen J P

eds Alcohol and Tobacco From Basic Science to Clinical Practice

Bethesda MD National Institute on Alcohol Abuse and

Alcoholism 107ndash128Wills T A Cleary S D (1999) Peer and adolescent substance use

among 6thndash9th graders Latent growth analyses of influence versus

selection mechanisms Health Psychology 18453ndash463

2014 Sussman et al

ORDER REPRINTS

Wills T A Hirky A E (1996) Coping and substance abuse InZeidner M Endler N S eds Handbook of Coping TheoryResearch and Applications New York Wiley 279ndash302

Wills T A Stoolmiller M (2002) The role of self-control in earlyescalation of substance use a time-varying analysis Journal ofConsulting and Clinical Psychology 70986ndash997

Wills T A Baker E Botvin G J (1989) Dimensions of assertivenessdifferential relationships to substance use in early adolescenceJournal of Consulting and Clinical Psychology 57(4)473ndash478

Wills T A Vaccaro D McNamara G (1994) Novelty seeking risktaking and related constructs as predictors of adolescent substanceuse an application of Cloningerrsquos theory Journal of SubstanceAbuse 61ndash20

Wills T A McNamara G Vaccaro D Hirky A E (1996a)Escalated substance use a longitudinal grouping analysis fromearly to middle adolescence Journal of Abnormal Psychology105166ndash180

Wills T A Pierce J P Evans R I (1996b) Large-scale environmentalrisk factors for substance use American Behavioral Scientist39808ndash822

Wills T A Windle M Cleary S D (1998) Role of temperamentnovelty-seeking and self-control in adolescent substance useJournal of Personality and Social Psychology 74387ndash406

Wills T A Sandy J M Shinar O (1999) Substance use level andproblems in late adolescence a mediational model based on self-control and coping motives Experimental and ClinicalPsychopharmacology 7122ndash134

Wills T A Cleary S D Filer M Shinar O Mariani J Spera K(2001) Temperament and self-control related to early-onsetsubstance use test of a developmental model Prevention Science2145ndash163

Wills T A Sandy J M Yaeger A (2002) Moderators of therelationship between substance use level and problems test of aself-regulation model in adolescence Journal of AbnormalPsychology 1113ndash21

Wills T A Gibbons F X Gerrard M Murry V Brody G (in press-a) Family communication and religiosity related to substance useand sexual behavior in early adolescence Psychology of AddictiveBehaviors

Wills T A Resko J Ainette M Mendoza D (in press-b) The role ofparent and peer support in adolescent substance use a test ofmediated effects Psychology of Addictive Behaviors

Motivation Skills and Decision Making 2015

ORDER REPRINTS

Young P T (1936) Motivation of Behavior New York John Wiley andSons

Zimmerman B J (2000) Attaining self-regulation a social cognitivemodel In Boekaerts M Pintrich P R eds Handbook of Self-Regulation San Diego Academic Press 13ndash39

2016 Sussman et al

Request PermissionOrder Reprints

Reprints of this article can also be ordered at

httpwwwdekkercomservletproductDOI101081JA200034769

Request Permission or Order Reprints Instantly

Interested in copying and sharing this article In most cases US Copyright Law requires that you get permission from the articlersquos rightsholder before using copyrighted content

All information and materials found in this article including but not limited to text trademarks patents logos graphics and images (the Materials) are the copyrighted works and other forms of intellectual property of Marcel Dekker Inc or its licensors All rights not expressly granted are reserved

Get permission to lawfully reproduce and distribute the Materials or order reprints quickly and painlessly Simply click on the Request Permission Order Reprints link below and follow the instructions Visit the US Copyright Office for information on Fair Use limitations of US copyright law Please refer to The Association of American Publishersrsquo (AAP) website for guidelines on Fair Use in the Classroom

The Materials are for your personal use only and cannot be reformatted reposted resold or distributed by electronic means or otherwise without permission from Marcel Dekker Inc Marcel Dekker Inc grants you the limited right to display the Materials only on your personal computer or personal wireless device and to copy and download single copies of such Materials provided that any copyright trademark or other notice appearing on such Materials is also retained by displayed copied or downloaded as part of the Materials and is not removed or obscured and provided you do not edit modify alter or enhance the Materials Please refer to our Website User Agreement for more details

ORDER REPRINTS

prevention that addresses child abuse and neglect (see later discussion ofthis topic)

Attitudinal Perspectives

Most youth consider themselves as being moderates They can alsoreliably identify drug use as being a deviant immoderate behaviorPresenting them with the disparity between their self-view as a moderateperson despite their deviant drug use can produce a desired behaviorchange (Sussman 1989 Upshaw and Ostrom 1984) An attitudinalperspective lesson can confront students with the inconsistency betweentheir general self-attitude ratings as moderates vs their more extremespecific behaviors (eg drug use) Adopting a self-perception as amoderate may inoculate youth when social pressures to experiment withdrugs arise A desire for internal consistency a similarity betweenattitudes and behavior may increase motivation to abstain from drugs(Festinger 1957 Heider 1958) Youth received lessons like these quitefavorably in previous work (Salomon et al 1984)

Skills

Direct instruction modeling practice and group reinforcementenhance social learning At least three basic kinds of skills needinstruction self-control communication and resource acquisition

Social Self-control Skills

Good self-control protects against substance use and buffers againstthe impact of risk factors (Bandura 1986 Catalano and Hawkins 1996Weissberg et al 1989 Wills et al 1998) Poor self-control involvesbehavioral affective and cognitive deficits Poor behavioral self-controlis associated with a need to regulate and stabilize mood possiblypreceding uncontrolled behavior or stemming from the consequences ofuncontrolled behavior Poor self-control behavior along with difficultiesin mood stabilization increases risk for substance use and rapidescalation to high levels of use which then can lead to physiologicaldependence (Wills and Stoolmiller 2002)

Self-control strategies cross physiological and personality boundariesbecause self-control also relates to coping motives for substance use a

1992 Sussman et al

ORDER REPRINTS

strong predictor of substance use problems (Wills et al 1999) Self-control includes cognition because developing self-control is the substratefor personality organization including not only behavioral and affectivecontrol but also attitudes values and views of the world as accepting orhostile and social perceptions about substance use as being attractive vsunattractive For example studies find poor self-control correlated withattitudinal tolerance for deviance and more favorable perceptions oftobacco and alcohol users whereas good self-control is related tofavorable perceptions of teens that abstain from drug use (Wills et alin press-a) Self-control approaches can be useful for preventionprograms by improving self and other perceptions academic perfor-mance and the impact or facilitation of negative life events goals that aresalient to teenagers and their parents (Wills and Stoolmiller 2002)

Youth often lack adequate coping skills they tend to lack restraint orplanfulness (Farrell and Danish 1993 Rutter et al 1997) Coping skillsinstruction may help increase self-control (Kendall and Braswell 1982)Coping skills instruction receives little attention in typical social influencesprogramming (Hansen 1992) although this material appears in life skillstraining (Botvin 1993 Botvin et al 1995 Wills 1986) In self-controlprogramming youth learn to assess their self-control particularly in socialcontexts (Sussman et al 2003) They learn the importance of thinkingahead and anticipating problem situations so that they are preparedbeforehand to deal with problems that may arise They also learn theimportance of context (eg not laughing at a funeral) Finally they learnassertiveness and anger management to help them better control theirreactions in social settings (Sambrano May 1999 Sussman et al 2002)

Listening and Communication Skills

Youth genuinely benefit from listening to information with an openmind and asking open-ended questions to keep a conversation goingThey can improve social skills by learning how to ask open-endedquestions establish eye contact appropriately nodding and orientingtheir body toward the other speaker (CPPRG 1999 Eggert and Herting1991 Hawkins et al 1999 Sussman et al 2002 2003) Neverthelesssocial skills training can create problems for nondrug using high-riskteens (Palinkas et al 1996 Sussman et al 1995b Wills et al in press-b)Training in drug refusal may create reactance in some samples (Sussmanet al 1996) Among high-risk youth enhancing assertiveness and datingskills may increase the scope of social entertainment options andinadvertently improve a teenrsquos ability to acquire drugs from new sources

Motivation Skills and Decision Making 1993

ORDER REPRINTS

(Wills et al 1989) Also there are cultural variations on what constitutesgood social skill (Unger et al 2004) There are good arguments forplacing high-risk teens together in activities with well-controlled teens sothat they can model adaptive social skills and problem solvingAdditionally utilizing motivation methods prior to instructing thespecific skill channels canalizes health-directed use of social skillsmastered Overall increasing social competence will have protectiveeffects for high-risk teens (Wills et al 1994) This idea is consistent withthe studies that have shown social withdrawal to increase risk for druguse (Kerr et al 1997) though there may be gender differences in theseeffects (Pulkkinen and Pitkanen 1994) Still it is most wise to includesocial skills training in conjunction with material addressing motivationand decision making Motivations regarding drug use need to beaddressed so behaviors learned are not misdirected

Resource Acquisition

Adults often assume that teens can access community services withlittle effort In fact few teens understand the availability of healthservices or other assistance Simple information including phonenumbers and locations can assist teens immensely (Carroll 1996Sussman et al 2002) Coaching teens on techniques for receivingassistance can prove productive Public assistance for drug use-relatedproblems and other life problems can help tremendously but negotiatingthe bureaucratic difficulties inherent in many of these systems can requireconsiderable skill (Eggert and Herting 1991 Sambrano May 1999Sussman et al 2002) Direct instruction modeling and structuredpractice in resource acquisition skills may help youth to increase theirknowledge and self-efficacy on how to acquire resources and to readilyaccess resources when needed (eg use of the bus system) These skillsmay generalize to comparable tasks later in life

Decision-Making

Prevention programs have employed several decision-making strate-gies For example the protocol from Project Reconnecting Youth(Project RY) is STEPS The acronym stands for Stop Think ofoptions Evaluate options Perform or take action on the chosen optionand then Self-praise for using steps for making healthy choices (Eggertand Herting 1991) The participants help set the agenda and take turns

1994 Sussman et al

ORDER REPRINTS

illustrating it on a flip chart This task helps share the leadership andfocuses the group work and time The lesson STEPS to Drug UseControl follows skills training sessions that cover understandingSTEPS as a decision-making model

Project Towards No Drug Abuse (TND)rsquos decision-making sessioninvolves four steps These steps are

1 Brainstorming (making a list of ideas without judging them)2 Weigh the pros and cons (the benefits and costs of each idea)3 Select the best option4 Follow through (try that option and reevaluate the decision)

(Sussman et al 2002)

These decision-making strategies are similar across different pro-grams except that they include some different emphases For exampleSTEPS includes a self-instruction to begin decision making and self-praise whereas the TND sequence includes more of an emphasis onfollowing through with the decision Generally each program requiresgenerating options evaluating them choosing the best and evaluatingthe outcome in an effort to make the next decision Teens tend to enjoypracticing decision making in bogus problem situations Youth soonlearn to engage in steps like these with considerable skill Training indecision making operates on variables that are intermediate in the causalprocess and thereby strengthen individual profiles of self-controlabilities so that they are more resilient in the face of proximal riskfactors for drug use such as life stresses and peer pressures

Modalities of Programming

Both school and nonschool prevention modalities have a rich andimportant history in substance abuse prevention research (Pentz 1994Pentz et al 2004) Schools provide a captive audience for educationalmaterial Youth spend 25 of their waking lives at school so thisenvironment has considerable potential Furthermore the school contextprovides a rich research history for building new studies and evaluatingtheir efficacy (Sussman et al 1995a) Community programs also offerconsiderable opportunity

Community programs often involve local leaders and organizations(eg coalitions community boards) (Goodman et al 1993 Kaftarianand Hansen 1994) that help mobilize numerous community unitsCommunity units include businesses media the family and governmental

Motivation Skills and Decision Making 1995

ORDER REPRINTS

agencies like the police or recreational departments as well as schoolsystems A network of community units working together to developpromote and implement educational programming could increase youthsrsquobonding to others across a wide variety of social contexts (Hawkins et al1992 Pentz 1994) Community units can provide numerous types ofspecific extra-classroom prevention opportunities (Pentz 1994)

Parent-or-family targeted prevention programs include offering earlychildhood education social support for parents managing crisesparenting skills training parent-child communication skills and resourceacquisition instruction or networking Mass media targeted programsinvolve programs or public service announcements with novel fastand unconventional messages (eg the American Legacy FoundationTRUTH campaign) use of the Internet and interactive CDs (eg videogames) Alternative means to involve youth include involvement in hikingclubs drug-free dances or other after-school events with prosocial adultmentors and with means to involve youth outside of school includingentry into different environments (ie outward bound) (Tobler 1986) Inaddition policy implementation and enforcement may contribute toother prevention programs (Pentz et al 1989) Indeed simultaneousprograms within and outside of schools over long periods might maintainthe positive effects that sometimes dissipate when school programsappear alone (Pentz 1994)

The Difference Between Targeted Prevention and Cessation

Targeted (secondary) prevention attempts to keep persons fromcrossing the invisible line where they funnel into a cycle of addiction andaccumulation of negative consequences Cessation programs (sometimesreferred to as tertiary prevention) take the stance that a behavior hasoccurred with definite and perhaps irreversible negative consequencesThe goal is to stop the behavior permit recovery from the damage learnhow to prevent relapse and learn how to live with permanent changes(eg neurotransmitter function drug use-related injury) It is not clearexactly where indicated prevention ends however and where cessationbegins For example an early version of the Project TND curriculum didnot achieve effects on cigarette smoking possibly because 46 of thesample already smoked cigarettes daily (while not engaging often in someother drug use) In a revised curriculum a smoking cessation componentwas added to the program and then an effect on cigarette smoking wasachieved Cessation material can appear with prevention material to

1996 Sussman et al

ORDER REPRINTS

maximize program effectiveness Careful program development can helpdetermine the best mix (Sussman et al 2002)

Summary of Evidence-based Targeted Drug Abuse Prevention

At present approximately 29 drug-use prevention programs havebeen evaluated favorably for their effects on drug use or other problembehavior (see Table 1) These 29 programs have been identified throughtwo sources Blueprints for Violence Prevention (Elliott 2003) and theSubstance Abuse and Mental Health Services Administrationrsquos(SAMSHA) science-based prevention programsrsquo guide (USDHHS2003) PsycINFO and MEDLINE searches of drug abuse preventionstudies since 1970 supplemented searches through these two guides (seeTable 1) Nine definitions of high-risk were used across these programsEleven programs focused on economic deprivation as the definition Sixprograms focused on delinquent behavior as the identifying characteristicto target Two programs each identified single-parent homes drug use orexposure to drug use family problems alternative high school attendanceor being at risk for dropout at a regular high school as the characteristicsto target subjects Finally one program each identified new immigrantstatus or residential facility placement as the defining characteristic ofbeing at high risk for drug use

Among these programs eight focused on preteens For example theEarly Risers program defined its high-risk youth as those 6ndash10 year-oldsthat suffered economic deprivation and exhibited aggressive or opposi-tional behavior Another five programs focused on a young teen agegroup For example Preventive Intervention defined its high-risk youthas those seventh to eighth graders who exhibited poor school andacademic discipline and reported family problems Another sevenprograms focused on an older teen age group For example ProjectTND defined its high-risk youth as those youth that attended alternativehigh schools Finally nine programs encompassed wide age ranges Forinstance Big Brothers Big Sisters of America defined its high-risk youthas 6ndash18 year-olds that lived in single-parent homes

Of these programs 10 involved multiple often flexible settings ofimplementation Another 13 programs focused on the school settingFour programs focused on the home setting Finally two programsfocused on a community agency setting In general these programsinvolved implementation by highly trained personnel Eighteen of theseprograms involved some motivation aspect generally motivationenhancement but sometimes including extrinsic reinforcement strategies

Motivation Skills and Decision Making 1997

ORDER REPRINTS

Twenty-six of these programs provided skills training Finally 18programs provided instruction in decision making Thus the MSDmodel tends to appear in a majority of these programs however all threecomponents were included together in only nine of these programs

Twenty of these programs involved at least one replication of theprogram and 14 involved three or more replications Further 14 of theseprograms were tested through use of experimental designs and nineinvolved use of only quasi-experimental designs Effects on drug use wereassessed and found in 22 of these programs For example theReconnecting Youth program was implemented to youth at risk fordropout This program involved 90 sessions within a comprehensive highschool class delivered generally over a semester with small studentgroups and a highly trained teacher Instruction included use of groupsupport and providing life skills training (norm setting self-esteem moodmanagement communication skills self-monitoring monitoring goalsschool bonding and social activities) with feedback to parents Programgoals were achieved through use of a quasi-experimental design showingeffects for school performance (18 improvement in grades) drug use(54 decrease in hard drug use) and suicide risk (32 decline inperceived stress) This programrsquos results have been replicated numeroustimes in numerous locations This program involved all three componentsof the MSD model except that motivation was provided through peergroup support not through provision motivation enhancement strate-gies These targeted programs present an optimistic picture for drug-useprevention that is focused on at-risk youth (see Table 1)

Not all targeted prevention programs have been found to beeffective One published program that failed to find positive effects wasProject PALS (Palinkas et al 1996) This project was developed for teengirls who were pregnant or at risk for pregnancy and drug use Theprogram consisted of school-based delivery of 16 sessions once a weekin a class The goal was to decrease drug use The PALS Skills TrainingProgram involved instruction in assertiveness providing and receivingfeedback social conversation handling requests and asking for help andmood management This program was tested against a normativeeducation program (called Facts of Life or FOL) which instructedvalues and decision making sexuality issues and contraception sexuallytransmitted diseases (STDs) drug use risks sexual assault prevalenceand norms material An experimental evaluation with a seven-monthspost-baseline was used The results indicated that the PALS programsubjects reported 29 times greater marijuana use than FOL amongbaseline nonusers No other differences were found It is possible that theprogram was not targeted to the right population that the mix of skills

1998 Sussman et al

ORDER REPRINTS

instructed was not appropriate or that skill training alone (withoutappropriate motivation material) may not be effective in drug useprevention Researchers should examine these possibilities and others tofurther understand program failures as well as program successes

Potential Limitations of Targeted Prevention

Dishion and colleagues (1995) suggest from various findings thatgrouping high-risk youth may lead to increased drug use This outcomecan result if youth come to learn deviant behavior from each other Theycan learn deviant behavior from each other in a program if they haveunstructured or unsupervised time together An essential feature ofseveral targeted programs (eg the RY and TND programs) is building apositive peer culture with group norms that decrease drug involvementand drug-use control problems The RYrsquos findings suggest that a positivepeer group component carefully fostered by a well-trained and competentRY group leader can direct the group toward lower risk behaviorSimilarly classroom management in Project TND involves developmentof positive norms of classroom behavior Further interaction betweenyouth is encouraged but is primarily teacher-directed and highlystructured (Sussman et al 2003) In both RY and Project TND theteacherrsquos role is to actively develop and maintain peer group support inthe class by modeling support positively reinforcing it among groupmembers and negatively reinforcing deviant peer bonds and activities(Eggert and Herting 1991 Vorrath and Brendtro 1985) The teachercreates and structures interactions among youth in prosocial directions(Sussman et al 2003)

Multiple Problem Behaviors of Adolescents

Acknowledging the relationship of drug use to other commonadolescent problems may facilitate identification of effective methods ofreducing drug use Researchers on tobacco alcohol and other drug useantisocial behavior high-risk sexual behavior and depression increas-ingly recognize that these problems are interrelated (McGee andNewcomb 1992) and stem to a large extent from the same environ-mental and biological factors (Biglan et al in press Eggert et al 1995Sussman and Ames 2001 Wills and Cleary 1995) Clearly it is necessaryto have strategies that address the entire range of problems and thecontext that influences those problems Indeed further reductions in

Motivation Skills and Decision Making 1999

ORDER REPRINTS

many problems require that we comprehensively target youth withmultiple problem behaviors

Biglan and colleagues (in press) provide a comprehensive review ofthe relationships among antisocial behavior tobacco alcohol and otherdrug use and high-risk sexual behavior It is clear that the same youngpeople are prone to the development of the entire range of problems In arecent review Moffitt and colleagues (2002) found that antisocialbehavior in early adolescence (rather than late adolescence) is a greaterrisk factor for developing multiple problems These findings point to theimportance of early intervention before youth develop serious problemsMoreover these different problems largely result from the same set ofenvironmental and biological factors

One implication is that disciplines dealing with these problemsother than drug abuse may contribute to dealing with the problem ofdrug use (Newcomb 1996b 1997) In particular research by dev-elopmental psychologists family social workers and sociologists onthe influence of parents on adolescent problem development and oninterventions to alter parenting practices contributes to our understandingof how to prevent or ameliorate drug abuse and other problems Onealso should note that nonsubstance use is not a guarantee for problemimmunity for the entire age range of people whatever their genderethnicity religiosity socioeconomic status (SEC) domicility etc It maybe argued that the most promising programs are those targeting thesemultiple levels of influence Several multidisciplinary programs haveachieved promising results We describe three of these empiricallyevaluated programs tested in various settings

Functional Family Therapy (FFT)FFT is an indicated intervention involving family treatment designed

for delinquent teenagers (also see Table 1) Developed in the early 1970sby Alexander and colleagues (1973) FFT focuses on family commu-nication and the establishment of rules and consequences Several studiesprovide encouraging reports of the programrsquos effectiveness (Alexander etal 1976 Barton et al 1985 Klein et al 1977 Waldron et al 2001) Inthe Waldron et al (2001) study researchers used FFT and anintervention with cognitive behavior therapy on teens referred formarijuana use Each of the interventions produced significant resultson marijuana use by the teens at four months but only the twointerventions combined maintained these results at seven months Theearlier studies found a greater number of results For example in the twoAlexander studies (1973 1976) improvement in family communicationposttreatment led to reduced delinquency Note that all the teens in these

2000 Sussman et al

ORDER REPRINTS

studies had histories of serious antisocial or delinquent behavior Thusachieving positive outcomes even if only short-term should encouragefurther research into the efficacy of FFT

Multisystemic Therapy (MST)As its name suggestsMST targets individual family peer school and

community influences of those youth offenders with serious problems thatmay include violence substance use and severe emotional problems (alsosee Table 1) Numerous researchers have published the results ofrandomized trials of MST (Henggeler et al 1996 1997 1998 Thorntonet al 2000) The most consistent findings across studies are decreased (1)drug use (2) re-arrest (3) self-reported criminal offense and (4) days inout-of-home placements Other consistent findings are improved familyrelations school attendance and psychiatric functioning One cautionarynote the programrsquos effectiveness lowers considerably if not implementedwith fidelity (Hengler et al 1997 1999) In other words all or key lessonsneed to be delivered as written by educators who are well-trained in usingthe strategies employed and youth need to be able to receive all material inan atmosphere conducive to learning the material The programdevelopers have instituted training strategies that address these fidelityissues thus shaping MST to be a very promising program for at-riskyouth

Multidimensional Treatment Foster Care (MTFC)MTFC targets family and peer factors influencing adolescents with a

pattern of repeat criminal offending (see Table 1) (Chamberlain 1994)This intervention includes placement of the youth into a foster homewith a foster parent trained in behavior management who receivessupport from intervention staff After the adolescent has begun torespond to the intervention in the foster home and after the parents havereceived the same training and support as the foster parents did theadolescent returns home Chamberlain and Reid (1998) tested theintervention with 85 boys with felony and other criminal histories andfound substantial benefits of the program Following treatment the boysassigned to MTFC (compared to those receiving community-based groupcare) showed fewer days in detention or lock-up twice as much timeliving with parents fewer misdemeanor and felony arrests and fewer self-reported index crimes felony arrests and general delinquency TheMTFC is a cost-effective alternative to incarceration however staffrequirements are extensive which may influence the ability of some

Motivation Skills and Decision Making 2001

ORDER REPRINTS

groups to apply the program with fidelity However as with each of theprograms described here the results of the randomized trials areencouraging

Future Research Needs in Targeted Prevention

Future research can help discern when and where targeted preventionprogramming will tend to work rather than produce potentiallydeleterious negative group effects or results that are irrelevant for pro-social healthy adaptation as well as what the critical necessary conditionsare for their effective operation within given de facto realities Comparedto the breadth of evaluated universal drug use prevention programs(Tobler et al 2000) relatively few targeted prevention programs havereceived empirical support Yet previous research suggests that universalschool-based drug use prevention programs implemented in junior highschool have relatively less chance of long-term success especially for thoseyouth that began using drugs before the prevention program wasimplemented Of course there are notable exceptions (eg effects lastedfor one and a half years effects lasted for six years) (Chou et al 1998Griffin et al 2003 Skara and Sussman 2003) Almost no research existsregarding maximization of booster programming with high-risk youthMore research on booster programs would help the field

While continuing to engage in this work there will be numerousissues to manage that go well beyond the scope of this article There willbe a need to avoid producing negative labeling effects while providingprogramming for those who are at risk for drug use It is possible thatcessation information needs to be included in the mix with preventionmaterial to provide better targeted-prevention effects There may be aneed to develop a teacher selection instrument to help select out teacherswho can deliver drug abuse prevention programming adequatelyCertainly definition of outcome variables needs continued explorationincluding analysis to ascertain the effects of programming on drug abusevs drug use and identification of the variables that are most closelylinked to change by targeted prevention components

A transdisciplinary approach helps to better understand the lifesituation of high-risk youth as based to some extent on both constitutionaland environmental factors (Fuqua et al 2004 Rutter et al 1997 Wills etal 1996b) From the transactional perspective their situation is in partconstitutional they may have temperamental characteristics that arepartly heritable and that have set the stage at earlier ages for decrements inself-control ability and academic performance that then increase risk for

2002 Sussman et al

ORDER REPRINTS

drug use However their situation is also part environmental based in parton family socialization and in part on the types of peers they have as well asthe type and quality of the physical and cultural environment-at-largeThere are many points at which a potential chain of failures can beinterrupted and the individualrsquos trajectory turned in a better directionProblems are not inevitable from starting level (Tarter and Vanyukov1994) and environmental modifications to support good self-controlability can help to avert an adverse impact from earlier experiences orcurrent difficulties (Brody et al 2002 Novak and Clayton 2001 Patock-Peckham et al 2001 Rutter et al 1997 Wills et al 2002)

The problems and needs of high-risk youth in our nationrsquos highschools demand our attention for designing and rigorously testingtargeted prevention approaches Substantial evidence shows that theseyouth are at greater risk for drug involvement and co-occurring problemssuch as aggression depression and suicidal behaviors as we previouslydiscussed It is hoped that the information presented in this article willstimulate others to join in extending this work including testing othermodels of targeted prevention

GLOSSARY

Universal programs Programs that aim to influence all subjects in acontext

Selective drug-abuse prevention programs Programs that servegroups at greater risk of ATOD usemdashfor example children of alcoholicparents They are at psychosocial risk for drug use and abuse

Indicated drug-abuse prevention programs Programs that attemptto benefit individuals who already show signs of drug involvement orrelated risk factors In indicated prevention programs the primary goal isto stem the progression of ATOD use or reduce drug involvementamong the high-risk youth

Targeted programming Programming that subsumes selective andindicated programming sometimes the other two types of programs thattarget specific groups lsquolsquoat riskrsquorsquo are considered together

ACKNOWLEDGMENTS

This research was supported by grants from the National Institute onDrug Abuse (DA01070 DA07601 DA13814 and DA16094) and by aResearch Scientist Development Award K02 DA00252 from theNational Institute on Drug Abuse

Motivation Skills and Decision Making 2003

ORDER REPRINTS

REFERENCES

Alexander J F Barton C Schiaro R S Parsons B V (1976)

Systems-behavioral intervention with families of delinquents

therapist characteristics family behavior and outcome Journal of

Consulting and Clinical Psychology 44(4)656ndash664Alexander J F Parsons B V (1973) Short-term behavioral interven-

tion with delinquent families impact on family process and

recidivism Journal of Abnormal Psychology 3219ndash225American psychiatric association (APA) (1994) Diagnostic and

Statistical Manual of Mental Disorders 4th edn (DSM-IV)

Washington DC American Psychiatric AssociationAmes S L Sussman S Dent C W (1999) Pro-drug-use myths and

competing constructs in the prediction of substance use among

youth at continuation high schools a one-year prospective study

Personality and Individual Differences 26987ndash1003Bachman S G Wadsworth K N OrsquoMalley P M Johnston L D

Schulenberg J E (1997) Smoking drinking and drug use in young

adulthood Mahwah NJ Lawrence Erlbaum Associates 8ndash25

153ndash190Bandura A (1986) Social Foundations of Thought and Action A Social

Cognitive Theory Englewood Cliffs NJ Prentice HallBarton C Alexander J F Waldron H Turner C W Warburton J

(1985) Generalizing treatment effects of functional family therapy

Three replications The American Journal of Family Therapy

13(3)16ndash26Battin-Pearson S R Newcomb M D Abbott R D Hill K G

Catalano R F Hawkins J D (2000) Predicting early high school

dropout Journal of Educational Psychology 92568ndash582Biglan A Brennan P A Foster S L Holder H D Miller T L

Cunningham P B et al (in press) Helping Adolescents at Risk

Prevention of Multiple Problem Behaviors New York NY Guilford

PressBindra D Stewart J (1996) Motivation Baltimore MD Penguin

BooksBlanton H Gibbons F X Gerrard M Conger K J Smith G E

(1998) The role of family and peers in the development of

prototypes associated with substance use Journal of Family

Psychology 11271ndash288

2004 Sussman et al

ORDER REPRINTS

Botvin G J (1993) School-based drug abuse prevention Long-termfollow-up results In First Annual Meeting of the Society forPrevention Research Kentuck Lexington Society for PreventionResearch

Botvin G J Baker E Dusenbury L Botvin E M Diaz T (1995)Long-term follow-up results of a randomized drug abuse preven-tion trial in a white middle-class population Journal of theAmerican Medical Association 2731106ndash1012

Brody G H Dorsey S Forehand R Armistead L (2002) Uniquecontributions of parenting and classroom processes to the self-control of AfricanndashAmerican children Child Development73274ndash286

Carroll M E (1996) Reducing drug abuse by enriching the environmentwith alternative nondrug reinforcers In Green L Kagel J Heds Advances in Behavioral Economics Norwood NJ NorwoodPublishing Corp 37ndash68

Carver C S Scheier M F (1998) On the Self-Regulation of BehaviorNew York Cambridge University Press

Catalano R F Hawkins J D (1996) The social developmental modela theory of antisocial behavior In Hawkins J D ed Delinquencyand Crime Current Theories New York Cambridge UniversityPress

Centers for Disease Control (CDC) (October 1999) Youth risk BehaviorSurveillancemdashNational Alternative High School Youth RiskBehavior Survey 1998 Morbidity and Mortality Weekly Report48 No SS-7

Chamberlain P (1994) Family connections A treatment foster caremodel for adolescents with delinquency Eugene OR CastaliaPublishing Company

Chamberlain P Reid J B (1998) Comparison of two communityalternatives to incarceration for chronic juvenile offenders Journalof Consulting and Clinical Psychology 66(4)624ndash633

Chassin L A Presson C C Sherman S J (1985) Stepping backwardin order to step forward an acquisition-oriented approach toprimary prevention Journal of Consulting and Clinical Psychology53612ndash622

Chou C-P Montgomery S Pentz M A Rohrbach L A JohnsonC A Flay B R MacKinnon D P (1998) Effects of acommunity-based prevention program on decreasing drug use inhigh-risk adolescentsAmerican Journal of Public Health 88944ndash948

Conducts Problems Prevention Research Group (CPPRG) (1999) Initialimpact of the fast track prevention trial for conduct problems I

Motivation Skills and Decision Making 2005

ORDER REPRINTS

The high-risk sample Journal of Consulting and Clinical Psychology

67631ndash647Conducts Problems Prevention Research Group (CPPRG) (2000)

Merging universal and indicated prevention programs the fast

track model Addictive Behaviors 25913ndash927Council of Philosophical Studies (1981) Psychology and the Philosophy

of Mind in the Philosophy Curriculum San Francisco San Francisco

State UniversityCummings K M Hellmann R Emont S L (1988) Correlates of

participation in a worksite stop smoking program Journal of

Behavioral Medicine 11267ndash277Curry S Wagner E H Gothaus L C (1990) Intrinsic and extrinsic

motivation for smoking cessation Journal of Consulting and

Clinical Psychology 58310ndash316Dent C W Sussman S McCuller W J Stacy A W (2001) Drug

abuse prevention among youth at comprehensive high schools

Preventive Medicine 32514ndash520Dewey J (1886) Psychology New York HarperDishion T J French D C Patterson G R (1995) The development

and ecology of antisocial behavior In Cicchetti D Cohen D

eds Manual of developmental psychopathology New York John

Wiley 421ndash471Eggert L L Herting J R (1991) Preventing teenage drug abuse

exploratory effects of network social support Youth and Society

22482ndash534 [Reprinted National Prevention Evaluation Research

CollectionRockville MD Aspen 1993]Eggert L L Herting J R Thompson E A Nicholas L J Dicker

B G (1994) Preventing adolescent drug abuse and high school

dropout through an intensive school-based social network devel-

opment program American Journal of Health Promotion

8202ndash214Eggert L L Thompson E A Herting J R Nicholas L J (1995)

Reducing suicide potential among high-risk youth tests of a school-

based prevention program Suicide amp Life-Threatening Behavior

25276ndash296Ellickson P L Bell R M (1990) Drug prevention in junior high a

multi-site longitudinal test Science 2471299ndash1305Elliott D S (Series ed) (2003) Blueprints for violence prevention

Boulder CO Institute of Behavioral Science Regents of the

University of Colorado wwwcoloradoeducspvblueprints

2006 Sussman et al

ORDER REPRINTS

Farrell A D Danish S J (1993) Peer drug associations and emotionalrestraint Causes or consequences of adolescent drug use Journal ofConsulting and Clinical Psychology 61327ndash334

Festinger L A (1957) A Theory of Cognitive Dissonance New YorkHarper amp Row

Fuqua J Stokols D Gress J Phillips K Harvey R (2004)Transdisciplinary collaboration as a basis for enhancing the scienceand prevention of substance use and abuse Substance Use ampMisuse

Giuliano J D (1994) A peer education program to promote the use ofconflict resolution skills among at-risk school-age males PublicHealth Reports 109158ndash169

Glynn K Levanthal H Hirschman R (1985) A cognitivedevelopmental approach to smoking prevention In Bell C SBattjes R eds Prevention research Deterring Drug Abuse AmongChildren and Adolescents Rockville MD NIDA ResearchMonograph 63

Glynn T J (1989) Essential elements of school-based smokingprevention programs Journal of School Health 59181ndash188

Goodman R M Burdine J N Meehan E McLeroy K R eds(1993) Community coalitions for health promotion Special issue ofHealth Education Research Theory and Practice 8309ndash453

Goodyear R D Newcomb M D Locke T F (2002) PregnantLatina teenagers psychosocial and developmental determinants ofhow they select and perceive the men who father their childrenJournal of Counseling Psychology 49187ndash201

Gordon R (1987) An operational classification of disease preventionIn Steinberg J A Silverman M M eds Preventing MentalDisorders Rockville MD DHHS 20ndash26

Graham J W Johnson C A Hansen W B Flay B R Gee M(1990) Drug use prevention programs gender and ethnicityevaluation of three seventh-grade project SMART cohortsPreventive Medicine 19305ndash313

Griffin K W Botvin G J Nichols T R Doyal M M (2003)Effectiveness of a universal drug abuse prevention approach foryouth at high risk for substance use initiation Preventive Medicine36(1)1ndash7

Hamilton S (August 20 2000) Views slowly changing on alternativeschools The Sacramento Bee 1ndash3

Hansen W B (1992) School-based substance abuse prevention a reviewof the state of the art in curriculum 1980ndash1990 Health EducationResearch 7403ndash430

Motivation Skills and Decision Making 2007

ORDER REPRINTS

Hansen W B Johnson C A Flay B R Graham J W Sobel J(1988) Affective and social influences approaches to the preventionof multiple substance abuse among seventh grade students resultsfrom project SMART Preventive Medicine 17135ndash154

Hansen W B Graham J W (1991) Preventing alcohol marijuanaand cigarette use among adolescents peer pressure and resistancetraining versus establishing conservative norms PreventiveMedicine 20414ndash430

Hawkins D H Catalano R F Miller J Y (1992) Risk andprotective factors for alcohol and other drug problems inadolescence and early adulthood Implications for substanceabuse prevention Psychological Bulletin 11254ndash105

Hawkins J D Catalano R F Kosterman R Abbott R Hill K G(1999) Preventing adolescent health-risk behaviors by strengthen-ing protection during childhood Archives of Pediatric amp AdolescentMedicine 153226ndash234

Heider F (1958) The Psychology of Interpersonal Relations New YorkWiley

Henggeler S W Pickrel S G Brondino M J Crouch J L (1996)Eliminating (almost) treatment dropout of substance abusing ordependent delinquents through home-based multisystemic therapyAmerican Journal of Psychiatry 153(3)427ndash428

Henggeler S W Melton G B Brondino M J Scherer D GHanley J H (1997) Multisystemic therapy with violent andchronic juvenile offenders and their families the role of treatmentfidelity in successful dissemination Journal of Consulting andClinical Psychology 65(5)821ndash833

Henggeler S W Schoenwald S K Borduin C M Rowland M DCunningham P B (1998) Multisystemic treatment of antisocialbehavior in children and adolescents New York The Guilford Press

Henggeler S W Pickrel S G Brondino M J (1999) Multisystemictreatment of substance-abusing and dependent delinquents out-comes treatment fidelity and transportability Mental HealthServices Residual 1(3)171ndash84

Johnson C A Pentz M A Weber M D Dwyer J H Baer NMacKinnon D P Hansen W B Flay B R (1990) Relativeeffectiveness of comprehensive community programming for drugabuse prevention with high-risk and low-risk adolescents Journalof Consulting and Clinical Psychology 58447ndash456

Kaftarian S J Hansen W B eds (1994) CSAP special issuecommunity partnership program Journal of Community Psychologypages 205

2008 Sussman et al

ORDER REPRINTS

Karoly P (1993) Mechanisms in self-regulation A systems view AnnualReview of Psychology 4423ndash51

Karoly P (1980) Person variables in therapeutic change and develop-ment In Karoly P Steffen J J eds Improving the Long-TermEffects of Psychotherapy New York Gardner Press 195ndash261

Kendall P C Braswell L (1982) Cognitive-behavioral self-controltherapy for children a components analysis Journal of Consultingand Clinical Psychology 50672ndash689

Kerr M Tremblay R E Pagani L Vitaro F (1997) Boysrsquobehavioral inhibition and the risk of later delinquency Archivesof General Psychiatry 54809ndash816

Klein N C Alexander J F Parsons B V (1977) Impact of familysystems intervention on recidivism and sibling delinquency a modelof primary prevention and program evaluation Journal ofConsulting and Clinical Psychology 45(3)469ndash474

Kumpfer K L (1999) Outcomes measures of interventions in the studyof children of substance-abusing parents Pediatrics 1031128ndash1144

Lau R R Hartman K A Ware J E (1986) Health as a valuemethodological and theoretical considerations Health Psychology525ndash43

Lichtenstein E L Glasgow R E (1997) A pragmatic framework forsmoking cessation implications for clinical and public healthprograms Psychology of Addictive Behaviors 11142ndash151

Locke T F Newcomb M D (in press) Childhood maltreatmentparent drug problems polydrug problems and parenting practicesa test of gender differences and four theoretical perspectivesJournal of Family Psychology

McCreary D R Newcomb M D Sadava S W (1999) The male rolealcohol use and alcohol problems a structural modeling examina-tion in adult women and men Journal of Counseling Psychology46109ndash124

McGee L Newcomb M D (1992) General deviance syndromeexpanded hierarchical evaluations at four ages from earlyadolescence to adulthood Journal of Consulting amp ClinicalPsychology 60766ndash776

Miller W R Brown J M (1991) Self-regulation as a conceptual basisfor the prevention of addictive behaviours In Heather N MillerW R Greeley J eds Self-control and the Addictive BehavioursSydney Australia Maxwell Macmillan 3ndash79

Miller W R Leckman A L Delaney H D Tinkcom M (1993)Long-term follow-up of behavioral self-control training forproblem drinkers Journal of Studies on Alcohol 53249ndash261

Motivation Skills and Decision Making 2009

ORDER REPRINTS

Miller W R Rollnick S (1991) Motivational InterviewingPreparing People to Change Addictive Behavior New YorkGuilford Press

Moffitt T E Caspi A Harrington H Milne B J (2002) Males onthe life-course-persistent and adolescence-limited antisocial path-ways follow-up at age 26 years Development and Psychopathology14(1)179ndash207

National Institute on Drug Abuse (NIDA) (1997) Drug abuseprevention What works NIH Publication 97-4110 DHHSNational Institutes of Health National Institute on Drug AbuseOffice of Science Policy and Communications Rockville MD

Newcomb M D (1992a) Substance abuse and control in the UnitedStates ethical and legal issues Social Science and Medicine35471ndash479

Newcomb M D (1992b) Understanding the multidimensional nature ofdrug use and abuse The role of consumption risk factors andprotective factors In Glantz M D Pickens R eds Vulnerabilityto Drug Abuse Washington DC American PsychologicalAssociation 255ndash298

Newcomb M D (1996a) Pseudomaturity among adolescents constructvalidation sex differences and associations in adulthood Journalof Drug Issues 26477ndash504

Newcomb M D (1996b) Adolescence Pathologizing a normal processThe Counseling Psychologist 24482ndash490

Newcomb M D (1997) Psychosocial predictors and consequences ofdrug use a developmental perspective within a prospective studyJournal of Addictive Diseases 1651ndash89

Newcomb M D Bentler P M (1988) Consequences of Adolescent DrugUse Impact on the Lives of Young Adults Beverly Hills CA Sage

Newcomb M D Bentler P M (1989) Substance use and abuse amongchildren and teenagers American Psychologist 44242ndash248

Newcomb M D Harlow L L (1986) Life events and substance useamong adolescents Mediating effects of perceived loss of controland meaninglessness in life Journal of Personality and SocialPsychology 51564ndash577

Newcomb M D Chou C-P Bentler P M Huba G J (1988)Cognitive motivations for drug use among adolescents longitudinaltests of gender differences and predictors of change in drug useJournal of Counseling Psychology 35426ndash438

Newcomb M D Abbott R D Catalano R F Hawkins J DBattin-Pearson S R Hill K (2002) Mediational and deviancetheories of late high school failure Process roles of structural

2010 Sussman et al

ORDER REPRINTS

strains academic competence and general versus specific problem

behaviors Journal of Counseling Psychology 49172ndash186Nezami E Sussman S Pentz M A (2003) Motivation in tobacco use

cessation research Substance Use amp Misuse 3825ndash5Novak S P Clayton R R (2001) The influence of school environment

and self-regulation on transitions between stages of cigarette

smoking Health Psychology 20196ndash207Offord D R (2000) Selection of levels of prevention Addictive

Behaviors 25833ndash842Palinkas L A Atkins C J Miller C Ferreira D (1996) Social skills

training for drug prevention in high-risk female adolescents

Preventive Medicine 25692ndash701Patock-Peckham J A Cheong J-W Balhorn M E Nagoshi C T

(2001) A model of parenting styles self-regulation perceived

drinking control and alcohol use and problems Alcoholism

Experimental and Clinical Research 251284ndash1292Pentz M A (1994) Directions for future research in drug abuse

prevention Preventive Medicine 23646ndash652Pentz M A Dwyer J H MacKinnon D Flay B R Hansen W B

Wang E Y I Johnson C A (1989) A multi-community trial for

primary prevention of adolescent drug abuse effects on drug use

prevalence JAMA 2623259ndash3266Pentz M A Mares D Schinke S Rohrbach L (in press) Political

science public policy and drug abuse prevention Substance Use amp

MisuseProchaska J O DiClemente C C (1982) Transtheoretical therapy

toward a more integrative model of change Psychotherapy Theory

Research and Practice 19275ndash288Pulkkinen L Pitkanen T (1994) A prospective study of the precursors

to problem drinking in young adulthood Journal of Studies on

Alcohol 55578ndash587Rathus S A Nevid J S (1977) Behavior Therapy Strategies for

Solving Problems in Living New York Doubleday and Company

IncResnicow K Botvin G (1993) School-based substance use prevention

programs why do effects decay Preventive Medicine 22484ndash490Rutter M Dunn J Plomin R Simonoff E Pickles A Maughan

B Ormel J Meyer J Eaves L (1997) Integrating nature and

nurture implications of person-environment interactions for

developmental psychopathology Development and Psychopathology

9335ndash364

Motivation Skills and Decision Making 2011

ORDER REPRINTS

Salomon G Stein Y Eisenberg S Klein L (1984) Adolescent

smokers and nonsmokers profiles and their changing structure

Preventive Medicine 13446ndash461Sambrano S (1999) National cross-site evaluation of high risk youth

programs In Interim findings Bulletin Washington DC CSAP

SAMSHA US DHHS May 1ndash16Schinke S P Gilchrist L D (1985) Preventing substance abuse with

children and adolescents Journal of Consulting and Clinical

Psychology 53596ndash602Skara S N Sussman S (2003) A review of 25 long-term adolescent

tobacco and other drug use prevention program evaluations

Preventive MedicineSmith C Lizotte A J Thornberry T P Krohn M D (1995)

Resilient youth identifying factors that prevent high-risk youth

from engaging in delinquency and drug use Delinquency and

Disrepute in the Life Course Greenwich CT John Hagan JAI

press 217ndash247Sommers P V (1972) The Biology of Behavior Australia Pty ltd

Sydney John Wiley amp SonsSt Pierre T L Kaltreider D L Mark M M Aikin K J (1992)

Drug prevention in a community setting a longitudinal study of the

relative effectiveness of a three-year primary prevention program in

boys and girls clubs across the nation American Journal of

Community Psychology 20673ndash706Stein J A Newcomb M D Bentler P M (1987) An eight year study

of multiple influences on drug use and drug use consequences

Journal of Personality and Social Psychology 531094ndash1105Sully J (1884) Outlines of Psychology New York D Appleton amp CoSussman S (1989) Two social influence perspectives of tobacco use

development and prevention Health Education Research Theory

and Practice 4213ndash223Sussman S (1991) Curriculum development in school-based prevention

research Health Education Research Theory and Practice

6339ndash351Sussman S (1996) Development of a school-based drug abuse

prevention curriculum for high risk youth Journal of

Psychoactive Drugs 28169ndash182Sussman S Ames S L (2001) The social psychology of drug abuse

Buckingham GB Open University PressSussman S Unger J (2004) A drug abuse theoretical integration a

transdisciplinary speculation Substance Use amp Misuse

2012 Sussman et al

ORDER REPRINTS

Sussman S Dent C W Burton D Stacy A W Flay B R (1995a)

Developing school-based tobacco use prevention and cessation

programs Thousand Oaks CA Sage Publications IncSussman S Dent C W Simon T R Stacy A W Galaif E R

Moss M A Craig S Johnson C A (1995b) Effectiveness of

social influence substance abuse prevention curricula in compre-

hensive and continuation high schools Drugs and Society 865ndash81Sussman S Dent C W Galaif E R (1997) The correlates of

substance abuse and dependence among adolescents at high risk

for drug abuse Journal of Substance Abuse 9241ndash255Sussman S Dent C W Stacy A W (1996) The relation of pro-drug

use myths with self-reported drug use among youth at continuation

high schools Journal of Applied Social Psychology 26214ndash267Sussman S Dent C W Stacy A Craig S (1998) One-year outcomes

of project towards no drug abuse Preventive Medicine 27632ndash642

(erratum 766)Sussman S Dent C W Stacy S (2002) Project towards no drug

abuse a review of the findings and future directions American

Journal of Health Behavior 26354ndash365Sussman S McCuller W J Dent C W (2003) The associations of

social self-control personality disorders and demographics with

drug use among high risk youth Addictive Behaviors 281159ndash1166Sussman S Rohrbach L Patel R Holiday K (2003) A look at an

interactive classroom-based drug abuse prevention program

Interactive contents and suggestions for research Journal of Drug

Education 33355ndash368Sussman S Sun P McCuller W J Dent C W (2003) Project

towards no drug abuse two year outcomes of a trial that compares

health educator delivery to self-instruction Preventive Medicine

37155ndash162Tarter R E Vanyukov M (1994) Alcoholism a developmental disorder

Journal of Consulting and Clinical Psychology 621096ndash1107Thornton T N Craft C A Dahlberg L L Lynch B S Baer K

(2000) Best Practices of Youth Violence Prevention A Sourcebook

for Community Action Atlanta GA Division of Violence

Prevention Centers for Disease Control and PreventionTobler N S (1986) Meta-analysis of 143 adolescent drug prevention

programs quantitative outcome of program participants compared to

a control or comparison group Journal of Drug Issues 16537ndash567Tobler N S Roona M R Ochshorn P Marshall D G Streke

A V Stackpole K M (2000) School-based adolescent drug

Motivation Skills and Decision Making 2013

ORDER REPRINTS

prevention programs 1998 Meta-analysis The Journal of Primary

Prevention 20275ndash336US Department of Health and Human Services (USDHHS) (2003)

Substance Abuse andMental Health Services Administration Center

for Substance Abuse Prevention Science-based prevention programs and

principles 2002 Rockville MD US DHHS (SMA)03-3764 Also

see httpmodelprogramssamhsagovUnger J Baezconde-Garbanati L Shakib S Palmer P H Nezami

E Mora J (2004) What are the implications of structuralcultural

theory for drug abuse prevention Substance Use amp MisuseUpshaw H S Ostrom T M (1984) Psychological perspective in

attitude research In Eiser J R ed Attitudinal Judgment New

York Springer-Verlag 23ndash42Valente T W Gallaher P Mouttapa M (2004) Using social network

theory to understand and prevent substance use a transdisciplinary

perspective Substance Use amp MisuseVorrath H Brendtro L (1985) Positive peer culture 2nd edn Aldine

ChicagoWaldron H B Slesnick N Brody J L Turner C W Peterson T R

(2001) Treatment outcomes for adolescent substance abuse at 4-

and 7-month assessments Journal of Consulting amp Clinical

Psychology 69(5)802ndash813Watson D L Tharp R G (2002) Self-directed behavior Self-

modification for personal adjustment 8th edn Belmont CA

WadsworthWeissberg R P Caplan M Z Sivo P J (1989) A new conceptual

framework for establishing school-based social competence promo-

tion programs In Bond L A Compas B E eds Primary

Prevention amp Promotion in the Schools Newbury Park CA Sage

255ndash296Wills T A (1986) Stress and coping in early adolescence relationships

to substance use in urban school samples Health Psychology

5503ndash529Wills T A Cleary S D (1995) Stress-coping model for alcohol-

tobacco interactions in adolescence In Fertig J B Allen J P

eds Alcohol and Tobacco From Basic Science to Clinical Practice

Bethesda MD National Institute on Alcohol Abuse and

Alcoholism 107ndash128Wills T A Cleary S D (1999) Peer and adolescent substance use

among 6thndash9th graders Latent growth analyses of influence versus

selection mechanisms Health Psychology 18453ndash463

2014 Sussman et al

ORDER REPRINTS

Wills T A Hirky A E (1996) Coping and substance abuse InZeidner M Endler N S eds Handbook of Coping TheoryResearch and Applications New York Wiley 279ndash302

Wills T A Stoolmiller M (2002) The role of self-control in earlyescalation of substance use a time-varying analysis Journal ofConsulting and Clinical Psychology 70986ndash997

Wills T A Baker E Botvin G J (1989) Dimensions of assertivenessdifferential relationships to substance use in early adolescenceJournal of Consulting and Clinical Psychology 57(4)473ndash478

Wills T A Vaccaro D McNamara G (1994) Novelty seeking risktaking and related constructs as predictors of adolescent substanceuse an application of Cloningerrsquos theory Journal of SubstanceAbuse 61ndash20

Wills T A McNamara G Vaccaro D Hirky A E (1996a)Escalated substance use a longitudinal grouping analysis fromearly to middle adolescence Journal of Abnormal Psychology105166ndash180

Wills T A Pierce J P Evans R I (1996b) Large-scale environmentalrisk factors for substance use American Behavioral Scientist39808ndash822

Wills T A Windle M Cleary S D (1998) Role of temperamentnovelty-seeking and self-control in adolescent substance useJournal of Personality and Social Psychology 74387ndash406

Wills T A Sandy J M Shinar O (1999) Substance use level andproblems in late adolescence a mediational model based on self-control and coping motives Experimental and ClinicalPsychopharmacology 7122ndash134

Wills T A Cleary S D Filer M Shinar O Mariani J Spera K(2001) Temperament and self-control related to early-onsetsubstance use test of a developmental model Prevention Science2145ndash163

Wills T A Sandy J M Yaeger A (2002) Moderators of therelationship between substance use level and problems test of aself-regulation model in adolescence Journal of AbnormalPsychology 1113ndash21

Wills T A Gibbons F X Gerrard M Murry V Brody G (in press-a) Family communication and religiosity related to substance useand sexual behavior in early adolescence Psychology of AddictiveBehaviors

Wills T A Resko J Ainette M Mendoza D (in press-b) The role ofparent and peer support in adolescent substance use a test ofmediated effects Psychology of Addictive Behaviors

Motivation Skills and Decision Making 2015

ORDER REPRINTS

Young P T (1936) Motivation of Behavior New York John Wiley andSons

Zimmerman B J (2000) Attaining self-regulation a social cognitivemodel In Boekaerts M Pintrich P R eds Handbook of Self-Regulation San Diego Academic Press 13ndash39

2016 Sussman et al

Request PermissionOrder Reprints

Reprints of this article can also be ordered at

httpwwwdekkercomservletproductDOI101081JA200034769

Request Permission or Order Reprints Instantly

Interested in copying and sharing this article In most cases US Copyright Law requires that you get permission from the articlersquos rightsholder before using copyrighted content

All information and materials found in this article including but not limited to text trademarks patents logos graphics and images (the Materials) are the copyrighted works and other forms of intellectual property of Marcel Dekker Inc or its licensors All rights not expressly granted are reserved

Get permission to lawfully reproduce and distribute the Materials or order reprints quickly and painlessly Simply click on the Request Permission Order Reprints link below and follow the instructions Visit the US Copyright Office for information on Fair Use limitations of US copyright law Please refer to The Association of American Publishersrsquo (AAP) website for guidelines on Fair Use in the Classroom

The Materials are for your personal use only and cannot be reformatted reposted resold or distributed by electronic means or otherwise without permission from Marcel Dekker Inc Marcel Dekker Inc grants you the limited right to display the Materials only on your personal computer or personal wireless device and to copy and download single copies of such Materials provided that any copyright trademark or other notice appearing on such Materials is also retained by displayed copied or downloaded as part of the Materials and is not removed or obscured and provided you do not edit modify alter or enhance the Materials Please refer to our Website User Agreement for more details

ORDER REPRINTS

strong predictor of substance use problems (Wills et al 1999) Self-control includes cognition because developing self-control is the substratefor personality organization including not only behavioral and affectivecontrol but also attitudes values and views of the world as accepting orhostile and social perceptions about substance use as being attractive vsunattractive For example studies find poor self-control correlated withattitudinal tolerance for deviance and more favorable perceptions oftobacco and alcohol users whereas good self-control is related tofavorable perceptions of teens that abstain from drug use (Wills et alin press-a) Self-control approaches can be useful for preventionprograms by improving self and other perceptions academic perfor-mance and the impact or facilitation of negative life events goals that aresalient to teenagers and their parents (Wills and Stoolmiller 2002)

Youth often lack adequate coping skills they tend to lack restraint orplanfulness (Farrell and Danish 1993 Rutter et al 1997) Coping skillsinstruction may help increase self-control (Kendall and Braswell 1982)Coping skills instruction receives little attention in typical social influencesprogramming (Hansen 1992) although this material appears in life skillstraining (Botvin 1993 Botvin et al 1995 Wills 1986) In self-controlprogramming youth learn to assess their self-control particularly in socialcontexts (Sussman et al 2003) They learn the importance of thinkingahead and anticipating problem situations so that they are preparedbeforehand to deal with problems that may arise They also learn theimportance of context (eg not laughing at a funeral) Finally they learnassertiveness and anger management to help them better control theirreactions in social settings (Sambrano May 1999 Sussman et al 2002)

Listening and Communication Skills

Youth genuinely benefit from listening to information with an openmind and asking open-ended questions to keep a conversation goingThey can improve social skills by learning how to ask open-endedquestions establish eye contact appropriately nodding and orientingtheir body toward the other speaker (CPPRG 1999 Eggert and Herting1991 Hawkins et al 1999 Sussman et al 2002 2003) Neverthelesssocial skills training can create problems for nondrug using high-riskteens (Palinkas et al 1996 Sussman et al 1995b Wills et al in press-b)Training in drug refusal may create reactance in some samples (Sussmanet al 1996) Among high-risk youth enhancing assertiveness and datingskills may increase the scope of social entertainment options andinadvertently improve a teenrsquos ability to acquire drugs from new sources

Motivation Skills and Decision Making 1993

ORDER REPRINTS

(Wills et al 1989) Also there are cultural variations on what constitutesgood social skill (Unger et al 2004) There are good arguments forplacing high-risk teens together in activities with well-controlled teens sothat they can model adaptive social skills and problem solvingAdditionally utilizing motivation methods prior to instructing thespecific skill channels canalizes health-directed use of social skillsmastered Overall increasing social competence will have protectiveeffects for high-risk teens (Wills et al 1994) This idea is consistent withthe studies that have shown social withdrawal to increase risk for druguse (Kerr et al 1997) though there may be gender differences in theseeffects (Pulkkinen and Pitkanen 1994) Still it is most wise to includesocial skills training in conjunction with material addressing motivationand decision making Motivations regarding drug use need to beaddressed so behaviors learned are not misdirected

Resource Acquisition

Adults often assume that teens can access community services withlittle effort In fact few teens understand the availability of healthservices or other assistance Simple information including phonenumbers and locations can assist teens immensely (Carroll 1996Sussman et al 2002) Coaching teens on techniques for receivingassistance can prove productive Public assistance for drug use-relatedproblems and other life problems can help tremendously but negotiatingthe bureaucratic difficulties inherent in many of these systems can requireconsiderable skill (Eggert and Herting 1991 Sambrano May 1999Sussman et al 2002) Direct instruction modeling and structuredpractice in resource acquisition skills may help youth to increase theirknowledge and self-efficacy on how to acquire resources and to readilyaccess resources when needed (eg use of the bus system) These skillsmay generalize to comparable tasks later in life

Decision-Making

Prevention programs have employed several decision-making strate-gies For example the protocol from Project Reconnecting Youth(Project RY) is STEPS The acronym stands for Stop Think ofoptions Evaluate options Perform or take action on the chosen optionand then Self-praise for using steps for making healthy choices (Eggertand Herting 1991) The participants help set the agenda and take turns

1994 Sussman et al

ORDER REPRINTS

illustrating it on a flip chart This task helps share the leadership andfocuses the group work and time The lesson STEPS to Drug UseControl follows skills training sessions that cover understandingSTEPS as a decision-making model

Project Towards No Drug Abuse (TND)rsquos decision-making sessioninvolves four steps These steps are

1 Brainstorming (making a list of ideas without judging them)2 Weigh the pros and cons (the benefits and costs of each idea)3 Select the best option4 Follow through (try that option and reevaluate the decision)

(Sussman et al 2002)

These decision-making strategies are similar across different pro-grams except that they include some different emphases For exampleSTEPS includes a self-instruction to begin decision making and self-praise whereas the TND sequence includes more of an emphasis onfollowing through with the decision Generally each program requiresgenerating options evaluating them choosing the best and evaluatingthe outcome in an effort to make the next decision Teens tend to enjoypracticing decision making in bogus problem situations Youth soonlearn to engage in steps like these with considerable skill Training indecision making operates on variables that are intermediate in the causalprocess and thereby strengthen individual profiles of self-controlabilities so that they are more resilient in the face of proximal riskfactors for drug use such as life stresses and peer pressures

Modalities of Programming

Both school and nonschool prevention modalities have a rich andimportant history in substance abuse prevention research (Pentz 1994Pentz et al 2004) Schools provide a captive audience for educationalmaterial Youth spend 25 of their waking lives at school so thisenvironment has considerable potential Furthermore the school contextprovides a rich research history for building new studies and evaluatingtheir efficacy (Sussman et al 1995a) Community programs also offerconsiderable opportunity

Community programs often involve local leaders and organizations(eg coalitions community boards) (Goodman et al 1993 Kaftarianand Hansen 1994) that help mobilize numerous community unitsCommunity units include businesses media the family and governmental

Motivation Skills and Decision Making 1995

ORDER REPRINTS

agencies like the police or recreational departments as well as schoolsystems A network of community units working together to developpromote and implement educational programming could increase youthsrsquobonding to others across a wide variety of social contexts (Hawkins et al1992 Pentz 1994) Community units can provide numerous types ofspecific extra-classroom prevention opportunities (Pentz 1994)

Parent-or-family targeted prevention programs include offering earlychildhood education social support for parents managing crisesparenting skills training parent-child communication skills and resourceacquisition instruction or networking Mass media targeted programsinvolve programs or public service announcements with novel fastand unconventional messages (eg the American Legacy FoundationTRUTH campaign) use of the Internet and interactive CDs (eg videogames) Alternative means to involve youth include involvement in hikingclubs drug-free dances or other after-school events with prosocial adultmentors and with means to involve youth outside of school includingentry into different environments (ie outward bound) (Tobler 1986) Inaddition policy implementation and enforcement may contribute toother prevention programs (Pentz et al 1989) Indeed simultaneousprograms within and outside of schools over long periods might maintainthe positive effects that sometimes dissipate when school programsappear alone (Pentz 1994)

The Difference Between Targeted Prevention and Cessation

Targeted (secondary) prevention attempts to keep persons fromcrossing the invisible line where they funnel into a cycle of addiction andaccumulation of negative consequences Cessation programs (sometimesreferred to as tertiary prevention) take the stance that a behavior hasoccurred with definite and perhaps irreversible negative consequencesThe goal is to stop the behavior permit recovery from the damage learnhow to prevent relapse and learn how to live with permanent changes(eg neurotransmitter function drug use-related injury) It is not clearexactly where indicated prevention ends however and where cessationbegins For example an early version of the Project TND curriculum didnot achieve effects on cigarette smoking possibly because 46 of thesample already smoked cigarettes daily (while not engaging often in someother drug use) In a revised curriculum a smoking cessation componentwas added to the program and then an effect on cigarette smoking wasachieved Cessation material can appear with prevention material to

1996 Sussman et al

ORDER REPRINTS

maximize program effectiveness Careful program development can helpdetermine the best mix (Sussman et al 2002)

Summary of Evidence-based Targeted Drug Abuse Prevention

At present approximately 29 drug-use prevention programs havebeen evaluated favorably for their effects on drug use or other problembehavior (see Table 1) These 29 programs have been identified throughtwo sources Blueprints for Violence Prevention (Elliott 2003) and theSubstance Abuse and Mental Health Services Administrationrsquos(SAMSHA) science-based prevention programsrsquo guide (USDHHS2003) PsycINFO and MEDLINE searches of drug abuse preventionstudies since 1970 supplemented searches through these two guides (seeTable 1) Nine definitions of high-risk were used across these programsEleven programs focused on economic deprivation as the definition Sixprograms focused on delinquent behavior as the identifying characteristicto target Two programs each identified single-parent homes drug use orexposure to drug use family problems alternative high school attendanceor being at risk for dropout at a regular high school as the characteristicsto target subjects Finally one program each identified new immigrantstatus or residential facility placement as the defining characteristic ofbeing at high risk for drug use

Among these programs eight focused on preteens For example theEarly Risers program defined its high-risk youth as those 6ndash10 year-oldsthat suffered economic deprivation and exhibited aggressive or opposi-tional behavior Another five programs focused on a young teen agegroup For example Preventive Intervention defined its high-risk youthas those seventh to eighth graders who exhibited poor school andacademic discipline and reported family problems Another sevenprograms focused on an older teen age group For example ProjectTND defined its high-risk youth as those youth that attended alternativehigh schools Finally nine programs encompassed wide age ranges Forinstance Big Brothers Big Sisters of America defined its high-risk youthas 6ndash18 year-olds that lived in single-parent homes

Of these programs 10 involved multiple often flexible settings ofimplementation Another 13 programs focused on the school settingFour programs focused on the home setting Finally two programsfocused on a community agency setting In general these programsinvolved implementation by highly trained personnel Eighteen of theseprograms involved some motivation aspect generally motivationenhancement but sometimes including extrinsic reinforcement strategies

Motivation Skills and Decision Making 1997

ORDER REPRINTS

Twenty-six of these programs provided skills training Finally 18programs provided instruction in decision making Thus the MSDmodel tends to appear in a majority of these programs however all threecomponents were included together in only nine of these programs

Twenty of these programs involved at least one replication of theprogram and 14 involved three or more replications Further 14 of theseprograms were tested through use of experimental designs and nineinvolved use of only quasi-experimental designs Effects on drug use wereassessed and found in 22 of these programs For example theReconnecting Youth program was implemented to youth at risk fordropout This program involved 90 sessions within a comprehensive highschool class delivered generally over a semester with small studentgroups and a highly trained teacher Instruction included use of groupsupport and providing life skills training (norm setting self-esteem moodmanagement communication skills self-monitoring monitoring goalsschool bonding and social activities) with feedback to parents Programgoals were achieved through use of a quasi-experimental design showingeffects for school performance (18 improvement in grades) drug use(54 decrease in hard drug use) and suicide risk (32 decline inperceived stress) This programrsquos results have been replicated numeroustimes in numerous locations This program involved all three componentsof the MSD model except that motivation was provided through peergroup support not through provision motivation enhancement strate-gies These targeted programs present an optimistic picture for drug-useprevention that is focused on at-risk youth (see Table 1)

Not all targeted prevention programs have been found to beeffective One published program that failed to find positive effects wasProject PALS (Palinkas et al 1996) This project was developed for teengirls who were pregnant or at risk for pregnancy and drug use Theprogram consisted of school-based delivery of 16 sessions once a weekin a class The goal was to decrease drug use The PALS Skills TrainingProgram involved instruction in assertiveness providing and receivingfeedback social conversation handling requests and asking for help andmood management This program was tested against a normativeeducation program (called Facts of Life or FOL) which instructedvalues and decision making sexuality issues and contraception sexuallytransmitted diseases (STDs) drug use risks sexual assault prevalenceand norms material An experimental evaluation with a seven-monthspost-baseline was used The results indicated that the PALS programsubjects reported 29 times greater marijuana use than FOL amongbaseline nonusers No other differences were found It is possible that theprogram was not targeted to the right population that the mix of skills

1998 Sussman et al

ORDER REPRINTS

instructed was not appropriate or that skill training alone (withoutappropriate motivation material) may not be effective in drug useprevention Researchers should examine these possibilities and others tofurther understand program failures as well as program successes

Potential Limitations of Targeted Prevention

Dishion and colleagues (1995) suggest from various findings thatgrouping high-risk youth may lead to increased drug use This outcomecan result if youth come to learn deviant behavior from each other Theycan learn deviant behavior from each other in a program if they haveunstructured or unsupervised time together An essential feature ofseveral targeted programs (eg the RY and TND programs) is building apositive peer culture with group norms that decrease drug involvementand drug-use control problems The RYrsquos findings suggest that a positivepeer group component carefully fostered by a well-trained and competentRY group leader can direct the group toward lower risk behaviorSimilarly classroom management in Project TND involves developmentof positive norms of classroom behavior Further interaction betweenyouth is encouraged but is primarily teacher-directed and highlystructured (Sussman et al 2003) In both RY and Project TND theteacherrsquos role is to actively develop and maintain peer group support inthe class by modeling support positively reinforcing it among groupmembers and negatively reinforcing deviant peer bonds and activities(Eggert and Herting 1991 Vorrath and Brendtro 1985) The teachercreates and structures interactions among youth in prosocial directions(Sussman et al 2003)

Multiple Problem Behaviors of Adolescents

Acknowledging the relationship of drug use to other commonadolescent problems may facilitate identification of effective methods ofreducing drug use Researchers on tobacco alcohol and other drug useantisocial behavior high-risk sexual behavior and depression increas-ingly recognize that these problems are interrelated (McGee andNewcomb 1992) and stem to a large extent from the same environ-mental and biological factors (Biglan et al in press Eggert et al 1995Sussman and Ames 2001 Wills and Cleary 1995) Clearly it is necessaryto have strategies that address the entire range of problems and thecontext that influences those problems Indeed further reductions in

Motivation Skills and Decision Making 1999

ORDER REPRINTS

many problems require that we comprehensively target youth withmultiple problem behaviors

Biglan and colleagues (in press) provide a comprehensive review ofthe relationships among antisocial behavior tobacco alcohol and otherdrug use and high-risk sexual behavior It is clear that the same youngpeople are prone to the development of the entire range of problems In arecent review Moffitt and colleagues (2002) found that antisocialbehavior in early adolescence (rather than late adolescence) is a greaterrisk factor for developing multiple problems These findings point to theimportance of early intervention before youth develop serious problemsMoreover these different problems largely result from the same set ofenvironmental and biological factors

One implication is that disciplines dealing with these problemsother than drug abuse may contribute to dealing with the problem ofdrug use (Newcomb 1996b 1997) In particular research by dev-elopmental psychologists family social workers and sociologists onthe influence of parents on adolescent problem development and oninterventions to alter parenting practices contributes to our understandingof how to prevent or ameliorate drug abuse and other problems Onealso should note that nonsubstance use is not a guarantee for problemimmunity for the entire age range of people whatever their genderethnicity religiosity socioeconomic status (SEC) domicility etc It maybe argued that the most promising programs are those targeting thesemultiple levels of influence Several multidisciplinary programs haveachieved promising results We describe three of these empiricallyevaluated programs tested in various settings

Functional Family Therapy (FFT)FFT is an indicated intervention involving family treatment designed

for delinquent teenagers (also see Table 1) Developed in the early 1970sby Alexander and colleagues (1973) FFT focuses on family commu-nication and the establishment of rules and consequences Several studiesprovide encouraging reports of the programrsquos effectiveness (Alexander etal 1976 Barton et al 1985 Klein et al 1977 Waldron et al 2001) Inthe Waldron et al (2001) study researchers used FFT and anintervention with cognitive behavior therapy on teens referred formarijuana use Each of the interventions produced significant resultson marijuana use by the teens at four months but only the twointerventions combined maintained these results at seven months Theearlier studies found a greater number of results For example in the twoAlexander studies (1973 1976) improvement in family communicationposttreatment led to reduced delinquency Note that all the teens in these

2000 Sussman et al

ORDER REPRINTS

studies had histories of serious antisocial or delinquent behavior Thusachieving positive outcomes even if only short-term should encouragefurther research into the efficacy of FFT

Multisystemic Therapy (MST)As its name suggestsMST targets individual family peer school and

community influences of those youth offenders with serious problems thatmay include violence substance use and severe emotional problems (alsosee Table 1) Numerous researchers have published the results ofrandomized trials of MST (Henggeler et al 1996 1997 1998 Thorntonet al 2000) The most consistent findings across studies are decreased (1)drug use (2) re-arrest (3) self-reported criminal offense and (4) days inout-of-home placements Other consistent findings are improved familyrelations school attendance and psychiatric functioning One cautionarynote the programrsquos effectiveness lowers considerably if not implementedwith fidelity (Hengler et al 1997 1999) In other words all or key lessonsneed to be delivered as written by educators who are well-trained in usingthe strategies employed and youth need to be able to receive all material inan atmosphere conducive to learning the material The programdevelopers have instituted training strategies that address these fidelityissues thus shaping MST to be a very promising program for at-riskyouth

Multidimensional Treatment Foster Care (MTFC)MTFC targets family and peer factors influencing adolescents with a

pattern of repeat criminal offending (see Table 1) (Chamberlain 1994)This intervention includes placement of the youth into a foster homewith a foster parent trained in behavior management who receivessupport from intervention staff After the adolescent has begun torespond to the intervention in the foster home and after the parents havereceived the same training and support as the foster parents did theadolescent returns home Chamberlain and Reid (1998) tested theintervention with 85 boys with felony and other criminal histories andfound substantial benefits of the program Following treatment the boysassigned to MTFC (compared to those receiving community-based groupcare) showed fewer days in detention or lock-up twice as much timeliving with parents fewer misdemeanor and felony arrests and fewer self-reported index crimes felony arrests and general delinquency TheMTFC is a cost-effective alternative to incarceration however staffrequirements are extensive which may influence the ability of some

Motivation Skills and Decision Making 2001

ORDER REPRINTS

groups to apply the program with fidelity However as with each of theprograms described here the results of the randomized trials areencouraging

Future Research Needs in Targeted Prevention

Future research can help discern when and where targeted preventionprogramming will tend to work rather than produce potentiallydeleterious negative group effects or results that are irrelevant for pro-social healthy adaptation as well as what the critical necessary conditionsare for their effective operation within given de facto realities Comparedto the breadth of evaluated universal drug use prevention programs(Tobler et al 2000) relatively few targeted prevention programs havereceived empirical support Yet previous research suggests that universalschool-based drug use prevention programs implemented in junior highschool have relatively less chance of long-term success especially for thoseyouth that began using drugs before the prevention program wasimplemented Of course there are notable exceptions (eg effects lastedfor one and a half years effects lasted for six years) (Chou et al 1998Griffin et al 2003 Skara and Sussman 2003) Almost no research existsregarding maximization of booster programming with high-risk youthMore research on booster programs would help the field

While continuing to engage in this work there will be numerousissues to manage that go well beyond the scope of this article There willbe a need to avoid producing negative labeling effects while providingprogramming for those who are at risk for drug use It is possible thatcessation information needs to be included in the mix with preventionmaterial to provide better targeted-prevention effects There may be aneed to develop a teacher selection instrument to help select out teacherswho can deliver drug abuse prevention programming adequatelyCertainly definition of outcome variables needs continued explorationincluding analysis to ascertain the effects of programming on drug abusevs drug use and identification of the variables that are most closelylinked to change by targeted prevention components

A transdisciplinary approach helps to better understand the lifesituation of high-risk youth as based to some extent on both constitutionaland environmental factors (Fuqua et al 2004 Rutter et al 1997 Wills etal 1996b) From the transactional perspective their situation is in partconstitutional they may have temperamental characteristics that arepartly heritable and that have set the stage at earlier ages for decrements inself-control ability and academic performance that then increase risk for

2002 Sussman et al

ORDER REPRINTS

drug use However their situation is also part environmental based in parton family socialization and in part on the types of peers they have as well asthe type and quality of the physical and cultural environment-at-largeThere are many points at which a potential chain of failures can beinterrupted and the individualrsquos trajectory turned in a better directionProblems are not inevitable from starting level (Tarter and Vanyukov1994) and environmental modifications to support good self-controlability can help to avert an adverse impact from earlier experiences orcurrent difficulties (Brody et al 2002 Novak and Clayton 2001 Patock-Peckham et al 2001 Rutter et al 1997 Wills et al 2002)

The problems and needs of high-risk youth in our nationrsquos highschools demand our attention for designing and rigorously testingtargeted prevention approaches Substantial evidence shows that theseyouth are at greater risk for drug involvement and co-occurring problemssuch as aggression depression and suicidal behaviors as we previouslydiscussed It is hoped that the information presented in this article willstimulate others to join in extending this work including testing othermodels of targeted prevention

GLOSSARY

Universal programs Programs that aim to influence all subjects in acontext

Selective drug-abuse prevention programs Programs that servegroups at greater risk of ATOD usemdashfor example children of alcoholicparents They are at psychosocial risk for drug use and abuse

Indicated drug-abuse prevention programs Programs that attemptto benefit individuals who already show signs of drug involvement orrelated risk factors In indicated prevention programs the primary goal isto stem the progression of ATOD use or reduce drug involvementamong the high-risk youth

Targeted programming Programming that subsumes selective andindicated programming sometimes the other two types of programs thattarget specific groups lsquolsquoat riskrsquorsquo are considered together

ACKNOWLEDGMENTS

This research was supported by grants from the National Institute onDrug Abuse (DA01070 DA07601 DA13814 and DA16094) and by aResearch Scientist Development Award K02 DA00252 from theNational Institute on Drug Abuse

Motivation Skills and Decision Making 2003

ORDER REPRINTS

REFERENCES

Alexander J F Barton C Schiaro R S Parsons B V (1976)

Systems-behavioral intervention with families of delinquents

therapist characteristics family behavior and outcome Journal of

Consulting and Clinical Psychology 44(4)656ndash664Alexander J F Parsons B V (1973) Short-term behavioral interven-

tion with delinquent families impact on family process and

recidivism Journal of Abnormal Psychology 3219ndash225American psychiatric association (APA) (1994) Diagnostic and

Statistical Manual of Mental Disorders 4th edn (DSM-IV)

Washington DC American Psychiatric AssociationAmes S L Sussman S Dent C W (1999) Pro-drug-use myths and

competing constructs in the prediction of substance use among

youth at continuation high schools a one-year prospective study

Personality and Individual Differences 26987ndash1003Bachman S G Wadsworth K N OrsquoMalley P M Johnston L D

Schulenberg J E (1997) Smoking drinking and drug use in young

adulthood Mahwah NJ Lawrence Erlbaum Associates 8ndash25

153ndash190Bandura A (1986) Social Foundations of Thought and Action A Social

Cognitive Theory Englewood Cliffs NJ Prentice HallBarton C Alexander J F Waldron H Turner C W Warburton J

(1985) Generalizing treatment effects of functional family therapy

Three replications The American Journal of Family Therapy

13(3)16ndash26Battin-Pearson S R Newcomb M D Abbott R D Hill K G

Catalano R F Hawkins J D (2000) Predicting early high school

dropout Journal of Educational Psychology 92568ndash582Biglan A Brennan P A Foster S L Holder H D Miller T L

Cunningham P B et al (in press) Helping Adolescents at Risk

Prevention of Multiple Problem Behaviors New York NY Guilford

PressBindra D Stewart J (1996) Motivation Baltimore MD Penguin

BooksBlanton H Gibbons F X Gerrard M Conger K J Smith G E

(1998) The role of family and peers in the development of

prototypes associated with substance use Journal of Family

Psychology 11271ndash288

2004 Sussman et al

ORDER REPRINTS

Botvin G J (1993) School-based drug abuse prevention Long-termfollow-up results In First Annual Meeting of the Society forPrevention Research Kentuck Lexington Society for PreventionResearch

Botvin G J Baker E Dusenbury L Botvin E M Diaz T (1995)Long-term follow-up results of a randomized drug abuse preven-tion trial in a white middle-class population Journal of theAmerican Medical Association 2731106ndash1012

Brody G H Dorsey S Forehand R Armistead L (2002) Uniquecontributions of parenting and classroom processes to the self-control of AfricanndashAmerican children Child Development73274ndash286

Carroll M E (1996) Reducing drug abuse by enriching the environmentwith alternative nondrug reinforcers In Green L Kagel J Heds Advances in Behavioral Economics Norwood NJ NorwoodPublishing Corp 37ndash68

Carver C S Scheier M F (1998) On the Self-Regulation of BehaviorNew York Cambridge University Press

Catalano R F Hawkins J D (1996) The social developmental modela theory of antisocial behavior In Hawkins J D ed Delinquencyand Crime Current Theories New York Cambridge UniversityPress

Centers for Disease Control (CDC) (October 1999) Youth risk BehaviorSurveillancemdashNational Alternative High School Youth RiskBehavior Survey 1998 Morbidity and Mortality Weekly Report48 No SS-7

Chamberlain P (1994) Family connections A treatment foster caremodel for adolescents with delinquency Eugene OR CastaliaPublishing Company

Chamberlain P Reid J B (1998) Comparison of two communityalternatives to incarceration for chronic juvenile offenders Journalof Consulting and Clinical Psychology 66(4)624ndash633

Chassin L A Presson C C Sherman S J (1985) Stepping backwardin order to step forward an acquisition-oriented approach toprimary prevention Journal of Consulting and Clinical Psychology53612ndash622

Chou C-P Montgomery S Pentz M A Rohrbach L A JohnsonC A Flay B R MacKinnon D P (1998) Effects of acommunity-based prevention program on decreasing drug use inhigh-risk adolescentsAmerican Journal of Public Health 88944ndash948

Conducts Problems Prevention Research Group (CPPRG) (1999) Initialimpact of the fast track prevention trial for conduct problems I

Motivation Skills and Decision Making 2005

ORDER REPRINTS

The high-risk sample Journal of Consulting and Clinical Psychology

67631ndash647Conducts Problems Prevention Research Group (CPPRG) (2000)

Merging universal and indicated prevention programs the fast

track model Addictive Behaviors 25913ndash927Council of Philosophical Studies (1981) Psychology and the Philosophy

of Mind in the Philosophy Curriculum San Francisco San Francisco

State UniversityCummings K M Hellmann R Emont S L (1988) Correlates of

participation in a worksite stop smoking program Journal of

Behavioral Medicine 11267ndash277Curry S Wagner E H Gothaus L C (1990) Intrinsic and extrinsic

motivation for smoking cessation Journal of Consulting and

Clinical Psychology 58310ndash316Dent C W Sussman S McCuller W J Stacy A W (2001) Drug

abuse prevention among youth at comprehensive high schools

Preventive Medicine 32514ndash520Dewey J (1886) Psychology New York HarperDishion T J French D C Patterson G R (1995) The development

and ecology of antisocial behavior In Cicchetti D Cohen D

eds Manual of developmental psychopathology New York John

Wiley 421ndash471Eggert L L Herting J R (1991) Preventing teenage drug abuse

exploratory effects of network social support Youth and Society

22482ndash534 [Reprinted National Prevention Evaluation Research

CollectionRockville MD Aspen 1993]Eggert L L Herting J R Thompson E A Nicholas L J Dicker

B G (1994) Preventing adolescent drug abuse and high school

dropout through an intensive school-based social network devel-

opment program American Journal of Health Promotion

8202ndash214Eggert L L Thompson E A Herting J R Nicholas L J (1995)

Reducing suicide potential among high-risk youth tests of a school-

based prevention program Suicide amp Life-Threatening Behavior

25276ndash296Ellickson P L Bell R M (1990) Drug prevention in junior high a

multi-site longitudinal test Science 2471299ndash1305Elliott D S (Series ed) (2003) Blueprints for violence prevention

Boulder CO Institute of Behavioral Science Regents of the

University of Colorado wwwcoloradoeducspvblueprints

2006 Sussman et al

ORDER REPRINTS

Farrell A D Danish S J (1993) Peer drug associations and emotionalrestraint Causes or consequences of adolescent drug use Journal ofConsulting and Clinical Psychology 61327ndash334

Festinger L A (1957) A Theory of Cognitive Dissonance New YorkHarper amp Row

Fuqua J Stokols D Gress J Phillips K Harvey R (2004)Transdisciplinary collaboration as a basis for enhancing the scienceand prevention of substance use and abuse Substance Use ampMisuse

Giuliano J D (1994) A peer education program to promote the use ofconflict resolution skills among at-risk school-age males PublicHealth Reports 109158ndash169

Glynn K Levanthal H Hirschman R (1985) A cognitivedevelopmental approach to smoking prevention In Bell C SBattjes R eds Prevention research Deterring Drug Abuse AmongChildren and Adolescents Rockville MD NIDA ResearchMonograph 63

Glynn T J (1989) Essential elements of school-based smokingprevention programs Journal of School Health 59181ndash188

Goodman R M Burdine J N Meehan E McLeroy K R eds(1993) Community coalitions for health promotion Special issue ofHealth Education Research Theory and Practice 8309ndash453

Goodyear R D Newcomb M D Locke T F (2002) PregnantLatina teenagers psychosocial and developmental determinants ofhow they select and perceive the men who father their childrenJournal of Counseling Psychology 49187ndash201

Gordon R (1987) An operational classification of disease preventionIn Steinberg J A Silverman M M eds Preventing MentalDisorders Rockville MD DHHS 20ndash26

Graham J W Johnson C A Hansen W B Flay B R Gee M(1990) Drug use prevention programs gender and ethnicityevaluation of three seventh-grade project SMART cohortsPreventive Medicine 19305ndash313

Griffin K W Botvin G J Nichols T R Doyal M M (2003)Effectiveness of a universal drug abuse prevention approach foryouth at high risk for substance use initiation Preventive Medicine36(1)1ndash7

Hamilton S (August 20 2000) Views slowly changing on alternativeschools The Sacramento Bee 1ndash3

Hansen W B (1992) School-based substance abuse prevention a reviewof the state of the art in curriculum 1980ndash1990 Health EducationResearch 7403ndash430

Motivation Skills and Decision Making 2007

ORDER REPRINTS

Hansen W B Johnson C A Flay B R Graham J W Sobel J(1988) Affective and social influences approaches to the preventionof multiple substance abuse among seventh grade students resultsfrom project SMART Preventive Medicine 17135ndash154

Hansen W B Graham J W (1991) Preventing alcohol marijuanaand cigarette use among adolescents peer pressure and resistancetraining versus establishing conservative norms PreventiveMedicine 20414ndash430

Hawkins D H Catalano R F Miller J Y (1992) Risk andprotective factors for alcohol and other drug problems inadolescence and early adulthood Implications for substanceabuse prevention Psychological Bulletin 11254ndash105

Hawkins J D Catalano R F Kosterman R Abbott R Hill K G(1999) Preventing adolescent health-risk behaviors by strengthen-ing protection during childhood Archives of Pediatric amp AdolescentMedicine 153226ndash234

Heider F (1958) The Psychology of Interpersonal Relations New YorkWiley

Henggeler S W Pickrel S G Brondino M J Crouch J L (1996)Eliminating (almost) treatment dropout of substance abusing ordependent delinquents through home-based multisystemic therapyAmerican Journal of Psychiatry 153(3)427ndash428

Henggeler S W Melton G B Brondino M J Scherer D GHanley J H (1997) Multisystemic therapy with violent andchronic juvenile offenders and their families the role of treatmentfidelity in successful dissemination Journal of Consulting andClinical Psychology 65(5)821ndash833

Henggeler S W Schoenwald S K Borduin C M Rowland M DCunningham P B (1998) Multisystemic treatment of antisocialbehavior in children and adolescents New York The Guilford Press

Henggeler S W Pickrel S G Brondino M J (1999) Multisystemictreatment of substance-abusing and dependent delinquents out-comes treatment fidelity and transportability Mental HealthServices Residual 1(3)171ndash84

Johnson C A Pentz M A Weber M D Dwyer J H Baer NMacKinnon D P Hansen W B Flay B R (1990) Relativeeffectiveness of comprehensive community programming for drugabuse prevention with high-risk and low-risk adolescents Journalof Consulting and Clinical Psychology 58447ndash456

Kaftarian S J Hansen W B eds (1994) CSAP special issuecommunity partnership program Journal of Community Psychologypages 205

2008 Sussman et al

ORDER REPRINTS

Karoly P (1993) Mechanisms in self-regulation A systems view AnnualReview of Psychology 4423ndash51

Karoly P (1980) Person variables in therapeutic change and develop-ment In Karoly P Steffen J J eds Improving the Long-TermEffects of Psychotherapy New York Gardner Press 195ndash261

Kendall P C Braswell L (1982) Cognitive-behavioral self-controltherapy for children a components analysis Journal of Consultingand Clinical Psychology 50672ndash689

Kerr M Tremblay R E Pagani L Vitaro F (1997) Boysrsquobehavioral inhibition and the risk of later delinquency Archivesof General Psychiatry 54809ndash816

Klein N C Alexander J F Parsons B V (1977) Impact of familysystems intervention on recidivism and sibling delinquency a modelof primary prevention and program evaluation Journal ofConsulting and Clinical Psychology 45(3)469ndash474

Kumpfer K L (1999) Outcomes measures of interventions in the studyof children of substance-abusing parents Pediatrics 1031128ndash1144

Lau R R Hartman K A Ware J E (1986) Health as a valuemethodological and theoretical considerations Health Psychology525ndash43

Lichtenstein E L Glasgow R E (1997) A pragmatic framework forsmoking cessation implications for clinical and public healthprograms Psychology of Addictive Behaviors 11142ndash151

Locke T F Newcomb M D (in press) Childhood maltreatmentparent drug problems polydrug problems and parenting practicesa test of gender differences and four theoretical perspectivesJournal of Family Psychology

McCreary D R Newcomb M D Sadava S W (1999) The male rolealcohol use and alcohol problems a structural modeling examina-tion in adult women and men Journal of Counseling Psychology46109ndash124

McGee L Newcomb M D (1992) General deviance syndromeexpanded hierarchical evaluations at four ages from earlyadolescence to adulthood Journal of Consulting amp ClinicalPsychology 60766ndash776

Miller W R Brown J M (1991) Self-regulation as a conceptual basisfor the prevention of addictive behaviours In Heather N MillerW R Greeley J eds Self-control and the Addictive BehavioursSydney Australia Maxwell Macmillan 3ndash79

Miller W R Leckman A L Delaney H D Tinkcom M (1993)Long-term follow-up of behavioral self-control training forproblem drinkers Journal of Studies on Alcohol 53249ndash261

Motivation Skills and Decision Making 2009

ORDER REPRINTS

Miller W R Rollnick S (1991) Motivational InterviewingPreparing People to Change Addictive Behavior New YorkGuilford Press

Moffitt T E Caspi A Harrington H Milne B J (2002) Males onthe life-course-persistent and adolescence-limited antisocial path-ways follow-up at age 26 years Development and Psychopathology14(1)179ndash207

National Institute on Drug Abuse (NIDA) (1997) Drug abuseprevention What works NIH Publication 97-4110 DHHSNational Institutes of Health National Institute on Drug AbuseOffice of Science Policy and Communications Rockville MD

Newcomb M D (1992a) Substance abuse and control in the UnitedStates ethical and legal issues Social Science and Medicine35471ndash479

Newcomb M D (1992b) Understanding the multidimensional nature ofdrug use and abuse The role of consumption risk factors andprotective factors In Glantz M D Pickens R eds Vulnerabilityto Drug Abuse Washington DC American PsychologicalAssociation 255ndash298

Newcomb M D (1996a) Pseudomaturity among adolescents constructvalidation sex differences and associations in adulthood Journalof Drug Issues 26477ndash504

Newcomb M D (1996b) Adolescence Pathologizing a normal processThe Counseling Psychologist 24482ndash490

Newcomb M D (1997) Psychosocial predictors and consequences ofdrug use a developmental perspective within a prospective studyJournal of Addictive Diseases 1651ndash89

Newcomb M D Bentler P M (1988) Consequences of Adolescent DrugUse Impact on the Lives of Young Adults Beverly Hills CA Sage

Newcomb M D Bentler P M (1989) Substance use and abuse amongchildren and teenagers American Psychologist 44242ndash248

Newcomb M D Harlow L L (1986) Life events and substance useamong adolescents Mediating effects of perceived loss of controland meaninglessness in life Journal of Personality and SocialPsychology 51564ndash577

Newcomb M D Chou C-P Bentler P M Huba G J (1988)Cognitive motivations for drug use among adolescents longitudinaltests of gender differences and predictors of change in drug useJournal of Counseling Psychology 35426ndash438

Newcomb M D Abbott R D Catalano R F Hawkins J DBattin-Pearson S R Hill K (2002) Mediational and deviancetheories of late high school failure Process roles of structural

2010 Sussman et al

ORDER REPRINTS

strains academic competence and general versus specific problem

behaviors Journal of Counseling Psychology 49172ndash186Nezami E Sussman S Pentz M A (2003) Motivation in tobacco use

cessation research Substance Use amp Misuse 3825ndash5Novak S P Clayton R R (2001) The influence of school environment

and self-regulation on transitions between stages of cigarette

smoking Health Psychology 20196ndash207Offord D R (2000) Selection of levels of prevention Addictive

Behaviors 25833ndash842Palinkas L A Atkins C J Miller C Ferreira D (1996) Social skills

training for drug prevention in high-risk female adolescents

Preventive Medicine 25692ndash701Patock-Peckham J A Cheong J-W Balhorn M E Nagoshi C T

(2001) A model of parenting styles self-regulation perceived

drinking control and alcohol use and problems Alcoholism

Experimental and Clinical Research 251284ndash1292Pentz M A (1994) Directions for future research in drug abuse

prevention Preventive Medicine 23646ndash652Pentz M A Dwyer J H MacKinnon D Flay B R Hansen W B

Wang E Y I Johnson C A (1989) A multi-community trial for

primary prevention of adolescent drug abuse effects on drug use

prevalence JAMA 2623259ndash3266Pentz M A Mares D Schinke S Rohrbach L (in press) Political

science public policy and drug abuse prevention Substance Use amp

MisuseProchaska J O DiClemente C C (1982) Transtheoretical therapy

toward a more integrative model of change Psychotherapy Theory

Research and Practice 19275ndash288Pulkkinen L Pitkanen T (1994) A prospective study of the precursors

to problem drinking in young adulthood Journal of Studies on

Alcohol 55578ndash587Rathus S A Nevid J S (1977) Behavior Therapy Strategies for

Solving Problems in Living New York Doubleday and Company

IncResnicow K Botvin G (1993) School-based substance use prevention

programs why do effects decay Preventive Medicine 22484ndash490Rutter M Dunn J Plomin R Simonoff E Pickles A Maughan

B Ormel J Meyer J Eaves L (1997) Integrating nature and

nurture implications of person-environment interactions for

developmental psychopathology Development and Psychopathology

9335ndash364

Motivation Skills and Decision Making 2011

ORDER REPRINTS

Salomon G Stein Y Eisenberg S Klein L (1984) Adolescent

smokers and nonsmokers profiles and their changing structure

Preventive Medicine 13446ndash461Sambrano S (1999) National cross-site evaluation of high risk youth

programs In Interim findings Bulletin Washington DC CSAP

SAMSHA US DHHS May 1ndash16Schinke S P Gilchrist L D (1985) Preventing substance abuse with

children and adolescents Journal of Consulting and Clinical

Psychology 53596ndash602Skara S N Sussman S (2003) A review of 25 long-term adolescent

tobacco and other drug use prevention program evaluations

Preventive MedicineSmith C Lizotte A J Thornberry T P Krohn M D (1995)

Resilient youth identifying factors that prevent high-risk youth

from engaging in delinquency and drug use Delinquency and

Disrepute in the Life Course Greenwich CT John Hagan JAI

press 217ndash247Sommers P V (1972) The Biology of Behavior Australia Pty ltd

Sydney John Wiley amp SonsSt Pierre T L Kaltreider D L Mark M M Aikin K J (1992)

Drug prevention in a community setting a longitudinal study of the

relative effectiveness of a three-year primary prevention program in

boys and girls clubs across the nation American Journal of

Community Psychology 20673ndash706Stein J A Newcomb M D Bentler P M (1987) An eight year study

of multiple influences on drug use and drug use consequences

Journal of Personality and Social Psychology 531094ndash1105Sully J (1884) Outlines of Psychology New York D Appleton amp CoSussman S (1989) Two social influence perspectives of tobacco use

development and prevention Health Education Research Theory

and Practice 4213ndash223Sussman S (1991) Curriculum development in school-based prevention

research Health Education Research Theory and Practice

6339ndash351Sussman S (1996) Development of a school-based drug abuse

prevention curriculum for high risk youth Journal of

Psychoactive Drugs 28169ndash182Sussman S Ames S L (2001) The social psychology of drug abuse

Buckingham GB Open University PressSussman S Unger J (2004) A drug abuse theoretical integration a

transdisciplinary speculation Substance Use amp Misuse

2012 Sussman et al

ORDER REPRINTS

Sussman S Dent C W Burton D Stacy A W Flay B R (1995a)

Developing school-based tobacco use prevention and cessation

programs Thousand Oaks CA Sage Publications IncSussman S Dent C W Simon T R Stacy A W Galaif E R

Moss M A Craig S Johnson C A (1995b) Effectiveness of

social influence substance abuse prevention curricula in compre-

hensive and continuation high schools Drugs and Society 865ndash81Sussman S Dent C W Galaif E R (1997) The correlates of

substance abuse and dependence among adolescents at high risk

for drug abuse Journal of Substance Abuse 9241ndash255Sussman S Dent C W Stacy A W (1996) The relation of pro-drug

use myths with self-reported drug use among youth at continuation

high schools Journal of Applied Social Psychology 26214ndash267Sussman S Dent C W Stacy A Craig S (1998) One-year outcomes

of project towards no drug abuse Preventive Medicine 27632ndash642

(erratum 766)Sussman S Dent C W Stacy S (2002) Project towards no drug

abuse a review of the findings and future directions American

Journal of Health Behavior 26354ndash365Sussman S McCuller W J Dent C W (2003) The associations of

social self-control personality disorders and demographics with

drug use among high risk youth Addictive Behaviors 281159ndash1166Sussman S Rohrbach L Patel R Holiday K (2003) A look at an

interactive classroom-based drug abuse prevention program

Interactive contents and suggestions for research Journal of Drug

Education 33355ndash368Sussman S Sun P McCuller W J Dent C W (2003) Project

towards no drug abuse two year outcomes of a trial that compares

health educator delivery to self-instruction Preventive Medicine

37155ndash162Tarter R E Vanyukov M (1994) Alcoholism a developmental disorder

Journal of Consulting and Clinical Psychology 621096ndash1107Thornton T N Craft C A Dahlberg L L Lynch B S Baer K

(2000) Best Practices of Youth Violence Prevention A Sourcebook

for Community Action Atlanta GA Division of Violence

Prevention Centers for Disease Control and PreventionTobler N S (1986) Meta-analysis of 143 adolescent drug prevention

programs quantitative outcome of program participants compared to

a control or comparison group Journal of Drug Issues 16537ndash567Tobler N S Roona M R Ochshorn P Marshall D G Streke

A V Stackpole K M (2000) School-based adolescent drug

Motivation Skills and Decision Making 2013

ORDER REPRINTS

prevention programs 1998 Meta-analysis The Journal of Primary

Prevention 20275ndash336US Department of Health and Human Services (USDHHS) (2003)

Substance Abuse andMental Health Services Administration Center

for Substance Abuse Prevention Science-based prevention programs and

principles 2002 Rockville MD US DHHS (SMA)03-3764 Also

see httpmodelprogramssamhsagovUnger J Baezconde-Garbanati L Shakib S Palmer P H Nezami

E Mora J (2004) What are the implications of structuralcultural

theory for drug abuse prevention Substance Use amp MisuseUpshaw H S Ostrom T M (1984) Psychological perspective in

attitude research In Eiser J R ed Attitudinal Judgment New

York Springer-Verlag 23ndash42Valente T W Gallaher P Mouttapa M (2004) Using social network

theory to understand and prevent substance use a transdisciplinary

perspective Substance Use amp MisuseVorrath H Brendtro L (1985) Positive peer culture 2nd edn Aldine

ChicagoWaldron H B Slesnick N Brody J L Turner C W Peterson T R

(2001) Treatment outcomes for adolescent substance abuse at 4-

and 7-month assessments Journal of Consulting amp Clinical

Psychology 69(5)802ndash813Watson D L Tharp R G (2002) Self-directed behavior Self-

modification for personal adjustment 8th edn Belmont CA

WadsworthWeissberg R P Caplan M Z Sivo P J (1989) A new conceptual

framework for establishing school-based social competence promo-

tion programs In Bond L A Compas B E eds Primary

Prevention amp Promotion in the Schools Newbury Park CA Sage

255ndash296Wills T A (1986) Stress and coping in early adolescence relationships

to substance use in urban school samples Health Psychology

5503ndash529Wills T A Cleary S D (1995) Stress-coping model for alcohol-

tobacco interactions in adolescence In Fertig J B Allen J P

eds Alcohol and Tobacco From Basic Science to Clinical Practice

Bethesda MD National Institute on Alcohol Abuse and

Alcoholism 107ndash128Wills T A Cleary S D (1999) Peer and adolescent substance use

among 6thndash9th graders Latent growth analyses of influence versus

selection mechanisms Health Psychology 18453ndash463

2014 Sussman et al

ORDER REPRINTS

Wills T A Hirky A E (1996) Coping and substance abuse InZeidner M Endler N S eds Handbook of Coping TheoryResearch and Applications New York Wiley 279ndash302

Wills T A Stoolmiller M (2002) The role of self-control in earlyescalation of substance use a time-varying analysis Journal ofConsulting and Clinical Psychology 70986ndash997

Wills T A Baker E Botvin G J (1989) Dimensions of assertivenessdifferential relationships to substance use in early adolescenceJournal of Consulting and Clinical Psychology 57(4)473ndash478

Wills T A Vaccaro D McNamara G (1994) Novelty seeking risktaking and related constructs as predictors of adolescent substanceuse an application of Cloningerrsquos theory Journal of SubstanceAbuse 61ndash20

Wills T A McNamara G Vaccaro D Hirky A E (1996a)Escalated substance use a longitudinal grouping analysis fromearly to middle adolescence Journal of Abnormal Psychology105166ndash180

Wills T A Pierce J P Evans R I (1996b) Large-scale environmentalrisk factors for substance use American Behavioral Scientist39808ndash822

Wills T A Windle M Cleary S D (1998) Role of temperamentnovelty-seeking and self-control in adolescent substance useJournal of Personality and Social Psychology 74387ndash406

Wills T A Sandy J M Shinar O (1999) Substance use level andproblems in late adolescence a mediational model based on self-control and coping motives Experimental and ClinicalPsychopharmacology 7122ndash134

Wills T A Cleary S D Filer M Shinar O Mariani J Spera K(2001) Temperament and self-control related to early-onsetsubstance use test of a developmental model Prevention Science2145ndash163

Wills T A Sandy J M Yaeger A (2002) Moderators of therelationship between substance use level and problems test of aself-regulation model in adolescence Journal of AbnormalPsychology 1113ndash21

Wills T A Gibbons F X Gerrard M Murry V Brody G (in press-a) Family communication and religiosity related to substance useand sexual behavior in early adolescence Psychology of AddictiveBehaviors

Wills T A Resko J Ainette M Mendoza D (in press-b) The role ofparent and peer support in adolescent substance use a test ofmediated effects Psychology of Addictive Behaviors

Motivation Skills and Decision Making 2015

ORDER REPRINTS

Young P T (1936) Motivation of Behavior New York John Wiley andSons

Zimmerman B J (2000) Attaining self-regulation a social cognitivemodel In Boekaerts M Pintrich P R eds Handbook of Self-Regulation San Diego Academic Press 13ndash39

2016 Sussman et al

Request PermissionOrder Reprints

Reprints of this article can also be ordered at

httpwwwdekkercomservletproductDOI101081JA200034769

Request Permission or Order Reprints Instantly

Interested in copying and sharing this article In most cases US Copyright Law requires that you get permission from the articlersquos rightsholder before using copyrighted content

All information and materials found in this article including but not limited to text trademarks patents logos graphics and images (the Materials) are the copyrighted works and other forms of intellectual property of Marcel Dekker Inc or its licensors All rights not expressly granted are reserved

Get permission to lawfully reproduce and distribute the Materials or order reprints quickly and painlessly Simply click on the Request Permission Order Reprints link below and follow the instructions Visit the US Copyright Office for information on Fair Use limitations of US copyright law Please refer to The Association of American Publishersrsquo (AAP) website for guidelines on Fair Use in the Classroom

The Materials are for your personal use only and cannot be reformatted reposted resold or distributed by electronic means or otherwise without permission from Marcel Dekker Inc Marcel Dekker Inc grants you the limited right to display the Materials only on your personal computer or personal wireless device and to copy and download single copies of such Materials provided that any copyright trademark or other notice appearing on such Materials is also retained by displayed copied or downloaded as part of the Materials and is not removed or obscured and provided you do not edit modify alter or enhance the Materials Please refer to our Website User Agreement for more details

ORDER REPRINTS

(Wills et al 1989) Also there are cultural variations on what constitutesgood social skill (Unger et al 2004) There are good arguments forplacing high-risk teens together in activities with well-controlled teens sothat they can model adaptive social skills and problem solvingAdditionally utilizing motivation methods prior to instructing thespecific skill channels canalizes health-directed use of social skillsmastered Overall increasing social competence will have protectiveeffects for high-risk teens (Wills et al 1994) This idea is consistent withthe studies that have shown social withdrawal to increase risk for druguse (Kerr et al 1997) though there may be gender differences in theseeffects (Pulkkinen and Pitkanen 1994) Still it is most wise to includesocial skills training in conjunction with material addressing motivationand decision making Motivations regarding drug use need to beaddressed so behaviors learned are not misdirected

Resource Acquisition

Adults often assume that teens can access community services withlittle effort In fact few teens understand the availability of healthservices or other assistance Simple information including phonenumbers and locations can assist teens immensely (Carroll 1996Sussman et al 2002) Coaching teens on techniques for receivingassistance can prove productive Public assistance for drug use-relatedproblems and other life problems can help tremendously but negotiatingthe bureaucratic difficulties inherent in many of these systems can requireconsiderable skill (Eggert and Herting 1991 Sambrano May 1999Sussman et al 2002) Direct instruction modeling and structuredpractice in resource acquisition skills may help youth to increase theirknowledge and self-efficacy on how to acquire resources and to readilyaccess resources when needed (eg use of the bus system) These skillsmay generalize to comparable tasks later in life

Decision-Making

Prevention programs have employed several decision-making strate-gies For example the protocol from Project Reconnecting Youth(Project RY) is STEPS The acronym stands for Stop Think ofoptions Evaluate options Perform or take action on the chosen optionand then Self-praise for using steps for making healthy choices (Eggertand Herting 1991) The participants help set the agenda and take turns

1994 Sussman et al

ORDER REPRINTS

illustrating it on a flip chart This task helps share the leadership andfocuses the group work and time The lesson STEPS to Drug UseControl follows skills training sessions that cover understandingSTEPS as a decision-making model

Project Towards No Drug Abuse (TND)rsquos decision-making sessioninvolves four steps These steps are

1 Brainstorming (making a list of ideas without judging them)2 Weigh the pros and cons (the benefits and costs of each idea)3 Select the best option4 Follow through (try that option and reevaluate the decision)

(Sussman et al 2002)

These decision-making strategies are similar across different pro-grams except that they include some different emphases For exampleSTEPS includes a self-instruction to begin decision making and self-praise whereas the TND sequence includes more of an emphasis onfollowing through with the decision Generally each program requiresgenerating options evaluating them choosing the best and evaluatingthe outcome in an effort to make the next decision Teens tend to enjoypracticing decision making in bogus problem situations Youth soonlearn to engage in steps like these with considerable skill Training indecision making operates on variables that are intermediate in the causalprocess and thereby strengthen individual profiles of self-controlabilities so that they are more resilient in the face of proximal riskfactors for drug use such as life stresses and peer pressures

Modalities of Programming

Both school and nonschool prevention modalities have a rich andimportant history in substance abuse prevention research (Pentz 1994Pentz et al 2004) Schools provide a captive audience for educationalmaterial Youth spend 25 of their waking lives at school so thisenvironment has considerable potential Furthermore the school contextprovides a rich research history for building new studies and evaluatingtheir efficacy (Sussman et al 1995a) Community programs also offerconsiderable opportunity

Community programs often involve local leaders and organizations(eg coalitions community boards) (Goodman et al 1993 Kaftarianand Hansen 1994) that help mobilize numerous community unitsCommunity units include businesses media the family and governmental

Motivation Skills and Decision Making 1995

ORDER REPRINTS

agencies like the police or recreational departments as well as schoolsystems A network of community units working together to developpromote and implement educational programming could increase youthsrsquobonding to others across a wide variety of social contexts (Hawkins et al1992 Pentz 1994) Community units can provide numerous types ofspecific extra-classroom prevention opportunities (Pentz 1994)

Parent-or-family targeted prevention programs include offering earlychildhood education social support for parents managing crisesparenting skills training parent-child communication skills and resourceacquisition instruction or networking Mass media targeted programsinvolve programs or public service announcements with novel fastand unconventional messages (eg the American Legacy FoundationTRUTH campaign) use of the Internet and interactive CDs (eg videogames) Alternative means to involve youth include involvement in hikingclubs drug-free dances or other after-school events with prosocial adultmentors and with means to involve youth outside of school includingentry into different environments (ie outward bound) (Tobler 1986) Inaddition policy implementation and enforcement may contribute toother prevention programs (Pentz et al 1989) Indeed simultaneousprograms within and outside of schools over long periods might maintainthe positive effects that sometimes dissipate when school programsappear alone (Pentz 1994)

The Difference Between Targeted Prevention and Cessation

Targeted (secondary) prevention attempts to keep persons fromcrossing the invisible line where they funnel into a cycle of addiction andaccumulation of negative consequences Cessation programs (sometimesreferred to as tertiary prevention) take the stance that a behavior hasoccurred with definite and perhaps irreversible negative consequencesThe goal is to stop the behavior permit recovery from the damage learnhow to prevent relapse and learn how to live with permanent changes(eg neurotransmitter function drug use-related injury) It is not clearexactly where indicated prevention ends however and where cessationbegins For example an early version of the Project TND curriculum didnot achieve effects on cigarette smoking possibly because 46 of thesample already smoked cigarettes daily (while not engaging often in someother drug use) In a revised curriculum a smoking cessation componentwas added to the program and then an effect on cigarette smoking wasachieved Cessation material can appear with prevention material to

1996 Sussman et al

ORDER REPRINTS

maximize program effectiveness Careful program development can helpdetermine the best mix (Sussman et al 2002)

Summary of Evidence-based Targeted Drug Abuse Prevention

At present approximately 29 drug-use prevention programs havebeen evaluated favorably for their effects on drug use or other problembehavior (see Table 1) These 29 programs have been identified throughtwo sources Blueprints for Violence Prevention (Elliott 2003) and theSubstance Abuse and Mental Health Services Administrationrsquos(SAMSHA) science-based prevention programsrsquo guide (USDHHS2003) PsycINFO and MEDLINE searches of drug abuse preventionstudies since 1970 supplemented searches through these two guides (seeTable 1) Nine definitions of high-risk were used across these programsEleven programs focused on economic deprivation as the definition Sixprograms focused on delinquent behavior as the identifying characteristicto target Two programs each identified single-parent homes drug use orexposure to drug use family problems alternative high school attendanceor being at risk for dropout at a regular high school as the characteristicsto target subjects Finally one program each identified new immigrantstatus or residential facility placement as the defining characteristic ofbeing at high risk for drug use

Among these programs eight focused on preteens For example theEarly Risers program defined its high-risk youth as those 6ndash10 year-oldsthat suffered economic deprivation and exhibited aggressive or opposi-tional behavior Another five programs focused on a young teen agegroup For example Preventive Intervention defined its high-risk youthas those seventh to eighth graders who exhibited poor school andacademic discipline and reported family problems Another sevenprograms focused on an older teen age group For example ProjectTND defined its high-risk youth as those youth that attended alternativehigh schools Finally nine programs encompassed wide age ranges Forinstance Big Brothers Big Sisters of America defined its high-risk youthas 6ndash18 year-olds that lived in single-parent homes

Of these programs 10 involved multiple often flexible settings ofimplementation Another 13 programs focused on the school settingFour programs focused on the home setting Finally two programsfocused on a community agency setting In general these programsinvolved implementation by highly trained personnel Eighteen of theseprograms involved some motivation aspect generally motivationenhancement but sometimes including extrinsic reinforcement strategies

Motivation Skills and Decision Making 1997

ORDER REPRINTS

Twenty-six of these programs provided skills training Finally 18programs provided instruction in decision making Thus the MSDmodel tends to appear in a majority of these programs however all threecomponents were included together in only nine of these programs

Twenty of these programs involved at least one replication of theprogram and 14 involved three or more replications Further 14 of theseprograms were tested through use of experimental designs and nineinvolved use of only quasi-experimental designs Effects on drug use wereassessed and found in 22 of these programs For example theReconnecting Youth program was implemented to youth at risk fordropout This program involved 90 sessions within a comprehensive highschool class delivered generally over a semester with small studentgroups and a highly trained teacher Instruction included use of groupsupport and providing life skills training (norm setting self-esteem moodmanagement communication skills self-monitoring monitoring goalsschool bonding and social activities) with feedback to parents Programgoals were achieved through use of a quasi-experimental design showingeffects for school performance (18 improvement in grades) drug use(54 decrease in hard drug use) and suicide risk (32 decline inperceived stress) This programrsquos results have been replicated numeroustimes in numerous locations This program involved all three componentsof the MSD model except that motivation was provided through peergroup support not through provision motivation enhancement strate-gies These targeted programs present an optimistic picture for drug-useprevention that is focused on at-risk youth (see Table 1)

Not all targeted prevention programs have been found to beeffective One published program that failed to find positive effects wasProject PALS (Palinkas et al 1996) This project was developed for teengirls who were pregnant or at risk for pregnancy and drug use Theprogram consisted of school-based delivery of 16 sessions once a weekin a class The goal was to decrease drug use The PALS Skills TrainingProgram involved instruction in assertiveness providing and receivingfeedback social conversation handling requests and asking for help andmood management This program was tested against a normativeeducation program (called Facts of Life or FOL) which instructedvalues and decision making sexuality issues and contraception sexuallytransmitted diseases (STDs) drug use risks sexual assault prevalenceand norms material An experimental evaluation with a seven-monthspost-baseline was used The results indicated that the PALS programsubjects reported 29 times greater marijuana use than FOL amongbaseline nonusers No other differences were found It is possible that theprogram was not targeted to the right population that the mix of skills

1998 Sussman et al

ORDER REPRINTS

instructed was not appropriate or that skill training alone (withoutappropriate motivation material) may not be effective in drug useprevention Researchers should examine these possibilities and others tofurther understand program failures as well as program successes

Potential Limitations of Targeted Prevention

Dishion and colleagues (1995) suggest from various findings thatgrouping high-risk youth may lead to increased drug use This outcomecan result if youth come to learn deviant behavior from each other Theycan learn deviant behavior from each other in a program if they haveunstructured or unsupervised time together An essential feature ofseveral targeted programs (eg the RY and TND programs) is building apositive peer culture with group norms that decrease drug involvementand drug-use control problems The RYrsquos findings suggest that a positivepeer group component carefully fostered by a well-trained and competentRY group leader can direct the group toward lower risk behaviorSimilarly classroom management in Project TND involves developmentof positive norms of classroom behavior Further interaction betweenyouth is encouraged but is primarily teacher-directed and highlystructured (Sussman et al 2003) In both RY and Project TND theteacherrsquos role is to actively develop and maintain peer group support inthe class by modeling support positively reinforcing it among groupmembers and negatively reinforcing deviant peer bonds and activities(Eggert and Herting 1991 Vorrath and Brendtro 1985) The teachercreates and structures interactions among youth in prosocial directions(Sussman et al 2003)

Multiple Problem Behaviors of Adolescents

Acknowledging the relationship of drug use to other commonadolescent problems may facilitate identification of effective methods ofreducing drug use Researchers on tobacco alcohol and other drug useantisocial behavior high-risk sexual behavior and depression increas-ingly recognize that these problems are interrelated (McGee andNewcomb 1992) and stem to a large extent from the same environ-mental and biological factors (Biglan et al in press Eggert et al 1995Sussman and Ames 2001 Wills and Cleary 1995) Clearly it is necessaryto have strategies that address the entire range of problems and thecontext that influences those problems Indeed further reductions in

Motivation Skills and Decision Making 1999

ORDER REPRINTS

many problems require that we comprehensively target youth withmultiple problem behaviors

Biglan and colleagues (in press) provide a comprehensive review ofthe relationships among antisocial behavior tobacco alcohol and otherdrug use and high-risk sexual behavior It is clear that the same youngpeople are prone to the development of the entire range of problems In arecent review Moffitt and colleagues (2002) found that antisocialbehavior in early adolescence (rather than late adolescence) is a greaterrisk factor for developing multiple problems These findings point to theimportance of early intervention before youth develop serious problemsMoreover these different problems largely result from the same set ofenvironmental and biological factors

One implication is that disciplines dealing with these problemsother than drug abuse may contribute to dealing with the problem ofdrug use (Newcomb 1996b 1997) In particular research by dev-elopmental psychologists family social workers and sociologists onthe influence of parents on adolescent problem development and oninterventions to alter parenting practices contributes to our understandingof how to prevent or ameliorate drug abuse and other problems Onealso should note that nonsubstance use is not a guarantee for problemimmunity for the entire age range of people whatever their genderethnicity religiosity socioeconomic status (SEC) domicility etc It maybe argued that the most promising programs are those targeting thesemultiple levels of influence Several multidisciplinary programs haveachieved promising results We describe three of these empiricallyevaluated programs tested in various settings

Functional Family Therapy (FFT)FFT is an indicated intervention involving family treatment designed

for delinquent teenagers (also see Table 1) Developed in the early 1970sby Alexander and colleagues (1973) FFT focuses on family commu-nication and the establishment of rules and consequences Several studiesprovide encouraging reports of the programrsquos effectiveness (Alexander etal 1976 Barton et al 1985 Klein et al 1977 Waldron et al 2001) Inthe Waldron et al (2001) study researchers used FFT and anintervention with cognitive behavior therapy on teens referred formarijuana use Each of the interventions produced significant resultson marijuana use by the teens at four months but only the twointerventions combined maintained these results at seven months Theearlier studies found a greater number of results For example in the twoAlexander studies (1973 1976) improvement in family communicationposttreatment led to reduced delinquency Note that all the teens in these

2000 Sussman et al

ORDER REPRINTS

studies had histories of serious antisocial or delinquent behavior Thusachieving positive outcomes even if only short-term should encouragefurther research into the efficacy of FFT

Multisystemic Therapy (MST)As its name suggestsMST targets individual family peer school and

community influences of those youth offenders with serious problems thatmay include violence substance use and severe emotional problems (alsosee Table 1) Numerous researchers have published the results ofrandomized trials of MST (Henggeler et al 1996 1997 1998 Thorntonet al 2000) The most consistent findings across studies are decreased (1)drug use (2) re-arrest (3) self-reported criminal offense and (4) days inout-of-home placements Other consistent findings are improved familyrelations school attendance and psychiatric functioning One cautionarynote the programrsquos effectiveness lowers considerably if not implementedwith fidelity (Hengler et al 1997 1999) In other words all or key lessonsneed to be delivered as written by educators who are well-trained in usingthe strategies employed and youth need to be able to receive all material inan atmosphere conducive to learning the material The programdevelopers have instituted training strategies that address these fidelityissues thus shaping MST to be a very promising program for at-riskyouth

Multidimensional Treatment Foster Care (MTFC)MTFC targets family and peer factors influencing adolescents with a

pattern of repeat criminal offending (see Table 1) (Chamberlain 1994)This intervention includes placement of the youth into a foster homewith a foster parent trained in behavior management who receivessupport from intervention staff After the adolescent has begun torespond to the intervention in the foster home and after the parents havereceived the same training and support as the foster parents did theadolescent returns home Chamberlain and Reid (1998) tested theintervention with 85 boys with felony and other criminal histories andfound substantial benefits of the program Following treatment the boysassigned to MTFC (compared to those receiving community-based groupcare) showed fewer days in detention or lock-up twice as much timeliving with parents fewer misdemeanor and felony arrests and fewer self-reported index crimes felony arrests and general delinquency TheMTFC is a cost-effective alternative to incarceration however staffrequirements are extensive which may influence the ability of some

Motivation Skills and Decision Making 2001

ORDER REPRINTS

groups to apply the program with fidelity However as with each of theprograms described here the results of the randomized trials areencouraging

Future Research Needs in Targeted Prevention

Future research can help discern when and where targeted preventionprogramming will tend to work rather than produce potentiallydeleterious negative group effects or results that are irrelevant for pro-social healthy adaptation as well as what the critical necessary conditionsare for their effective operation within given de facto realities Comparedto the breadth of evaluated universal drug use prevention programs(Tobler et al 2000) relatively few targeted prevention programs havereceived empirical support Yet previous research suggests that universalschool-based drug use prevention programs implemented in junior highschool have relatively less chance of long-term success especially for thoseyouth that began using drugs before the prevention program wasimplemented Of course there are notable exceptions (eg effects lastedfor one and a half years effects lasted for six years) (Chou et al 1998Griffin et al 2003 Skara and Sussman 2003) Almost no research existsregarding maximization of booster programming with high-risk youthMore research on booster programs would help the field

While continuing to engage in this work there will be numerousissues to manage that go well beyond the scope of this article There willbe a need to avoid producing negative labeling effects while providingprogramming for those who are at risk for drug use It is possible thatcessation information needs to be included in the mix with preventionmaterial to provide better targeted-prevention effects There may be aneed to develop a teacher selection instrument to help select out teacherswho can deliver drug abuse prevention programming adequatelyCertainly definition of outcome variables needs continued explorationincluding analysis to ascertain the effects of programming on drug abusevs drug use and identification of the variables that are most closelylinked to change by targeted prevention components

A transdisciplinary approach helps to better understand the lifesituation of high-risk youth as based to some extent on both constitutionaland environmental factors (Fuqua et al 2004 Rutter et al 1997 Wills etal 1996b) From the transactional perspective their situation is in partconstitutional they may have temperamental characteristics that arepartly heritable and that have set the stage at earlier ages for decrements inself-control ability and academic performance that then increase risk for

2002 Sussman et al

ORDER REPRINTS

drug use However their situation is also part environmental based in parton family socialization and in part on the types of peers they have as well asthe type and quality of the physical and cultural environment-at-largeThere are many points at which a potential chain of failures can beinterrupted and the individualrsquos trajectory turned in a better directionProblems are not inevitable from starting level (Tarter and Vanyukov1994) and environmental modifications to support good self-controlability can help to avert an adverse impact from earlier experiences orcurrent difficulties (Brody et al 2002 Novak and Clayton 2001 Patock-Peckham et al 2001 Rutter et al 1997 Wills et al 2002)

The problems and needs of high-risk youth in our nationrsquos highschools demand our attention for designing and rigorously testingtargeted prevention approaches Substantial evidence shows that theseyouth are at greater risk for drug involvement and co-occurring problemssuch as aggression depression and suicidal behaviors as we previouslydiscussed It is hoped that the information presented in this article willstimulate others to join in extending this work including testing othermodels of targeted prevention

GLOSSARY

Universal programs Programs that aim to influence all subjects in acontext

Selective drug-abuse prevention programs Programs that servegroups at greater risk of ATOD usemdashfor example children of alcoholicparents They are at psychosocial risk for drug use and abuse

Indicated drug-abuse prevention programs Programs that attemptto benefit individuals who already show signs of drug involvement orrelated risk factors In indicated prevention programs the primary goal isto stem the progression of ATOD use or reduce drug involvementamong the high-risk youth

Targeted programming Programming that subsumes selective andindicated programming sometimes the other two types of programs thattarget specific groups lsquolsquoat riskrsquorsquo are considered together

ACKNOWLEDGMENTS

This research was supported by grants from the National Institute onDrug Abuse (DA01070 DA07601 DA13814 and DA16094) and by aResearch Scientist Development Award K02 DA00252 from theNational Institute on Drug Abuse

Motivation Skills and Decision Making 2003

ORDER REPRINTS

REFERENCES

Alexander J F Barton C Schiaro R S Parsons B V (1976)

Systems-behavioral intervention with families of delinquents

therapist characteristics family behavior and outcome Journal of

Consulting and Clinical Psychology 44(4)656ndash664Alexander J F Parsons B V (1973) Short-term behavioral interven-

tion with delinquent families impact on family process and

recidivism Journal of Abnormal Psychology 3219ndash225American psychiatric association (APA) (1994) Diagnostic and

Statistical Manual of Mental Disorders 4th edn (DSM-IV)

Washington DC American Psychiatric AssociationAmes S L Sussman S Dent C W (1999) Pro-drug-use myths and

competing constructs in the prediction of substance use among

youth at continuation high schools a one-year prospective study

Personality and Individual Differences 26987ndash1003Bachman S G Wadsworth K N OrsquoMalley P M Johnston L D

Schulenberg J E (1997) Smoking drinking and drug use in young

adulthood Mahwah NJ Lawrence Erlbaum Associates 8ndash25

153ndash190Bandura A (1986) Social Foundations of Thought and Action A Social

Cognitive Theory Englewood Cliffs NJ Prentice HallBarton C Alexander J F Waldron H Turner C W Warburton J

(1985) Generalizing treatment effects of functional family therapy

Three replications The American Journal of Family Therapy

13(3)16ndash26Battin-Pearson S R Newcomb M D Abbott R D Hill K G

Catalano R F Hawkins J D (2000) Predicting early high school

dropout Journal of Educational Psychology 92568ndash582Biglan A Brennan P A Foster S L Holder H D Miller T L

Cunningham P B et al (in press) Helping Adolescents at Risk

Prevention of Multiple Problem Behaviors New York NY Guilford

PressBindra D Stewart J (1996) Motivation Baltimore MD Penguin

BooksBlanton H Gibbons F X Gerrard M Conger K J Smith G E

(1998) The role of family and peers in the development of

prototypes associated with substance use Journal of Family

Psychology 11271ndash288

2004 Sussman et al

ORDER REPRINTS

Botvin G J (1993) School-based drug abuse prevention Long-termfollow-up results In First Annual Meeting of the Society forPrevention Research Kentuck Lexington Society for PreventionResearch

Botvin G J Baker E Dusenbury L Botvin E M Diaz T (1995)Long-term follow-up results of a randomized drug abuse preven-tion trial in a white middle-class population Journal of theAmerican Medical Association 2731106ndash1012

Brody G H Dorsey S Forehand R Armistead L (2002) Uniquecontributions of parenting and classroom processes to the self-control of AfricanndashAmerican children Child Development73274ndash286

Carroll M E (1996) Reducing drug abuse by enriching the environmentwith alternative nondrug reinforcers In Green L Kagel J Heds Advances in Behavioral Economics Norwood NJ NorwoodPublishing Corp 37ndash68

Carver C S Scheier M F (1998) On the Self-Regulation of BehaviorNew York Cambridge University Press

Catalano R F Hawkins J D (1996) The social developmental modela theory of antisocial behavior In Hawkins J D ed Delinquencyand Crime Current Theories New York Cambridge UniversityPress

Centers for Disease Control (CDC) (October 1999) Youth risk BehaviorSurveillancemdashNational Alternative High School Youth RiskBehavior Survey 1998 Morbidity and Mortality Weekly Report48 No SS-7

Chamberlain P (1994) Family connections A treatment foster caremodel for adolescents with delinquency Eugene OR CastaliaPublishing Company

Chamberlain P Reid J B (1998) Comparison of two communityalternatives to incarceration for chronic juvenile offenders Journalof Consulting and Clinical Psychology 66(4)624ndash633

Chassin L A Presson C C Sherman S J (1985) Stepping backwardin order to step forward an acquisition-oriented approach toprimary prevention Journal of Consulting and Clinical Psychology53612ndash622

Chou C-P Montgomery S Pentz M A Rohrbach L A JohnsonC A Flay B R MacKinnon D P (1998) Effects of acommunity-based prevention program on decreasing drug use inhigh-risk adolescentsAmerican Journal of Public Health 88944ndash948

Conducts Problems Prevention Research Group (CPPRG) (1999) Initialimpact of the fast track prevention trial for conduct problems I

Motivation Skills and Decision Making 2005

ORDER REPRINTS

The high-risk sample Journal of Consulting and Clinical Psychology

67631ndash647Conducts Problems Prevention Research Group (CPPRG) (2000)

Merging universal and indicated prevention programs the fast

track model Addictive Behaviors 25913ndash927Council of Philosophical Studies (1981) Psychology and the Philosophy

of Mind in the Philosophy Curriculum San Francisco San Francisco

State UniversityCummings K M Hellmann R Emont S L (1988) Correlates of

participation in a worksite stop smoking program Journal of

Behavioral Medicine 11267ndash277Curry S Wagner E H Gothaus L C (1990) Intrinsic and extrinsic

motivation for smoking cessation Journal of Consulting and

Clinical Psychology 58310ndash316Dent C W Sussman S McCuller W J Stacy A W (2001) Drug

abuse prevention among youth at comprehensive high schools

Preventive Medicine 32514ndash520Dewey J (1886) Psychology New York HarperDishion T J French D C Patterson G R (1995) The development

and ecology of antisocial behavior In Cicchetti D Cohen D

eds Manual of developmental psychopathology New York John

Wiley 421ndash471Eggert L L Herting J R (1991) Preventing teenage drug abuse

exploratory effects of network social support Youth and Society

22482ndash534 [Reprinted National Prevention Evaluation Research

CollectionRockville MD Aspen 1993]Eggert L L Herting J R Thompson E A Nicholas L J Dicker

B G (1994) Preventing adolescent drug abuse and high school

dropout through an intensive school-based social network devel-

opment program American Journal of Health Promotion

8202ndash214Eggert L L Thompson E A Herting J R Nicholas L J (1995)

Reducing suicide potential among high-risk youth tests of a school-

based prevention program Suicide amp Life-Threatening Behavior

25276ndash296Ellickson P L Bell R M (1990) Drug prevention in junior high a

multi-site longitudinal test Science 2471299ndash1305Elliott D S (Series ed) (2003) Blueprints for violence prevention

Boulder CO Institute of Behavioral Science Regents of the

University of Colorado wwwcoloradoeducspvblueprints

2006 Sussman et al

ORDER REPRINTS

Farrell A D Danish S J (1993) Peer drug associations and emotionalrestraint Causes or consequences of adolescent drug use Journal ofConsulting and Clinical Psychology 61327ndash334

Festinger L A (1957) A Theory of Cognitive Dissonance New YorkHarper amp Row

Fuqua J Stokols D Gress J Phillips K Harvey R (2004)Transdisciplinary collaboration as a basis for enhancing the scienceand prevention of substance use and abuse Substance Use ampMisuse

Giuliano J D (1994) A peer education program to promote the use ofconflict resolution skills among at-risk school-age males PublicHealth Reports 109158ndash169

Glynn K Levanthal H Hirschman R (1985) A cognitivedevelopmental approach to smoking prevention In Bell C SBattjes R eds Prevention research Deterring Drug Abuse AmongChildren and Adolescents Rockville MD NIDA ResearchMonograph 63

Glynn T J (1989) Essential elements of school-based smokingprevention programs Journal of School Health 59181ndash188

Goodman R M Burdine J N Meehan E McLeroy K R eds(1993) Community coalitions for health promotion Special issue ofHealth Education Research Theory and Practice 8309ndash453

Goodyear R D Newcomb M D Locke T F (2002) PregnantLatina teenagers psychosocial and developmental determinants ofhow they select and perceive the men who father their childrenJournal of Counseling Psychology 49187ndash201

Gordon R (1987) An operational classification of disease preventionIn Steinberg J A Silverman M M eds Preventing MentalDisorders Rockville MD DHHS 20ndash26

Graham J W Johnson C A Hansen W B Flay B R Gee M(1990) Drug use prevention programs gender and ethnicityevaluation of three seventh-grade project SMART cohortsPreventive Medicine 19305ndash313

Griffin K W Botvin G J Nichols T R Doyal M M (2003)Effectiveness of a universal drug abuse prevention approach foryouth at high risk for substance use initiation Preventive Medicine36(1)1ndash7

Hamilton S (August 20 2000) Views slowly changing on alternativeschools The Sacramento Bee 1ndash3

Hansen W B (1992) School-based substance abuse prevention a reviewof the state of the art in curriculum 1980ndash1990 Health EducationResearch 7403ndash430

Motivation Skills and Decision Making 2007

ORDER REPRINTS

Hansen W B Johnson C A Flay B R Graham J W Sobel J(1988) Affective and social influences approaches to the preventionof multiple substance abuse among seventh grade students resultsfrom project SMART Preventive Medicine 17135ndash154

Hansen W B Graham J W (1991) Preventing alcohol marijuanaand cigarette use among adolescents peer pressure and resistancetraining versus establishing conservative norms PreventiveMedicine 20414ndash430

Hawkins D H Catalano R F Miller J Y (1992) Risk andprotective factors for alcohol and other drug problems inadolescence and early adulthood Implications for substanceabuse prevention Psychological Bulletin 11254ndash105

Hawkins J D Catalano R F Kosterman R Abbott R Hill K G(1999) Preventing adolescent health-risk behaviors by strengthen-ing protection during childhood Archives of Pediatric amp AdolescentMedicine 153226ndash234

Heider F (1958) The Psychology of Interpersonal Relations New YorkWiley

Henggeler S W Pickrel S G Brondino M J Crouch J L (1996)Eliminating (almost) treatment dropout of substance abusing ordependent delinquents through home-based multisystemic therapyAmerican Journal of Psychiatry 153(3)427ndash428

Henggeler S W Melton G B Brondino M J Scherer D GHanley J H (1997) Multisystemic therapy with violent andchronic juvenile offenders and their families the role of treatmentfidelity in successful dissemination Journal of Consulting andClinical Psychology 65(5)821ndash833

Henggeler S W Schoenwald S K Borduin C M Rowland M DCunningham P B (1998) Multisystemic treatment of antisocialbehavior in children and adolescents New York The Guilford Press

Henggeler S W Pickrel S G Brondino M J (1999) Multisystemictreatment of substance-abusing and dependent delinquents out-comes treatment fidelity and transportability Mental HealthServices Residual 1(3)171ndash84

Johnson C A Pentz M A Weber M D Dwyer J H Baer NMacKinnon D P Hansen W B Flay B R (1990) Relativeeffectiveness of comprehensive community programming for drugabuse prevention with high-risk and low-risk adolescents Journalof Consulting and Clinical Psychology 58447ndash456

Kaftarian S J Hansen W B eds (1994) CSAP special issuecommunity partnership program Journal of Community Psychologypages 205

2008 Sussman et al

ORDER REPRINTS

Karoly P (1993) Mechanisms in self-regulation A systems view AnnualReview of Psychology 4423ndash51

Karoly P (1980) Person variables in therapeutic change and develop-ment In Karoly P Steffen J J eds Improving the Long-TermEffects of Psychotherapy New York Gardner Press 195ndash261

Kendall P C Braswell L (1982) Cognitive-behavioral self-controltherapy for children a components analysis Journal of Consultingand Clinical Psychology 50672ndash689

Kerr M Tremblay R E Pagani L Vitaro F (1997) Boysrsquobehavioral inhibition and the risk of later delinquency Archivesof General Psychiatry 54809ndash816

Klein N C Alexander J F Parsons B V (1977) Impact of familysystems intervention on recidivism and sibling delinquency a modelof primary prevention and program evaluation Journal ofConsulting and Clinical Psychology 45(3)469ndash474

Kumpfer K L (1999) Outcomes measures of interventions in the studyof children of substance-abusing parents Pediatrics 1031128ndash1144

Lau R R Hartman K A Ware J E (1986) Health as a valuemethodological and theoretical considerations Health Psychology525ndash43

Lichtenstein E L Glasgow R E (1997) A pragmatic framework forsmoking cessation implications for clinical and public healthprograms Psychology of Addictive Behaviors 11142ndash151

Locke T F Newcomb M D (in press) Childhood maltreatmentparent drug problems polydrug problems and parenting practicesa test of gender differences and four theoretical perspectivesJournal of Family Psychology

McCreary D R Newcomb M D Sadava S W (1999) The male rolealcohol use and alcohol problems a structural modeling examina-tion in adult women and men Journal of Counseling Psychology46109ndash124

McGee L Newcomb M D (1992) General deviance syndromeexpanded hierarchical evaluations at four ages from earlyadolescence to adulthood Journal of Consulting amp ClinicalPsychology 60766ndash776

Miller W R Brown J M (1991) Self-regulation as a conceptual basisfor the prevention of addictive behaviours In Heather N MillerW R Greeley J eds Self-control and the Addictive BehavioursSydney Australia Maxwell Macmillan 3ndash79

Miller W R Leckman A L Delaney H D Tinkcom M (1993)Long-term follow-up of behavioral self-control training forproblem drinkers Journal of Studies on Alcohol 53249ndash261

Motivation Skills and Decision Making 2009

ORDER REPRINTS

Miller W R Rollnick S (1991) Motivational InterviewingPreparing People to Change Addictive Behavior New YorkGuilford Press

Moffitt T E Caspi A Harrington H Milne B J (2002) Males onthe life-course-persistent and adolescence-limited antisocial path-ways follow-up at age 26 years Development and Psychopathology14(1)179ndash207

National Institute on Drug Abuse (NIDA) (1997) Drug abuseprevention What works NIH Publication 97-4110 DHHSNational Institutes of Health National Institute on Drug AbuseOffice of Science Policy and Communications Rockville MD

Newcomb M D (1992a) Substance abuse and control in the UnitedStates ethical and legal issues Social Science and Medicine35471ndash479

Newcomb M D (1992b) Understanding the multidimensional nature ofdrug use and abuse The role of consumption risk factors andprotective factors In Glantz M D Pickens R eds Vulnerabilityto Drug Abuse Washington DC American PsychologicalAssociation 255ndash298

Newcomb M D (1996a) Pseudomaturity among adolescents constructvalidation sex differences and associations in adulthood Journalof Drug Issues 26477ndash504

Newcomb M D (1996b) Adolescence Pathologizing a normal processThe Counseling Psychologist 24482ndash490

Newcomb M D (1997) Psychosocial predictors and consequences ofdrug use a developmental perspective within a prospective studyJournal of Addictive Diseases 1651ndash89

Newcomb M D Bentler P M (1988) Consequences of Adolescent DrugUse Impact on the Lives of Young Adults Beverly Hills CA Sage

Newcomb M D Bentler P M (1989) Substance use and abuse amongchildren and teenagers American Psychologist 44242ndash248

Newcomb M D Harlow L L (1986) Life events and substance useamong adolescents Mediating effects of perceived loss of controland meaninglessness in life Journal of Personality and SocialPsychology 51564ndash577

Newcomb M D Chou C-P Bentler P M Huba G J (1988)Cognitive motivations for drug use among adolescents longitudinaltests of gender differences and predictors of change in drug useJournal of Counseling Psychology 35426ndash438

Newcomb M D Abbott R D Catalano R F Hawkins J DBattin-Pearson S R Hill K (2002) Mediational and deviancetheories of late high school failure Process roles of structural

2010 Sussman et al

ORDER REPRINTS

strains academic competence and general versus specific problem

behaviors Journal of Counseling Psychology 49172ndash186Nezami E Sussman S Pentz M A (2003) Motivation in tobacco use

cessation research Substance Use amp Misuse 3825ndash5Novak S P Clayton R R (2001) The influence of school environment

and self-regulation on transitions between stages of cigarette

smoking Health Psychology 20196ndash207Offord D R (2000) Selection of levels of prevention Addictive

Behaviors 25833ndash842Palinkas L A Atkins C J Miller C Ferreira D (1996) Social skills

training for drug prevention in high-risk female adolescents

Preventive Medicine 25692ndash701Patock-Peckham J A Cheong J-W Balhorn M E Nagoshi C T

(2001) A model of parenting styles self-regulation perceived

drinking control and alcohol use and problems Alcoholism

Experimental and Clinical Research 251284ndash1292Pentz M A (1994) Directions for future research in drug abuse

prevention Preventive Medicine 23646ndash652Pentz M A Dwyer J H MacKinnon D Flay B R Hansen W B

Wang E Y I Johnson C A (1989) A multi-community trial for

primary prevention of adolescent drug abuse effects on drug use

prevalence JAMA 2623259ndash3266Pentz M A Mares D Schinke S Rohrbach L (in press) Political

science public policy and drug abuse prevention Substance Use amp

MisuseProchaska J O DiClemente C C (1982) Transtheoretical therapy

toward a more integrative model of change Psychotherapy Theory

Research and Practice 19275ndash288Pulkkinen L Pitkanen T (1994) A prospective study of the precursors

to problem drinking in young adulthood Journal of Studies on

Alcohol 55578ndash587Rathus S A Nevid J S (1977) Behavior Therapy Strategies for

Solving Problems in Living New York Doubleday and Company

IncResnicow K Botvin G (1993) School-based substance use prevention

programs why do effects decay Preventive Medicine 22484ndash490Rutter M Dunn J Plomin R Simonoff E Pickles A Maughan

B Ormel J Meyer J Eaves L (1997) Integrating nature and

nurture implications of person-environment interactions for

developmental psychopathology Development and Psychopathology

9335ndash364

Motivation Skills and Decision Making 2011

ORDER REPRINTS

Salomon G Stein Y Eisenberg S Klein L (1984) Adolescent

smokers and nonsmokers profiles and their changing structure

Preventive Medicine 13446ndash461Sambrano S (1999) National cross-site evaluation of high risk youth

programs In Interim findings Bulletin Washington DC CSAP

SAMSHA US DHHS May 1ndash16Schinke S P Gilchrist L D (1985) Preventing substance abuse with

children and adolescents Journal of Consulting and Clinical

Psychology 53596ndash602Skara S N Sussman S (2003) A review of 25 long-term adolescent

tobacco and other drug use prevention program evaluations

Preventive MedicineSmith C Lizotte A J Thornberry T P Krohn M D (1995)

Resilient youth identifying factors that prevent high-risk youth

from engaging in delinquency and drug use Delinquency and

Disrepute in the Life Course Greenwich CT John Hagan JAI

press 217ndash247Sommers P V (1972) The Biology of Behavior Australia Pty ltd

Sydney John Wiley amp SonsSt Pierre T L Kaltreider D L Mark M M Aikin K J (1992)

Drug prevention in a community setting a longitudinal study of the

relative effectiveness of a three-year primary prevention program in

boys and girls clubs across the nation American Journal of

Community Psychology 20673ndash706Stein J A Newcomb M D Bentler P M (1987) An eight year study

of multiple influences on drug use and drug use consequences

Journal of Personality and Social Psychology 531094ndash1105Sully J (1884) Outlines of Psychology New York D Appleton amp CoSussman S (1989) Two social influence perspectives of tobacco use

development and prevention Health Education Research Theory

and Practice 4213ndash223Sussman S (1991) Curriculum development in school-based prevention

research Health Education Research Theory and Practice

6339ndash351Sussman S (1996) Development of a school-based drug abuse

prevention curriculum for high risk youth Journal of

Psychoactive Drugs 28169ndash182Sussman S Ames S L (2001) The social psychology of drug abuse

Buckingham GB Open University PressSussman S Unger J (2004) A drug abuse theoretical integration a

transdisciplinary speculation Substance Use amp Misuse

2012 Sussman et al

ORDER REPRINTS

Sussman S Dent C W Burton D Stacy A W Flay B R (1995a)

Developing school-based tobacco use prevention and cessation

programs Thousand Oaks CA Sage Publications IncSussman S Dent C W Simon T R Stacy A W Galaif E R

Moss M A Craig S Johnson C A (1995b) Effectiveness of

social influence substance abuse prevention curricula in compre-

hensive and continuation high schools Drugs and Society 865ndash81Sussman S Dent C W Galaif E R (1997) The correlates of

substance abuse and dependence among adolescents at high risk

for drug abuse Journal of Substance Abuse 9241ndash255Sussman S Dent C W Stacy A W (1996) The relation of pro-drug

use myths with self-reported drug use among youth at continuation

high schools Journal of Applied Social Psychology 26214ndash267Sussman S Dent C W Stacy A Craig S (1998) One-year outcomes

of project towards no drug abuse Preventive Medicine 27632ndash642

(erratum 766)Sussman S Dent C W Stacy S (2002) Project towards no drug

abuse a review of the findings and future directions American

Journal of Health Behavior 26354ndash365Sussman S McCuller W J Dent C W (2003) The associations of

social self-control personality disorders and demographics with

drug use among high risk youth Addictive Behaviors 281159ndash1166Sussman S Rohrbach L Patel R Holiday K (2003) A look at an

interactive classroom-based drug abuse prevention program

Interactive contents and suggestions for research Journal of Drug

Education 33355ndash368Sussman S Sun P McCuller W J Dent C W (2003) Project

towards no drug abuse two year outcomes of a trial that compares

health educator delivery to self-instruction Preventive Medicine

37155ndash162Tarter R E Vanyukov M (1994) Alcoholism a developmental disorder

Journal of Consulting and Clinical Psychology 621096ndash1107Thornton T N Craft C A Dahlberg L L Lynch B S Baer K

(2000) Best Practices of Youth Violence Prevention A Sourcebook

for Community Action Atlanta GA Division of Violence

Prevention Centers for Disease Control and PreventionTobler N S (1986) Meta-analysis of 143 adolescent drug prevention

programs quantitative outcome of program participants compared to

a control or comparison group Journal of Drug Issues 16537ndash567Tobler N S Roona M R Ochshorn P Marshall D G Streke

A V Stackpole K M (2000) School-based adolescent drug

Motivation Skills and Decision Making 2013

ORDER REPRINTS

prevention programs 1998 Meta-analysis The Journal of Primary

Prevention 20275ndash336US Department of Health and Human Services (USDHHS) (2003)

Substance Abuse andMental Health Services Administration Center

for Substance Abuse Prevention Science-based prevention programs and

principles 2002 Rockville MD US DHHS (SMA)03-3764 Also

see httpmodelprogramssamhsagovUnger J Baezconde-Garbanati L Shakib S Palmer P H Nezami

E Mora J (2004) What are the implications of structuralcultural

theory for drug abuse prevention Substance Use amp MisuseUpshaw H S Ostrom T M (1984) Psychological perspective in

attitude research In Eiser J R ed Attitudinal Judgment New

York Springer-Verlag 23ndash42Valente T W Gallaher P Mouttapa M (2004) Using social network

theory to understand and prevent substance use a transdisciplinary

perspective Substance Use amp MisuseVorrath H Brendtro L (1985) Positive peer culture 2nd edn Aldine

ChicagoWaldron H B Slesnick N Brody J L Turner C W Peterson T R

(2001) Treatment outcomes for adolescent substance abuse at 4-

and 7-month assessments Journal of Consulting amp Clinical

Psychology 69(5)802ndash813Watson D L Tharp R G (2002) Self-directed behavior Self-

modification for personal adjustment 8th edn Belmont CA

WadsworthWeissberg R P Caplan M Z Sivo P J (1989) A new conceptual

framework for establishing school-based social competence promo-

tion programs In Bond L A Compas B E eds Primary

Prevention amp Promotion in the Schools Newbury Park CA Sage

255ndash296Wills T A (1986) Stress and coping in early adolescence relationships

to substance use in urban school samples Health Psychology

5503ndash529Wills T A Cleary S D (1995) Stress-coping model for alcohol-

tobacco interactions in adolescence In Fertig J B Allen J P

eds Alcohol and Tobacco From Basic Science to Clinical Practice

Bethesda MD National Institute on Alcohol Abuse and

Alcoholism 107ndash128Wills T A Cleary S D (1999) Peer and adolescent substance use

among 6thndash9th graders Latent growth analyses of influence versus

selection mechanisms Health Psychology 18453ndash463

2014 Sussman et al

ORDER REPRINTS

Wills T A Hirky A E (1996) Coping and substance abuse InZeidner M Endler N S eds Handbook of Coping TheoryResearch and Applications New York Wiley 279ndash302

Wills T A Stoolmiller M (2002) The role of self-control in earlyescalation of substance use a time-varying analysis Journal ofConsulting and Clinical Psychology 70986ndash997

Wills T A Baker E Botvin G J (1989) Dimensions of assertivenessdifferential relationships to substance use in early adolescenceJournal of Consulting and Clinical Psychology 57(4)473ndash478

Wills T A Vaccaro D McNamara G (1994) Novelty seeking risktaking and related constructs as predictors of adolescent substanceuse an application of Cloningerrsquos theory Journal of SubstanceAbuse 61ndash20

Wills T A McNamara G Vaccaro D Hirky A E (1996a)Escalated substance use a longitudinal grouping analysis fromearly to middle adolescence Journal of Abnormal Psychology105166ndash180

Wills T A Pierce J P Evans R I (1996b) Large-scale environmentalrisk factors for substance use American Behavioral Scientist39808ndash822

Wills T A Windle M Cleary S D (1998) Role of temperamentnovelty-seeking and self-control in adolescent substance useJournal of Personality and Social Psychology 74387ndash406

Wills T A Sandy J M Shinar O (1999) Substance use level andproblems in late adolescence a mediational model based on self-control and coping motives Experimental and ClinicalPsychopharmacology 7122ndash134

Wills T A Cleary S D Filer M Shinar O Mariani J Spera K(2001) Temperament and self-control related to early-onsetsubstance use test of a developmental model Prevention Science2145ndash163

Wills T A Sandy J M Yaeger A (2002) Moderators of therelationship between substance use level and problems test of aself-regulation model in adolescence Journal of AbnormalPsychology 1113ndash21

Wills T A Gibbons F X Gerrard M Murry V Brody G (in press-a) Family communication and religiosity related to substance useand sexual behavior in early adolescence Psychology of AddictiveBehaviors

Wills T A Resko J Ainette M Mendoza D (in press-b) The role ofparent and peer support in adolescent substance use a test ofmediated effects Psychology of Addictive Behaviors

Motivation Skills and Decision Making 2015

ORDER REPRINTS

Young P T (1936) Motivation of Behavior New York John Wiley andSons

Zimmerman B J (2000) Attaining self-regulation a social cognitivemodel In Boekaerts M Pintrich P R eds Handbook of Self-Regulation San Diego Academic Press 13ndash39

2016 Sussman et al

Request PermissionOrder Reprints

Reprints of this article can also be ordered at

httpwwwdekkercomservletproductDOI101081JA200034769

Request Permission or Order Reprints Instantly

Interested in copying and sharing this article In most cases US Copyright Law requires that you get permission from the articlersquos rightsholder before using copyrighted content

All information and materials found in this article including but not limited to text trademarks patents logos graphics and images (the Materials) are the copyrighted works and other forms of intellectual property of Marcel Dekker Inc or its licensors All rights not expressly granted are reserved

Get permission to lawfully reproduce and distribute the Materials or order reprints quickly and painlessly Simply click on the Request Permission Order Reprints link below and follow the instructions Visit the US Copyright Office for information on Fair Use limitations of US copyright law Please refer to The Association of American Publishersrsquo (AAP) website for guidelines on Fair Use in the Classroom

The Materials are for your personal use only and cannot be reformatted reposted resold or distributed by electronic means or otherwise without permission from Marcel Dekker Inc Marcel Dekker Inc grants you the limited right to display the Materials only on your personal computer or personal wireless device and to copy and download single copies of such Materials provided that any copyright trademark or other notice appearing on such Materials is also retained by displayed copied or downloaded as part of the Materials and is not removed or obscured and provided you do not edit modify alter or enhance the Materials Please refer to our Website User Agreement for more details

ORDER REPRINTS

illustrating it on a flip chart This task helps share the leadership andfocuses the group work and time The lesson STEPS to Drug UseControl follows skills training sessions that cover understandingSTEPS as a decision-making model

Project Towards No Drug Abuse (TND)rsquos decision-making sessioninvolves four steps These steps are

1 Brainstorming (making a list of ideas without judging them)2 Weigh the pros and cons (the benefits and costs of each idea)3 Select the best option4 Follow through (try that option and reevaluate the decision)

(Sussman et al 2002)

These decision-making strategies are similar across different pro-grams except that they include some different emphases For exampleSTEPS includes a self-instruction to begin decision making and self-praise whereas the TND sequence includes more of an emphasis onfollowing through with the decision Generally each program requiresgenerating options evaluating them choosing the best and evaluatingthe outcome in an effort to make the next decision Teens tend to enjoypracticing decision making in bogus problem situations Youth soonlearn to engage in steps like these with considerable skill Training indecision making operates on variables that are intermediate in the causalprocess and thereby strengthen individual profiles of self-controlabilities so that they are more resilient in the face of proximal riskfactors for drug use such as life stresses and peer pressures

Modalities of Programming

Both school and nonschool prevention modalities have a rich andimportant history in substance abuse prevention research (Pentz 1994Pentz et al 2004) Schools provide a captive audience for educationalmaterial Youth spend 25 of their waking lives at school so thisenvironment has considerable potential Furthermore the school contextprovides a rich research history for building new studies and evaluatingtheir efficacy (Sussman et al 1995a) Community programs also offerconsiderable opportunity

Community programs often involve local leaders and organizations(eg coalitions community boards) (Goodman et al 1993 Kaftarianand Hansen 1994) that help mobilize numerous community unitsCommunity units include businesses media the family and governmental

Motivation Skills and Decision Making 1995

ORDER REPRINTS

agencies like the police or recreational departments as well as schoolsystems A network of community units working together to developpromote and implement educational programming could increase youthsrsquobonding to others across a wide variety of social contexts (Hawkins et al1992 Pentz 1994) Community units can provide numerous types ofspecific extra-classroom prevention opportunities (Pentz 1994)

Parent-or-family targeted prevention programs include offering earlychildhood education social support for parents managing crisesparenting skills training parent-child communication skills and resourceacquisition instruction or networking Mass media targeted programsinvolve programs or public service announcements with novel fastand unconventional messages (eg the American Legacy FoundationTRUTH campaign) use of the Internet and interactive CDs (eg videogames) Alternative means to involve youth include involvement in hikingclubs drug-free dances or other after-school events with prosocial adultmentors and with means to involve youth outside of school includingentry into different environments (ie outward bound) (Tobler 1986) Inaddition policy implementation and enforcement may contribute toother prevention programs (Pentz et al 1989) Indeed simultaneousprograms within and outside of schools over long periods might maintainthe positive effects that sometimes dissipate when school programsappear alone (Pentz 1994)

The Difference Between Targeted Prevention and Cessation

Targeted (secondary) prevention attempts to keep persons fromcrossing the invisible line where they funnel into a cycle of addiction andaccumulation of negative consequences Cessation programs (sometimesreferred to as tertiary prevention) take the stance that a behavior hasoccurred with definite and perhaps irreversible negative consequencesThe goal is to stop the behavior permit recovery from the damage learnhow to prevent relapse and learn how to live with permanent changes(eg neurotransmitter function drug use-related injury) It is not clearexactly where indicated prevention ends however and where cessationbegins For example an early version of the Project TND curriculum didnot achieve effects on cigarette smoking possibly because 46 of thesample already smoked cigarettes daily (while not engaging often in someother drug use) In a revised curriculum a smoking cessation componentwas added to the program and then an effect on cigarette smoking wasachieved Cessation material can appear with prevention material to

1996 Sussman et al

ORDER REPRINTS

maximize program effectiveness Careful program development can helpdetermine the best mix (Sussman et al 2002)

Summary of Evidence-based Targeted Drug Abuse Prevention

At present approximately 29 drug-use prevention programs havebeen evaluated favorably for their effects on drug use or other problembehavior (see Table 1) These 29 programs have been identified throughtwo sources Blueprints for Violence Prevention (Elliott 2003) and theSubstance Abuse and Mental Health Services Administrationrsquos(SAMSHA) science-based prevention programsrsquo guide (USDHHS2003) PsycINFO and MEDLINE searches of drug abuse preventionstudies since 1970 supplemented searches through these two guides (seeTable 1) Nine definitions of high-risk were used across these programsEleven programs focused on economic deprivation as the definition Sixprograms focused on delinquent behavior as the identifying characteristicto target Two programs each identified single-parent homes drug use orexposure to drug use family problems alternative high school attendanceor being at risk for dropout at a regular high school as the characteristicsto target subjects Finally one program each identified new immigrantstatus or residential facility placement as the defining characteristic ofbeing at high risk for drug use

Among these programs eight focused on preteens For example theEarly Risers program defined its high-risk youth as those 6ndash10 year-oldsthat suffered economic deprivation and exhibited aggressive or opposi-tional behavior Another five programs focused on a young teen agegroup For example Preventive Intervention defined its high-risk youthas those seventh to eighth graders who exhibited poor school andacademic discipline and reported family problems Another sevenprograms focused on an older teen age group For example ProjectTND defined its high-risk youth as those youth that attended alternativehigh schools Finally nine programs encompassed wide age ranges Forinstance Big Brothers Big Sisters of America defined its high-risk youthas 6ndash18 year-olds that lived in single-parent homes

Of these programs 10 involved multiple often flexible settings ofimplementation Another 13 programs focused on the school settingFour programs focused on the home setting Finally two programsfocused on a community agency setting In general these programsinvolved implementation by highly trained personnel Eighteen of theseprograms involved some motivation aspect generally motivationenhancement but sometimes including extrinsic reinforcement strategies

Motivation Skills and Decision Making 1997

ORDER REPRINTS

Twenty-six of these programs provided skills training Finally 18programs provided instruction in decision making Thus the MSDmodel tends to appear in a majority of these programs however all threecomponents were included together in only nine of these programs

Twenty of these programs involved at least one replication of theprogram and 14 involved three or more replications Further 14 of theseprograms were tested through use of experimental designs and nineinvolved use of only quasi-experimental designs Effects on drug use wereassessed and found in 22 of these programs For example theReconnecting Youth program was implemented to youth at risk fordropout This program involved 90 sessions within a comprehensive highschool class delivered generally over a semester with small studentgroups and a highly trained teacher Instruction included use of groupsupport and providing life skills training (norm setting self-esteem moodmanagement communication skills self-monitoring monitoring goalsschool bonding and social activities) with feedback to parents Programgoals were achieved through use of a quasi-experimental design showingeffects for school performance (18 improvement in grades) drug use(54 decrease in hard drug use) and suicide risk (32 decline inperceived stress) This programrsquos results have been replicated numeroustimes in numerous locations This program involved all three componentsof the MSD model except that motivation was provided through peergroup support not through provision motivation enhancement strate-gies These targeted programs present an optimistic picture for drug-useprevention that is focused on at-risk youth (see Table 1)

Not all targeted prevention programs have been found to beeffective One published program that failed to find positive effects wasProject PALS (Palinkas et al 1996) This project was developed for teengirls who were pregnant or at risk for pregnancy and drug use Theprogram consisted of school-based delivery of 16 sessions once a weekin a class The goal was to decrease drug use The PALS Skills TrainingProgram involved instruction in assertiveness providing and receivingfeedback social conversation handling requests and asking for help andmood management This program was tested against a normativeeducation program (called Facts of Life or FOL) which instructedvalues and decision making sexuality issues and contraception sexuallytransmitted diseases (STDs) drug use risks sexual assault prevalenceand norms material An experimental evaluation with a seven-monthspost-baseline was used The results indicated that the PALS programsubjects reported 29 times greater marijuana use than FOL amongbaseline nonusers No other differences were found It is possible that theprogram was not targeted to the right population that the mix of skills

1998 Sussman et al

ORDER REPRINTS

instructed was not appropriate or that skill training alone (withoutappropriate motivation material) may not be effective in drug useprevention Researchers should examine these possibilities and others tofurther understand program failures as well as program successes

Potential Limitations of Targeted Prevention

Dishion and colleagues (1995) suggest from various findings thatgrouping high-risk youth may lead to increased drug use This outcomecan result if youth come to learn deviant behavior from each other Theycan learn deviant behavior from each other in a program if they haveunstructured or unsupervised time together An essential feature ofseveral targeted programs (eg the RY and TND programs) is building apositive peer culture with group norms that decrease drug involvementand drug-use control problems The RYrsquos findings suggest that a positivepeer group component carefully fostered by a well-trained and competentRY group leader can direct the group toward lower risk behaviorSimilarly classroom management in Project TND involves developmentof positive norms of classroom behavior Further interaction betweenyouth is encouraged but is primarily teacher-directed and highlystructured (Sussman et al 2003) In both RY and Project TND theteacherrsquos role is to actively develop and maintain peer group support inthe class by modeling support positively reinforcing it among groupmembers and negatively reinforcing deviant peer bonds and activities(Eggert and Herting 1991 Vorrath and Brendtro 1985) The teachercreates and structures interactions among youth in prosocial directions(Sussman et al 2003)

Multiple Problem Behaviors of Adolescents

Acknowledging the relationship of drug use to other commonadolescent problems may facilitate identification of effective methods ofreducing drug use Researchers on tobacco alcohol and other drug useantisocial behavior high-risk sexual behavior and depression increas-ingly recognize that these problems are interrelated (McGee andNewcomb 1992) and stem to a large extent from the same environ-mental and biological factors (Biglan et al in press Eggert et al 1995Sussman and Ames 2001 Wills and Cleary 1995) Clearly it is necessaryto have strategies that address the entire range of problems and thecontext that influences those problems Indeed further reductions in

Motivation Skills and Decision Making 1999

ORDER REPRINTS

many problems require that we comprehensively target youth withmultiple problem behaviors

Biglan and colleagues (in press) provide a comprehensive review ofthe relationships among antisocial behavior tobacco alcohol and otherdrug use and high-risk sexual behavior It is clear that the same youngpeople are prone to the development of the entire range of problems In arecent review Moffitt and colleagues (2002) found that antisocialbehavior in early adolescence (rather than late adolescence) is a greaterrisk factor for developing multiple problems These findings point to theimportance of early intervention before youth develop serious problemsMoreover these different problems largely result from the same set ofenvironmental and biological factors

One implication is that disciplines dealing with these problemsother than drug abuse may contribute to dealing with the problem ofdrug use (Newcomb 1996b 1997) In particular research by dev-elopmental psychologists family social workers and sociologists onthe influence of parents on adolescent problem development and oninterventions to alter parenting practices contributes to our understandingof how to prevent or ameliorate drug abuse and other problems Onealso should note that nonsubstance use is not a guarantee for problemimmunity for the entire age range of people whatever their genderethnicity religiosity socioeconomic status (SEC) domicility etc It maybe argued that the most promising programs are those targeting thesemultiple levels of influence Several multidisciplinary programs haveachieved promising results We describe three of these empiricallyevaluated programs tested in various settings

Functional Family Therapy (FFT)FFT is an indicated intervention involving family treatment designed

for delinquent teenagers (also see Table 1) Developed in the early 1970sby Alexander and colleagues (1973) FFT focuses on family commu-nication and the establishment of rules and consequences Several studiesprovide encouraging reports of the programrsquos effectiveness (Alexander etal 1976 Barton et al 1985 Klein et al 1977 Waldron et al 2001) Inthe Waldron et al (2001) study researchers used FFT and anintervention with cognitive behavior therapy on teens referred formarijuana use Each of the interventions produced significant resultson marijuana use by the teens at four months but only the twointerventions combined maintained these results at seven months Theearlier studies found a greater number of results For example in the twoAlexander studies (1973 1976) improvement in family communicationposttreatment led to reduced delinquency Note that all the teens in these

2000 Sussman et al

ORDER REPRINTS

studies had histories of serious antisocial or delinquent behavior Thusachieving positive outcomes even if only short-term should encouragefurther research into the efficacy of FFT

Multisystemic Therapy (MST)As its name suggestsMST targets individual family peer school and

community influences of those youth offenders with serious problems thatmay include violence substance use and severe emotional problems (alsosee Table 1) Numerous researchers have published the results ofrandomized trials of MST (Henggeler et al 1996 1997 1998 Thorntonet al 2000) The most consistent findings across studies are decreased (1)drug use (2) re-arrest (3) self-reported criminal offense and (4) days inout-of-home placements Other consistent findings are improved familyrelations school attendance and psychiatric functioning One cautionarynote the programrsquos effectiveness lowers considerably if not implementedwith fidelity (Hengler et al 1997 1999) In other words all or key lessonsneed to be delivered as written by educators who are well-trained in usingthe strategies employed and youth need to be able to receive all material inan atmosphere conducive to learning the material The programdevelopers have instituted training strategies that address these fidelityissues thus shaping MST to be a very promising program for at-riskyouth

Multidimensional Treatment Foster Care (MTFC)MTFC targets family and peer factors influencing adolescents with a

pattern of repeat criminal offending (see Table 1) (Chamberlain 1994)This intervention includes placement of the youth into a foster homewith a foster parent trained in behavior management who receivessupport from intervention staff After the adolescent has begun torespond to the intervention in the foster home and after the parents havereceived the same training and support as the foster parents did theadolescent returns home Chamberlain and Reid (1998) tested theintervention with 85 boys with felony and other criminal histories andfound substantial benefits of the program Following treatment the boysassigned to MTFC (compared to those receiving community-based groupcare) showed fewer days in detention or lock-up twice as much timeliving with parents fewer misdemeanor and felony arrests and fewer self-reported index crimes felony arrests and general delinquency TheMTFC is a cost-effective alternative to incarceration however staffrequirements are extensive which may influence the ability of some

Motivation Skills and Decision Making 2001

ORDER REPRINTS

groups to apply the program with fidelity However as with each of theprograms described here the results of the randomized trials areencouraging

Future Research Needs in Targeted Prevention

Future research can help discern when and where targeted preventionprogramming will tend to work rather than produce potentiallydeleterious negative group effects or results that are irrelevant for pro-social healthy adaptation as well as what the critical necessary conditionsare for their effective operation within given de facto realities Comparedto the breadth of evaluated universal drug use prevention programs(Tobler et al 2000) relatively few targeted prevention programs havereceived empirical support Yet previous research suggests that universalschool-based drug use prevention programs implemented in junior highschool have relatively less chance of long-term success especially for thoseyouth that began using drugs before the prevention program wasimplemented Of course there are notable exceptions (eg effects lastedfor one and a half years effects lasted for six years) (Chou et al 1998Griffin et al 2003 Skara and Sussman 2003) Almost no research existsregarding maximization of booster programming with high-risk youthMore research on booster programs would help the field

While continuing to engage in this work there will be numerousissues to manage that go well beyond the scope of this article There willbe a need to avoid producing negative labeling effects while providingprogramming for those who are at risk for drug use It is possible thatcessation information needs to be included in the mix with preventionmaterial to provide better targeted-prevention effects There may be aneed to develop a teacher selection instrument to help select out teacherswho can deliver drug abuse prevention programming adequatelyCertainly definition of outcome variables needs continued explorationincluding analysis to ascertain the effects of programming on drug abusevs drug use and identification of the variables that are most closelylinked to change by targeted prevention components

A transdisciplinary approach helps to better understand the lifesituation of high-risk youth as based to some extent on both constitutionaland environmental factors (Fuqua et al 2004 Rutter et al 1997 Wills etal 1996b) From the transactional perspective their situation is in partconstitutional they may have temperamental characteristics that arepartly heritable and that have set the stage at earlier ages for decrements inself-control ability and academic performance that then increase risk for

2002 Sussman et al

ORDER REPRINTS

drug use However their situation is also part environmental based in parton family socialization and in part on the types of peers they have as well asthe type and quality of the physical and cultural environment-at-largeThere are many points at which a potential chain of failures can beinterrupted and the individualrsquos trajectory turned in a better directionProblems are not inevitable from starting level (Tarter and Vanyukov1994) and environmental modifications to support good self-controlability can help to avert an adverse impact from earlier experiences orcurrent difficulties (Brody et al 2002 Novak and Clayton 2001 Patock-Peckham et al 2001 Rutter et al 1997 Wills et al 2002)

The problems and needs of high-risk youth in our nationrsquos highschools demand our attention for designing and rigorously testingtargeted prevention approaches Substantial evidence shows that theseyouth are at greater risk for drug involvement and co-occurring problemssuch as aggression depression and suicidal behaviors as we previouslydiscussed It is hoped that the information presented in this article willstimulate others to join in extending this work including testing othermodels of targeted prevention

GLOSSARY

Universal programs Programs that aim to influence all subjects in acontext

Selective drug-abuse prevention programs Programs that servegroups at greater risk of ATOD usemdashfor example children of alcoholicparents They are at psychosocial risk for drug use and abuse

Indicated drug-abuse prevention programs Programs that attemptto benefit individuals who already show signs of drug involvement orrelated risk factors In indicated prevention programs the primary goal isto stem the progression of ATOD use or reduce drug involvementamong the high-risk youth

Targeted programming Programming that subsumes selective andindicated programming sometimes the other two types of programs thattarget specific groups lsquolsquoat riskrsquorsquo are considered together

ACKNOWLEDGMENTS

This research was supported by grants from the National Institute onDrug Abuse (DA01070 DA07601 DA13814 and DA16094) and by aResearch Scientist Development Award K02 DA00252 from theNational Institute on Drug Abuse

Motivation Skills and Decision Making 2003

ORDER REPRINTS

REFERENCES

Alexander J F Barton C Schiaro R S Parsons B V (1976)

Systems-behavioral intervention with families of delinquents

therapist characteristics family behavior and outcome Journal of

Consulting and Clinical Psychology 44(4)656ndash664Alexander J F Parsons B V (1973) Short-term behavioral interven-

tion with delinquent families impact on family process and

recidivism Journal of Abnormal Psychology 3219ndash225American psychiatric association (APA) (1994) Diagnostic and

Statistical Manual of Mental Disorders 4th edn (DSM-IV)

Washington DC American Psychiatric AssociationAmes S L Sussman S Dent C W (1999) Pro-drug-use myths and

competing constructs in the prediction of substance use among

youth at continuation high schools a one-year prospective study

Personality and Individual Differences 26987ndash1003Bachman S G Wadsworth K N OrsquoMalley P M Johnston L D

Schulenberg J E (1997) Smoking drinking and drug use in young

adulthood Mahwah NJ Lawrence Erlbaum Associates 8ndash25

153ndash190Bandura A (1986) Social Foundations of Thought and Action A Social

Cognitive Theory Englewood Cliffs NJ Prentice HallBarton C Alexander J F Waldron H Turner C W Warburton J

(1985) Generalizing treatment effects of functional family therapy

Three replications The American Journal of Family Therapy

13(3)16ndash26Battin-Pearson S R Newcomb M D Abbott R D Hill K G

Catalano R F Hawkins J D (2000) Predicting early high school

dropout Journal of Educational Psychology 92568ndash582Biglan A Brennan P A Foster S L Holder H D Miller T L

Cunningham P B et al (in press) Helping Adolescents at Risk

Prevention of Multiple Problem Behaviors New York NY Guilford

PressBindra D Stewart J (1996) Motivation Baltimore MD Penguin

BooksBlanton H Gibbons F X Gerrard M Conger K J Smith G E

(1998) The role of family and peers in the development of

prototypes associated with substance use Journal of Family

Psychology 11271ndash288

2004 Sussman et al

ORDER REPRINTS

Botvin G J (1993) School-based drug abuse prevention Long-termfollow-up results In First Annual Meeting of the Society forPrevention Research Kentuck Lexington Society for PreventionResearch

Botvin G J Baker E Dusenbury L Botvin E M Diaz T (1995)Long-term follow-up results of a randomized drug abuse preven-tion trial in a white middle-class population Journal of theAmerican Medical Association 2731106ndash1012

Brody G H Dorsey S Forehand R Armistead L (2002) Uniquecontributions of parenting and classroom processes to the self-control of AfricanndashAmerican children Child Development73274ndash286

Carroll M E (1996) Reducing drug abuse by enriching the environmentwith alternative nondrug reinforcers In Green L Kagel J Heds Advances in Behavioral Economics Norwood NJ NorwoodPublishing Corp 37ndash68

Carver C S Scheier M F (1998) On the Self-Regulation of BehaviorNew York Cambridge University Press

Catalano R F Hawkins J D (1996) The social developmental modela theory of antisocial behavior In Hawkins J D ed Delinquencyand Crime Current Theories New York Cambridge UniversityPress

Centers for Disease Control (CDC) (October 1999) Youth risk BehaviorSurveillancemdashNational Alternative High School Youth RiskBehavior Survey 1998 Morbidity and Mortality Weekly Report48 No SS-7

Chamberlain P (1994) Family connections A treatment foster caremodel for adolescents with delinquency Eugene OR CastaliaPublishing Company

Chamberlain P Reid J B (1998) Comparison of two communityalternatives to incarceration for chronic juvenile offenders Journalof Consulting and Clinical Psychology 66(4)624ndash633

Chassin L A Presson C C Sherman S J (1985) Stepping backwardin order to step forward an acquisition-oriented approach toprimary prevention Journal of Consulting and Clinical Psychology53612ndash622

Chou C-P Montgomery S Pentz M A Rohrbach L A JohnsonC A Flay B R MacKinnon D P (1998) Effects of acommunity-based prevention program on decreasing drug use inhigh-risk adolescentsAmerican Journal of Public Health 88944ndash948

Conducts Problems Prevention Research Group (CPPRG) (1999) Initialimpact of the fast track prevention trial for conduct problems I

Motivation Skills and Decision Making 2005

ORDER REPRINTS

The high-risk sample Journal of Consulting and Clinical Psychology

67631ndash647Conducts Problems Prevention Research Group (CPPRG) (2000)

Merging universal and indicated prevention programs the fast

track model Addictive Behaviors 25913ndash927Council of Philosophical Studies (1981) Psychology and the Philosophy

of Mind in the Philosophy Curriculum San Francisco San Francisco

State UniversityCummings K M Hellmann R Emont S L (1988) Correlates of

participation in a worksite stop smoking program Journal of

Behavioral Medicine 11267ndash277Curry S Wagner E H Gothaus L C (1990) Intrinsic and extrinsic

motivation for smoking cessation Journal of Consulting and

Clinical Psychology 58310ndash316Dent C W Sussman S McCuller W J Stacy A W (2001) Drug

abuse prevention among youth at comprehensive high schools

Preventive Medicine 32514ndash520Dewey J (1886) Psychology New York HarperDishion T J French D C Patterson G R (1995) The development

and ecology of antisocial behavior In Cicchetti D Cohen D

eds Manual of developmental psychopathology New York John

Wiley 421ndash471Eggert L L Herting J R (1991) Preventing teenage drug abuse

exploratory effects of network social support Youth and Society

22482ndash534 [Reprinted National Prevention Evaluation Research

CollectionRockville MD Aspen 1993]Eggert L L Herting J R Thompson E A Nicholas L J Dicker

B G (1994) Preventing adolescent drug abuse and high school

dropout through an intensive school-based social network devel-

opment program American Journal of Health Promotion

8202ndash214Eggert L L Thompson E A Herting J R Nicholas L J (1995)

Reducing suicide potential among high-risk youth tests of a school-

based prevention program Suicide amp Life-Threatening Behavior

25276ndash296Ellickson P L Bell R M (1990) Drug prevention in junior high a

multi-site longitudinal test Science 2471299ndash1305Elliott D S (Series ed) (2003) Blueprints for violence prevention

Boulder CO Institute of Behavioral Science Regents of the

University of Colorado wwwcoloradoeducspvblueprints

2006 Sussman et al

ORDER REPRINTS

Farrell A D Danish S J (1993) Peer drug associations and emotionalrestraint Causes or consequences of adolescent drug use Journal ofConsulting and Clinical Psychology 61327ndash334

Festinger L A (1957) A Theory of Cognitive Dissonance New YorkHarper amp Row

Fuqua J Stokols D Gress J Phillips K Harvey R (2004)Transdisciplinary collaboration as a basis for enhancing the scienceand prevention of substance use and abuse Substance Use ampMisuse

Giuliano J D (1994) A peer education program to promote the use ofconflict resolution skills among at-risk school-age males PublicHealth Reports 109158ndash169

Glynn K Levanthal H Hirschman R (1985) A cognitivedevelopmental approach to smoking prevention In Bell C SBattjes R eds Prevention research Deterring Drug Abuse AmongChildren and Adolescents Rockville MD NIDA ResearchMonograph 63

Glynn T J (1989) Essential elements of school-based smokingprevention programs Journal of School Health 59181ndash188

Goodman R M Burdine J N Meehan E McLeroy K R eds(1993) Community coalitions for health promotion Special issue ofHealth Education Research Theory and Practice 8309ndash453

Goodyear R D Newcomb M D Locke T F (2002) PregnantLatina teenagers psychosocial and developmental determinants ofhow they select and perceive the men who father their childrenJournal of Counseling Psychology 49187ndash201

Gordon R (1987) An operational classification of disease preventionIn Steinberg J A Silverman M M eds Preventing MentalDisorders Rockville MD DHHS 20ndash26

Graham J W Johnson C A Hansen W B Flay B R Gee M(1990) Drug use prevention programs gender and ethnicityevaluation of three seventh-grade project SMART cohortsPreventive Medicine 19305ndash313

Griffin K W Botvin G J Nichols T R Doyal M M (2003)Effectiveness of a universal drug abuse prevention approach foryouth at high risk for substance use initiation Preventive Medicine36(1)1ndash7

Hamilton S (August 20 2000) Views slowly changing on alternativeschools The Sacramento Bee 1ndash3

Hansen W B (1992) School-based substance abuse prevention a reviewof the state of the art in curriculum 1980ndash1990 Health EducationResearch 7403ndash430

Motivation Skills and Decision Making 2007

ORDER REPRINTS

Hansen W B Johnson C A Flay B R Graham J W Sobel J(1988) Affective and social influences approaches to the preventionof multiple substance abuse among seventh grade students resultsfrom project SMART Preventive Medicine 17135ndash154

Hansen W B Graham J W (1991) Preventing alcohol marijuanaand cigarette use among adolescents peer pressure and resistancetraining versus establishing conservative norms PreventiveMedicine 20414ndash430

Hawkins D H Catalano R F Miller J Y (1992) Risk andprotective factors for alcohol and other drug problems inadolescence and early adulthood Implications for substanceabuse prevention Psychological Bulletin 11254ndash105

Hawkins J D Catalano R F Kosterman R Abbott R Hill K G(1999) Preventing adolescent health-risk behaviors by strengthen-ing protection during childhood Archives of Pediatric amp AdolescentMedicine 153226ndash234

Heider F (1958) The Psychology of Interpersonal Relations New YorkWiley

Henggeler S W Pickrel S G Brondino M J Crouch J L (1996)Eliminating (almost) treatment dropout of substance abusing ordependent delinquents through home-based multisystemic therapyAmerican Journal of Psychiatry 153(3)427ndash428

Henggeler S W Melton G B Brondino M J Scherer D GHanley J H (1997) Multisystemic therapy with violent andchronic juvenile offenders and their families the role of treatmentfidelity in successful dissemination Journal of Consulting andClinical Psychology 65(5)821ndash833

Henggeler S W Schoenwald S K Borduin C M Rowland M DCunningham P B (1998) Multisystemic treatment of antisocialbehavior in children and adolescents New York The Guilford Press

Henggeler S W Pickrel S G Brondino M J (1999) Multisystemictreatment of substance-abusing and dependent delinquents out-comes treatment fidelity and transportability Mental HealthServices Residual 1(3)171ndash84

Johnson C A Pentz M A Weber M D Dwyer J H Baer NMacKinnon D P Hansen W B Flay B R (1990) Relativeeffectiveness of comprehensive community programming for drugabuse prevention with high-risk and low-risk adolescents Journalof Consulting and Clinical Psychology 58447ndash456

Kaftarian S J Hansen W B eds (1994) CSAP special issuecommunity partnership program Journal of Community Psychologypages 205

2008 Sussman et al

ORDER REPRINTS

Karoly P (1993) Mechanisms in self-regulation A systems view AnnualReview of Psychology 4423ndash51

Karoly P (1980) Person variables in therapeutic change and develop-ment In Karoly P Steffen J J eds Improving the Long-TermEffects of Psychotherapy New York Gardner Press 195ndash261

Kendall P C Braswell L (1982) Cognitive-behavioral self-controltherapy for children a components analysis Journal of Consultingand Clinical Psychology 50672ndash689

Kerr M Tremblay R E Pagani L Vitaro F (1997) Boysrsquobehavioral inhibition and the risk of later delinquency Archivesof General Psychiatry 54809ndash816

Klein N C Alexander J F Parsons B V (1977) Impact of familysystems intervention on recidivism and sibling delinquency a modelof primary prevention and program evaluation Journal ofConsulting and Clinical Psychology 45(3)469ndash474

Kumpfer K L (1999) Outcomes measures of interventions in the studyof children of substance-abusing parents Pediatrics 1031128ndash1144

Lau R R Hartman K A Ware J E (1986) Health as a valuemethodological and theoretical considerations Health Psychology525ndash43

Lichtenstein E L Glasgow R E (1997) A pragmatic framework forsmoking cessation implications for clinical and public healthprograms Psychology of Addictive Behaviors 11142ndash151

Locke T F Newcomb M D (in press) Childhood maltreatmentparent drug problems polydrug problems and parenting practicesa test of gender differences and four theoretical perspectivesJournal of Family Psychology

McCreary D R Newcomb M D Sadava S W (1999) The male rolealcohol use and alcohol problems a structural modeling examina-tion in adult women and men Journal of Counseling Psychology46109ndash124

McGee L Newcomb M D (1992) General deviance syndromeexpanded hierarchical evaluations at four ages from earlyadolescence to adulthood Journal of Consulting amp ClinicalPsychology 60766ndash776

Miller W R Brown J M (1991) Self-regulation as a conceptual basisfor the prevention of addictive behaviours In Heather N MillerW R Greeley J eds Self-control and the Addictive BehavioursSydney Australia Maxwell Macmillan 3ndash79

Miller W R Leckman A L Delaney H D Tinkcom M (1993)Long-term follow-up of behavioral self-control training forproblem drinkers Journal of Studies on Alcohol 53249ndash261

Motivation Skills and Decision Making 2009

ORDER REPRINTS

Miller W R Rollnick S (1991) Motivational InterviewingPreparing People to Change Addictive Behavior New YorkGuilford Press

Moffitt T E Caspi A Harrington H Milne B J (2002) Males onthe life-course-persistent and adolescence-limited antisocial path-ways follow-up at age 26 years Development and Psychopathology14(1)179ndash207

National Institute on Drug Abuse (NIDA) (1997) Drug abuseprevention What works NIH Publication 97-4110 DHHSNational Institutes of Health National Institute on Drug AbuseOffice of Science Policy and Communications Rockville MD

Newcomb M D (1992a) Substance abuse and control in the UnitedStates ethical and legal issues Social Science and Medicine35471ndash479

Newcomb M D (1992b) Understanding the multidimensional nature ofdrug use and abuse The role of consumption risk factors andprotective factors In Glantz M D Pickens R eds Vulnerabilityto Drug Abuse Washington DC American PsychologicalAssociation 255ndash298

Newcomb M D (1996a) Pseudomaturity among adolescents constructvalidation sex differences and associations in adulthood Journalof Drug Issues 26477ndash504

Newcomb M D (1996b) Adolescence Pathologizing a normal processThe Counseling Psychologist 24482ndash490

Newcomb M D (1997) Psychosocial predictors and consequences ofdrug use a developmental perspective within a prospective studyJournal of Addictive Diseases 1651ndash89

Newcomb M D Bentler P M (1988) Consequences of Adolescent DrugUse Impact on the Lives of Young Adults Beverly Hills CA Sage

Newcomb M D Bentler P M (1989) Substance use and abuse amongchildren and teenagers American Psychologist 44242ndash248

Newcomb M D Harlow L L (1986) Life events and substance useamong adolescents Mediating effects of perceived loss of controland meaninglessness in life Journal of Personality and SocialPsychology 51564ndash577

Newcomb M D Chou C-P Bentler P M Huba G J (1988)Cognitive motivations for drug use among adolescents longitudinaltests of gender differences and predictors of change in drug useJournal of Counseling Psychology 35426ndash438

Newcomb M D Abbott R D Catalano R F Hawkins J DBattin-Pearson S R Hill K (2002) Mediational and deviancetheories of late high school failure Process roles of structural

2010 Sussman et al

ORDER REPRINTS

strains academic competence and general versus specific problem

behaviors Journal of Counseling Psychology 49172ndash186Nezami E Sussman S Pentz M A (2003) Motivation in tobacco use

cessation research Substance Use amp Misuse 3825ndash5Novak S P Clayton R R (2001) The influence of school environment

and self-regulation on transitions between stages of cigarette

smoking Health Psychology 20196ndash207Offord D R (2000) Selection of levels of prevention Addictive

Behaviors 25833ndash842Palinkas L A Atkins C J Miller C Ferreira D (1996) Social skills

training for drug prevention in high-risk female adolescents

Preventive Medicine 25692ndash701Patock-Peckham J A Cheong J-W Balhorn M E Nagoshi C T

(2001) A model of parenting styles self-regulation perceived

drinking control and alcohol use and problems Alcoholism

Experimental and Clinical Research 251284ndash1292Pentz M A (1994) Directions for future research in drug abuse

prevention Preventive Medicine 23646ndash652Pentz M A Dwyer J H MacKinnon D Flay B R Hansen W B

Wang E Y I Johnson C A (1989) A multi-community trial for

primary prevention of adolescent drug abuse effects on drug use

prevalence JAMA 2623259ndash3266Pentz M A Mares D Schinke S Rohrbach L (in press) Political

science public policy and drug abuse prevention Substance Use amp

MisuseProchaska J O DiClemente C C (1982) Transtheoretical therapy

toward a more integrative model of change Psychotherapy Theory

Research and Practice 19275ndash288Pulkkinen L Pitkanen T (1994) A prospective study of the precursors

to problem drinking in young adulthood Journal of Studies on

Alcohol 55578ndash587Rathus S A Nevid J S (1977) Behavior Therapy Strategies for

Solving Problems in Living New York Doubleday and Company

IncResnicow K Botvin G (1993) School-based substance use prevention

programs why do effects decay Preventive Medicine 22484ndash490Rutter M Dunn J Plomin R Simonoff E Pickles A Maughan

B Ormel J Meyer J Eaves L (1997) Integrating nature and

nurture implications of person-environment interactions for

developmental psychopathology Development and Psychopathology

9335ndash364

Motivation Skills and Decision Making 2011

ORDER REPRINTS

Salomon G Stein Y Eisenberg S Klein L (1984) Adolescent

smokers and nonsmokers profiles and their changing structure

Preventive Medicine 13446ndash461Sambrano S (1999) National cross-site evaluation of high risk youth

programs In Interim findings Bulletin Washington DC CSAP

SAMSHA US DHHS May 1ndash16Schinke S P Gilchrist L D (1985) Preventing substance abuse with

children and adolescents Journal of Consulting and Clinical

Psychology 53596ndash602Skara S N Sussman S (2003) A review of 25 long-term adolescent

tobacco and other drug use prevention program evaluations

Preventive MedicineSmith C Lizotte A J Thornberry T P Krohn M D (1995)

Resilient youth identifying factors that prevent high-risk youth

from engaging in delinquency and drug use Delinquency and

Disrepute in the Life Course Greenwich CT John Hagan JAI

press 217ndash247Sommers P V (1972) The Biology of Behavior Australia Pty ltd

Sydney John Wiley amp SonsSt Pierre T L Kaltreider D L Mark M M Aikin K J (1992)

Drug prevention in a community setting a longitudinal study of the

relative effectiveness of a three-year primary prevention program in

boys and girls clubs across the nation American Journal of

Community Psychology 20673ndash706Stein J A Newcomb M D Bentler P M (1987) An eight year study

of multiple influences on drug use and drug use consequences

Journal of Personality and Social Psychology 531094ndash1105Sully J (1884) Outlines of Psychology New York D Appleton amp CoSussman S (1989) Two social influence perspectives of tobacco use

development and prevention Health Education Research Theory

and Practice 4213ndash223Sussman S (1991) Curriculum development in school-based prevention

research Health Education Research Theory and Practice

6339ndash351Sussman S (1996) Development of a school-based drug abuse

prevention curriculum for high risk youth Journal of

Psychoactive Drugs 28169ndash182Sussman S Ames S L (2001) The social psychology of drug abuse

Buckingham GB Open University PressSussman S Unger J (2004) A drug abuse theoretical integration a

transdisciplinary speculation Substance Use amp Misuse

2012 Sussman et al

ORDER REPRINTS

Sussman S Dent C W Burton D Stacy A W Flay B R (1995a)

Developing school-based tobacco use prevention and cessation

programs Thousand Oaks CA Sage Publications IncSussman S Dent C W Simon T R Stacy A W Galaif E R

Moss M A Craig S Johnson C A (1995b) Effectiveness of

social influence substance abuse prevention curricula in compre-

hensive and continuation high schools Drugs and Society 865ndash81Sussman S Dent C W Galaif E R (1997) The correlates of

substance abuse and dependence among adolescents at high risk

for drug abuse Journal of Substance Abuse 9241ndash255Sussman S Dent C W Stacy A W (1996) The relation of pro-drug

use myths with self-reported drug use among youth at continuation

high schools Journal of Applied Social Psychology 26214ndash267Sussman S Dent C W Stacy A Craig S (1998) One-year outcomes

of project towards no drug abuse Preventive Medicine 27632ndash642

(erratum 766)Sussman S Dent C W Stacy S (2002) Project towards no drug

abuse a review of the findings and future directions American

Journal of Health Behavior 26354ndash365Sussman S McCuller W J Dent C W (2003) The associations of

social self-control personality disorders and demographics with

drug use among high risk youth Addictive Behaviors 281159ndash1166Sussman S Rohrbach L Patel R Holiday K (2003) A look at an

interactive classroom-based drug abuse prevention program

Interactive contents and suggestions for research Journal of Drug

Education 33355ndash368Sussman S Sun P McCuller W J Dent C W (2003) Project

towards no drug abuse two year outcomes of a trial that compares

health educator delivery to self-instruction Preventive Medicine

37155ndash162Tarter R E Vanyukov M (1994) Alcoholism a developmental disorder

Journal of Consulting and Clinical Psychology 621096ndash1107Thornton T N Craft C A Dahlberg L L Lynch B S Baer K

(2000) Best Practices of Youth Violence Prevention A Sourcebook

for Community Action Atlanta GA Division of Violence

Prevention Centers for Disease Control and PreventionTobler N S (1986) Meta-analysis of 143 adolescent drug prevention

programs quantitative outcome of program participants compared to

a control or comparison group Journal of Drug Issues 16537ndash567Tobler N S Roona M R Ochshorn P Marshall D G Streke

A V Stackpole K M (2000) School-based adolescent drug

Motivation Skills and Decision Making 2013

ORDER REPRINTS

prevention programs 1998 Meta-analysis The Journal of Primary

Prevention 20275ndash336US Department of Health and Human Services (USDHHS) (2003)

Substance Abuse andMental Health Services Administration Center

for Substance Abuse Prevention Science-based prevention programs and

principles 2002 Rockville MD US DHHS (SMA)03-3764 Also

see httpmodelprogramssamhsagovUnger J Baezconde-Garbanati L Shakib S Palmer P H Nezami

E Mora J (2004) What are the implications of structuralcultural

theory for drug abuse prevention Substance Use amp MisuseUpshaw H S Ostrom T M (1984) Psychological perspective in

attitude research In Eiser J R ed Attitudinal Judgment New

York Springer-Verlag 23ndash42Valente T W Gallaher P Mouttapa M (2004) Using social network

theory to understand and prevent substance use a transdisciplinary

perspective Substance Use amp MisuseVorrath H Brendtro L (1985) Positive peer culture 2nd edn Aldine

ChicagoWaldron H B Slesnick N Brody J L Turner C W Peterson T R

(2001) Treatment outcomes for adolescent substance abuse at 4-

and 7-month assessments Journal of Consulting amp Clinical

Psychology 69(5)802ndash813Watson D L Tharp R G (2002) Self-directed behavior Self-

modification for personal adjustment 8th edn Belmont CA

WadsworthWeissberg R P Caplan M Z Sivo P J (1989) A new conceptual

framework for establishing school-based social competence promo-

tion programs In Bond L A Compas B E eds Primary

Prevention amp Promotion in the Schools Newbury Park CA Sage

255ndash296Wills T A (1986) Stress and coping in early adolescence relationships

to substance use in urban school samples Health Psychology

5503ndash529Wills T A Cleary S D (1995) Stress-coping model for alcohol-

tobacco interactions in adolescence In Fertig J B Allen J P

eds Alcohol and Tobacco From Basic Science to Clinical Practice

Bethesda MD National Institute on Alcohol Abuse and

Alcoholism 107ndash128Wills T A Cleary S D (1999) Peer and adolescent substance use

among 6thndash9th graders Latent growth analyses of influence versus

selection mechanisms Health Psychology 18453ndash463

2014 Sussman et al

ORDER REPRINTS

Wills T A Hirky A E (1996) Coping and substance abuse InZeidner M Endler N S eds Handbook of Coping TheoryResearch and Applications New York Wiley 279ndash302

Wills T A Stoolmiller M (2002) The role of self-control in earlyescalation of substance use a time-varying analysis Journal ofConsulting and Clinical Psychology 70986ndash997

Wills T A Baker E Botvin G J (1989) Dimensions of assertivenessdifferential relationships to substance use in early adolescenceJournal of Consulting and Clinical Psychology 57(4)473ndash478

Wills T A Vaccaro D McNamara G (1994) Novelty seeking risktaking and related constructs as predictors of adolescent substanceuse an application of Cloningerrsquos theory Journal of SubstanceAbuse 61ndash20

Wills T A McNamara G Vaccaro D Hirky A E (1996a)Escalated substance use a longitudinal grouping analysis fromearly to middle adolescence Journal of Abnormal Psychology105166ndash180

Wills T A Pierce J P Evans R I (1996b) Large-scale environmentalrisk factors for substance use American Behavioral Scientist39808ndash822

Wills T A Windle M Cleary S D (1998) Role of temperamentnovelty-seeking and self-control in adolescent substance useJournal of Personality and Social Psychology 74387ndash406

Wills T A Sandy J M Shinar O (1999) Substance use level andproblems in late adolescence a mediational model based on self-control and coping motives Experimental and ClinicalPsychopharmacology 7122ndash134

Wills T A Cleary S D Filer M Shinar O Mariani J Spera K(2001) Temperament and self-control related to early-onsetsubstance use test of a developmental model Prevention Science2145ndash163

Wills T A Sandy J M Yaeger A (2002) Moderators of therelationship between substance use level and problems test of aself-regulation model in adolescence Journal of AbnormalPsychology 1113ndash21

Wills T A Gibbons F X Gerrard M Murry V Brody G (in press-a) Family communication and religiosity related to substance useand sexual behavior in early adolescence Psychology of AddictiveBehaviors

Wills T A Resko J Ainette M Mendoza D (in press-b) The role ofparent and peer support in adolescent substance use a test ofmediated effects Psychology of Addictive Behaviors

Motivation Skills and Decision Making 2015

ORDER REPRINTS

Young P T (1936) Motivation of Behavior New York John Wiley andSons

Zimmerman B J (2000) Attaining self-regulation a social cognitivemodel In Boekaerts M Pintrich P R eds Handbook of Self-Regulation San Diego Academic Press 13ndash39

2016 Sussman et al

Request PermissionOrder Reprints

Reprints of this article can also be ordered at

httpwwwdekkercomservletproductDOI101081JA200034769

Request Permission or Order Reprints Instantly

Interested in copying and sharing this article In most cases US Copyright Law requires that you get permission from the articlersquos rightsholder before using copyrighted content

All information and materials found in this article including but not limited to text trademarks patents logos graphics and images (the Materials) are the copyrighted works and other forms of intellectual property of Marcel Dekker Inc or its licensors All rights not expressly granted are reserved

Get permission to lawfully reproduce and distribute the Materials or order reprints quickly and painlessly Simply click on the Request Permission Order Reprints link below and follow the instructions Visit the US Copyright Office for information on Fair Use limitations of US copyright law Please refer to The Association of American Publishersrsquo (AAP) website for guidelines on Fair Use in the Classroom

The Materials are for your personal use only and cannot be reformatted reposted resold or distributed by electronic means or otherwise without permission from Marcel Dekker Inc Marcel Dekker Inc grants you the limited right to display the Materials only on your personal computer or personal wireless device and to copy and download single copies of such Materials provided that any copyright trademark or other notice appearing on such Materials is also retained by displayed copied or downloaded as part of the Materials and is not removed or obscured and provided you do not edit modify alter or enhance the Materials Please refer to our Website User Agreement for more details

ORDER REPRINTS

agencies like the police or recreational departments as well as schoolsystems A network of community units working together to developpromote and implement educational programming could increase youthsrsquobonding to others across a wide variety of social contexts (Hawkins et al1992 Pentz 1994) Community units can provide numerous types ofspecific extra-classroom prevention opportunities (Pentz 1994)

Parent-or-family targeted prevention programs include offering earlychildhood education social support for parents managing crisesparenting skills training parent-child communication skills and resourceacquisition instruction or networking Mass media targeted programsinvolve programs or public service announcements with novel fastand unconventional messages (eg the American Legacy FoundationTRUTH campaign) use of the Internet and interactive CDs (eg videogames) Alternative means to involve youth include involvement in hikingclubs drug-free dances or other after-school events with prosocial adultmentors and with means to involve youth outside of school includingentry into different environments (ie outward bound) (Tobler 1986) Inaddition policy implementation and enforcement may contribute toother prevention programs (Pentz et al 1989) Indeed simultaneousprograms within and outside of schools over long periods might maintainthe positive effects that sometimes dissipate when school programsappear alone (Pentz 1994)

The Difference Between Targeted Prevention and Cessation

Targeted (secondary) prevention attempts to keep persons fromcrossing the invisible line where they funnel into a cycle of addiction andaccumulation of negative consequences Cessation programs (sometimesreferred to as tertiary prevention) take the stance that a behavior hasoccurred with definite and perhaps irreversible negative consequencesThe goal is to stop the behavior permit recovery from the damage learnhow to prevent relapse and learn how to live with permanent changes(eg neurotransmitter function drug use-related injury) It is not clearexactly where indicated prevention ends however and where cessationbegins For example an early version of the Project TND curriculum didnot achieve effects on cigarette smoking possibly because 46 of thesample already smoked cigarettes daily (while not engaging often in someother drug use) In a revised curriculum a smoking cessation componentwas added to the program and then an effect on cigarette smoking wasachieved Cessation material can appear with prevention material to

1996 Sussman et al

ORDER REPRINTS

maximize program effectiveness Careful program development can helpdetermine the best mix (Sussman et al 2002)

Summary of Evidence-based Targeted Drug Abuse Prevention

At present approximately 29 drug-use prevention programs havebeen evaluated favorably for their effects on drug use or other problembehavior (see Table 1) These 29 programs have been identified throughtwo sources Blueprints for Violence Prevention (Elliott 2003) and theSubstance Abuse and Mental Health Services Administrationrsquos(SAMSHA) science-based prevention programsrsquo guide (USDHHS2003) PsycINFO and MEDLINE searches of drug abuse preventionstudies since 1970 supplemented searches through these two guides (seeTable 1) Nine definitions of high-risk were used across these programsEleven programs focused on economic deprivation as the definition Sixprograms focused on delinquent behavior as the identifying characteristicto target Two programs each identified single-parent homes drug use orexposure to drug use family problems alternative high school attendanceor being at risk for dropout at a regular high school as the characteristicsto target subjects Finally one program each identified new immigrantstatus or residential facility placement as the defining characteristic ofbeing at high risk for drug use

Among these programs eight focused on preteens For example theEarly Risers program defined its high-risk youth as those 6ndash10 year-oldsthat suffered economic deprivation and exhibited aggressive or opposi-tional behavior Another five programs focused on a young teen agegroup For example Preventive Intervention defined its high-risk youthas those seventh to eighth graders who exhibited poor school andacademic discipline and reported family problems Another sevenprograms focused on an older teen age group For example ProjectTND defined its high-risk youth as those youth that attended alternativehigh schools Finally nine programs encompassed wide age ranges Forinstance Big Brothers Big Sisters of America defined its high-risk youthas 6ndash18 year-olds that lived in single-parent homes

Of these programs 10 involved multiple often flexible settings ofimplementation Another 13 programs focused on the school settingFour programs focused on the home setting Finally two programsfocused on a community agency setting In general these programsinvolved implementation by highly trained personnel Eighteen of theseprograms involved some motivation aspect generally motivationenhancement but sometimes including extrinsic reinforcement strategies

Motivation Skills and Decision Making 1997

ORDER REPRINTS

Twenty-six of these programs provided skills training Finally 18programs provided instruction in decision making Thus the MSDmodel tends to appear in a majority of these programs however all threecomponents were included together in only nine of these programs

Twenty of these programs involved at least one replication of theprogram and 14 involved three or more replications Further 14 of theseprograms were tested through use of experimental designs and nineinvolved use of only quasi-experimental designs Effects on drug use wereassessed and found in 22 of these programs For example theReconnecting Youth program was implemented to youth at risk fordropout This program involved 90 sessions within a comprehensive highschool class delivered generally over a semester with small studentgroups and a highly trained teacher Instruction included use of groupsupport and providing life skills training (norm setting self-esteem moodmanagement communication skills self-monitoring monitoring goalsschool bonding and social activities) with feedback to parents Programgoals were achieved through use of a quasi-experimental design showingeffects for school performance (18 improvement in grades) drug use(54 decrease in hard drug use) and suicide risk (32 decline inperceived stress) This programrsquos results have been replicated numeroustimes in numerous locations This program involved all three componentsof the MSD model except that motivation was provided through peergroup support not through provision motivation enhancement strate-gies These targeted programs present an optimistic picture for drug-useprevention that is focused on at-risk youth (see Table 1)

Not all targeted prevention programs have been found to beeffective One published program that failed to find positive effects wasProject PALS (Palinkas et al 1996) This project was developed for teengirls who were pregnant or at risk for pregnancy and drug use Theprogram consisted of school-based delivery of 16 sessions once a weekin a class The goal was to decrease drug use The PALS Skills TrainingProgram involved instruction in assertiveness providing and receivingfeedback social conversation handling requests and asking for help andmood management This program was tested against a normativeeducation program (called Facts of Life or FOL) which instructedvalues and decision making sexuality issues and contraception sexuallytransmitted diseases (STDs) drug use risks sexual assault prevalenceand norms material An experimental evaluation with a seven-monthspost-baseline was used The results indicated that the PALS programsubjects reported 29 times greater marijuana use than FOL amongbaseline nonusers No other differences were found It is possible that theprogram was not targeted to the right population that the mix of skills

1998 Sussman et al

ORDER REPRINTS

instructed was not appropriate or that skill training alone (withoutappropriate motivation material) may not be effective in drug useprevention Researchers should examine these possibilities and others tofurther understand program failures as well as program successes

Potential Limitations of Targeted Prevention

Dishion and colleagues (1995) suggest from various findings thatgrouping high-risk youth may lead to increased drug use This outcomecan result if youth come to learn deviant behavior from each other Theycan learn deviant behavior from each other in a program if they haveunstructured or unsupervised time together An essential feature ofseveral targeted programs (eg the RY and TND programs) is building apositive peer culture with group norms that decrease drug involvementand drug-use control problems The RYrsquos findings suggest that a positivepeer group component carefully fostered by a well-trained and competentRY group leader can direct the group toward lower risk behaviorSimilarly classroom management in Project TND involves developmentof positive norms of classroom behavior Further interaction betweenyouth is encouraged but is primarily teacher-directed and highlystructured (Sussman et al 2003) In both RY and Project TND theteacherrsquos role is to actively develop and maintain peer group support inthe class by modeling support positively reinforcing it among groupmembers and negatively reinforcing deviant peer bonds and activities(Eggert and Herting 1991 Vorrath and Brendtro 1985) The teachercreates and structures interactions among youth in prosocial directions(Sussman et al 2003)

Multiple Problem Behaviors of Adolescents

Acknowledging the relationship of drug use to other commonadolescent problems may facilitate identification of effective methods ofreducing drug use Researchers on tobacco alcohol and other drug useantisocial behavior high-risk sexual behavior and depression increas-ingly recognize that these problems are interrelated (McGee andNewcomb 1992) and stem to a large extent from the same environ-mental and biological factors (Biglan et al in press Eggert et al 1995Sussman and Ames 2001 Wills and Cleary 1995) Clearly it is necessaryto have strategies that address the entire range of problems and thecontext that influences those problems Indeed further reductions in

Motivation Skills and Decision Making 1999

ORDER REPRINTS

many problems require that we comprehensively target youth withmultiple problem behaviors

Biglan and colleagues (in press) provide a comprehensive review ofthe relationships among antisocial behavior tobacco alcohol and otherdrug use and high-risk sexual behavior It is clear that the same youngpeople are prone to the development of the entire range of problems In arecent review Moffitt and colleagues (2002) found that antisocialbehavior in early adolescence (rather than late adolescence) is a greaterrisk factor for developing multiple problems These findings point to theimportance of early intervention before youth develop serious problemsMoreover these different problems largely result from the same set ofenvironmental and biological factors

One implication is that disciplines dealing with these problemsother than drug abuse may contribute to dealing with the problem ofdrug use (Newcomb 1996b 1997) In particular research by dev-elopmental psychologists family social workers and sociologists onthe influence of parents on adolescent problem development and oninterventions to alter parenting practices contributes to our understandingof how to prevent or ameliorate drug abuse and other problems Onealso should note that nonsubstance use is not a guarantee for problemimmunity for the entire age range of people whatever their genderethnicity religiosity socioeconomic status (SEC) domicility etc It maybe argued that the most promising programs are those targeting thesemultiple levels of influence Several multidisciplinary programs haveachieved promising results We describe three of these empiricallyevaluated programs tested in various settings

Functional Family Therapy (FFT)FFT is an indicated intervention involving family treatment designed

for delinquent teenagers (also see Table 1) Developed in the early 1970sby Alexander and colleagues (1973) FFT focuses on family commu-nication and the establishment of rules and consequences Several studiesprovide encouraging reports of the programrsquos effectiveness (Alexander etal 1976 Barton et al 1985 Klein et al 1977 Waldron et al 2001) Inthe Waldron et al (2001) study researchers used FFT and anintervention with cognitive behavior therapy on teens referred formarijuana use Each of the interventions produced significant resultson marijuana use by the teens at four months but only the twointerventions combined maintained these results at seven months Theearlier studies found a greater number of results For example in the twoAlexander studies (1973 1976) improvement in family communicationposttreatment led to reduced delinquency Note that all the teens in these

2000 Sussman et al

ORDER REPRINTS

studies had histories of serious antisocial or delinquent behavior Thusachieving positive outcomes even if only short-term should encouragefurther research into the efficacy of FFT

Multisystemic Therapy (MST)As its name suggestsMST targets individual family peer school and

community influences of those youth offenders with serious problems thatmay include violence substance use and severe emotional problems (alsosee Table 1) Numerous researchers have published the results ofrandomized trials of MST (Henggeler et al 1996 1997 1998 Thorntonet al 2000) The most consistent findings across studies are decreased (1)drug use (2) re-arrest (3) self-reported criminal offense and (4) days inout-of-home placements Other consistent findings are improved familyrelations school attendance and psychiatric functioning One cautionarynote the programrsquos effectiveness lowers considerably if not implementedwith fidelity (Hengler et al 1997 1999) In other words all or key lessonsneed to be delivered as written by educators who are well-trained in usingthe strategies employed and youth need to be able to receive all material inan atmosphere conducive to learning the material The programdevelopers have instituted training strategies that address these fidelityissues thus shaping MST to be a very promising program for at-riskyouth

Multidimensional Treatment Foster Care (MTFC)MTFC targets family and peer factors influencing adolescents with a

pattern of repeat criminal offending (see Table 1) (Chamberlain 1994)This intervention includes placement of the youth into a foster homewith a foster parent trained in behavior management who receivessupport from intervention staff After the adolescent has begun torespond to the intervention in the foster home and after the parents havereceived the same training and support as the foster parents did theadolescent returns home Chamberlain and Reid (1998) tested theintervention with 85 boys with felony and other criminal histories andfound substantial benefits of the program Following treatment the boysassigned to MTFC (compared to those receiving community-based groupcare) showed fewer days in detention or lock-up twice as much timeliving with parents fewer misdemeanor and felony arrests and fewer self-reported index crimes felony arrests and general delinquency TheMTFC is a cost-effective alternative to incarceration however staffrequirements are extensive which may influence the ability of some

Motivation Skills and Decision Making 2001

ORDER REPRINTS

groups to apply the program with fidelity However as with each of theprograms described here the results of the randomized trials areencouraging

Future Research Needs in Targeted Prevention

Future research can help discern when and where targeted preventionprogramming will tend to work rather than produce potentiallydeleterious negative group effects or results that are irrelevant for pro-social healthy adaptation as well as what the critical necessary conditionsare for their effective operation within given de facto realities Comparedto the breadth of evaluated universal drug use prevention programs(Tobler et al 2000) relatively few targeted prevention programs havereceived empirical support Yet previous research suggests that universalschool-based drug use prevention programs implemented in junior highschool have relatively less chance of long-term success especially for thoseyouth that began using drugs before the prevention program wasimplemented Of course there are notable exceptions (eg effects lastedfor one and a half years effects lasted for six years) (Chou et al 1998Griffin et al 2003 Skara and Sussman 2003) Almost no research existsregarding maximization of booster programming with high-risk youthMore research on booster programs would help the field

While continuing to engage in this work there will be numerousissues to manage that go well beyond the scope of this article There willbe a need to avoid producing negative labeling effects while providingprogramming for those who are at risk for drug use It is possible thatcessation information needs to be included in the mix with preventionmaterial to provide better targeted-prevention effects There may be aneed to develop a teacher selection instrument to help select out teacherswho can deliver drug abuse prevention programming adequatelyCertainly definition of outcome variables needs continued explorationincluding analysis to ascertain the effects of programming on drug abusevs drug use and identification of the variables that are most closelylinked to change by targeted prevention components

A transdisciplinary approach helps to better understand the lifesituation of high-risk youth as based to some extent on both constitutionaland environmental factors (Fuqua et al 2004 Rutter et al 1997 Wills etal 1996b) From the transactional perspective their situation is in partconstitutional they may have temperamental characteristics that arepartly heritable and that have set the stage at earlier ages for decrements inself-control ability and academic performance that then increase risk for

2002 Sussman et al

ORDER REPRINTS

drug use However their situation is also part environmental based in parton family socialization and in part on the types of peers they have as well asthe type and quality of the physical and cultural environment-at-largeThere are many points at which a potential chain of failures can beinterrupted and the individualrsquos trajectory turned in a better directionProblems are not inevitable from starting level (Tarter and Vanyukov1994) and environmental modifications to support good self-controlability can help to avert an adverse impact from earlier experiences orcurrent difficulties (Brody et al 2002 Novak and Clayton 2001 Patock-Peckham et al 2001 Rutter et al 1997 Wills et al 2002)

The problems and needs of high-risk youth in our nationrsquos highschools demand our attention for designing and rigorously testingtargeted prevention approaches Substantial evidence shows that theseyouth are at greater risk for drug involvement and co-occurring problemssuch as aggression depression and suicidal behaviors as we previouslydiscussed It is hoped that the information presented in this article willstimulate others to join in extending this work including testing othermodels of targeted prevention

GLOSSARY

Universal programs Programs that aim to influence all subjects in acontext

Selective drug-abuse prevention programs Programs that servegroups at greater risk of ATOD usemdashfor example children of alcoholicparents They are at psychosocial risk for drug use and abuse

Indicated drug-abuse prevention programs Programs that attemptto benefit individuals who already show signs of drug involvement orrelated risk factors In indicated prevention programs the primary goal isto stem the progression of ATOD use or reduce drug involvementamong the high-risk youth

Targeted programming Programming that subsumes selective andindicated programming sometimes the other two types of programs thattarget specific groups lsquolsquoat riskrsquorsquo are considered together

ACKNOWLEDGMENTS

This research was supported by grants from the National Institute onDrug Abuse (DA01070 DA07601 DA13814 and DA16094) and by aResearch Scientist Development Award K02 DA00252 from theNational Institute on Drug Abuse

Motivation Skills and Decision Making 2003

ORDER REPRINTS

REFERENCES

Alexander J F Barton C Schiaro R S Parsons B V (1976)

Systems-behavioral intervention with families of delinquents

therapist characteristics family behavior and outcome Journal of

Consulting and Clinical Psychology 44(4)656ndash664Alexander J F Parsons B V (1973) Short-term behavioral interven-

tion with delinquent families impact on family process and

recidivism Journal of Abnormal Psychology 3219ndash225American psychiatric association (APA) (1994) Diagnostic and

Statistical Manual of Mental Disorders 4th edn (DSM-IV)

Washington DC American Psychiatric AssociationAmes S L Sussman S Dent C W (1999) Pro-drug-use myths and

competing constructs in the prediction of substance use among

youth at continuation high schools a one-year prospective study

Personality and Individual Differences 26987ndash1003Bachman S G Wadsworth K N OrsquoMalley P M Johnston L D

Schulenberg J E (1997) Smoking drinking and drug use in young

adulthood Mahwah NJ Lawrence Erlbaum Associates 8ndash25

153ndash190Bandura A (1986) Social Foundations of Thought and Action A Social

Cognitive Theory Englewood Cliffs NJ Prentice HallBarton C Alexander J F Waldron H Turner C W Warburton J

(1985) Generalizing treatment effects of functional family therapy

Three replications The American Journal of Family Therapy

13(3)16ndash26Battin-Pearson S R Newcomb M D Abbott R D Hill K G

Catalano R F Hawkins J D (2000) Predicting early high school

dropout Journal of Educational Psychology 92568ndash582Biglan A Brennan P A Foster S L Holder H D Miller T L

Cunningham P B et al (in press) Helping Adolescents at Risk

Prevention of Multiple Problem Behaviors New York NY Guilford

PressBindra D Stewart J (1996) Motivation Baltimore MD Penguin

BooksBlanton H Gibbons F X Gerrard M Conger K J Smith G E

(1998) The role of family and peers in the development of

prototypes associated with substance use Journal of Family

Psychology 11271ndash288

2004 Sussman et al

ORDER REPRINTS

Botvin G J (1993) School-based drug abuse prevention Long-termfollow-up results In First Annual Meeting of the Society forPrevention Research Kentuck Lexington Society for PreventionResearch

Botvin G J Baker E Dusenbury L Botvin E M Diaz T (1995)Long-term follow-up results of a randomized drug abuse preven-tion trial in a white middle-class population Journal of theAmerican Medical Association 2731106ndash1012

Brody G H Dorsey S Forehand R Armistead L (2002) Uniquecontributions of parenting and classroom processes to the self-control of AfricanndashAmerican children Child Development73274ndash286

Carroll M E (1996) Reducing drug abuse by enriching the environmentwith alternative nondrug reinforcers In Green L Kagel J Heds Advances in Behavioral Economics Norwood NJ NorwoodPublishing Corp 37ndash68

Carver C S Scheier M F (1998) On the Self-Regulation of BehaviorNew York Cambridge University Press

Catalano R F Hawkins J D (1996) The social developmental modela theory of antisocial behavior In Hawkins J D ed Delinquencyand Crime Current Theories New York Cambridge UniversityPress

Centers for Disease Control (CDC) (October 1999) Youth risk BehaviorSurveillancemdashNational Alternative High School Youth RiskBehavior Survey 1998 Morbidity and Mortality Weekly Report48 No SS-7

Chamberlain P (1994) Family connections A treatment foster caremodel for adolescents with delinquency Eugene OR CastaliaPublishing Company

Chamberlain P Reid J B (1998) Comparison of two communityalternatives to incarceration for chronic juvenile offenders Journalof Consulting and Clinical Psychology 66(4)624ndash633

Chassin L A Presson C C Sherman S J (1985) Stepping backwardin order to step forward an acquisition-oriented approach toprimary prevention Journal of Consulting and Clinical Psychology53612ndash622

Chou C-P Montgomery S Pentz M A Rohrbach L A JohnsonC A Flay B R MacKinnon D P (1998) Effects of acommunity-based prevention program on decreasing drug use inhigh-risk adolescentsAmerican Journal of Public Health 88944ndash948

Conducts Problems Prevention Research Group (CPPRG) (1999) Initialimpact of the fast track prevention trial for conduct problems I

Motivation Skills and Decision Making 2005

ORDER REPRINTS

The high-risk sample Journal of Consulting and Clinical Psychology

67631ndash647Conducts Problems Prevention Research Group (CPPRG) (2000)

Merging universal and indicated prevention programs the fast

track model Addictive Behaviors 25913ndash927Council of Philosophical Studies (1981) Psychology and the Philosophy

of Mind in the Philosophy Curriculum San Francisco San Francisco

State UniversityCummings K M Hellmann R Emont S L (1988) Correlates of

participation in a worksite stop smoking program Journal of

Behavioral Medicine 11267ndash277Curry S Wagner E H Gothaus L C (1990) Intrinsic and extrinsic

motivation for smoking cessation Journal of Consulting and

Clinical Psychology 58310ndash316Dent C W Sussman S McCuller W J Stacy A W (2001) Drug

abuse prevention among youth at comprehensive high schools

Preventive Medicine 32514ndash520Dewey J (1886) Psychology New York HarperDishion T J French D C Patterson G R (1995) The development

and ecology of antisocial behavior In Cicchetti D Cohen D

eds Manual of developmental psychopathology New York John

Wiley 421ndash471Eggert L L Herting J R (1991) Preventing teenage drug abuse

exploratory effects of network social support Youth and Society

22482ndash534 [Reprinted National Prevention Evaluation Research

CollectionRockville MD Aspen 1993]Eggert L L Herting J R Thompson E A Nicholas L J Dicker

B G (1994) Preventing adolescent drug abuse and high school

dropout through an intensive school-based social network devel-

opment program American Journal of Health Promotion

8202ndash214Eggert L L Thompson E A Herting J R Nicholas L J (1995)

Reducing suicide potential among high-risk youth tests of a school-

based prevention program Suicide amp Life-Threatening Behavior

25276ndash296Ellickson P L Bell R M (1990) Drug prevention in junior high a

multi-site longitudinal test Science 2471299ndash1305Elliott D S (Series ed) (2003) Blueprints for violence prevention

Boulder CO Institute of Behavioral Science Regents of the

University of Colorado wwwcoloradoeducspvblueprints

2006 Sussman et al

ORDER REPRINTS

Farrell A D Danish S J (1993) Peer drug associations and emotionalrestraint Causes or consequences of adolescent drug use Journal ofConsulting and Clinical Psychology 61327ndash334

Festinger L A (1957) A Theory of Cognitive Dissonance New YorkHarper amp Row

Fuqua J Stokols D Gress J Phillips K Harvey R (2004)Transdisciplinary collaboration as a basis for enhancing the scienceand prevention of substance use and abuse Substance Use ampMisuse

Giuliano J D (1994) A peer education program to promote the use ofconflict resolution skills among at-risk school-age males PublicHealth Reports 109158ndash169

Glynn K Levanthal H Hirschman R (1985) A cognitivedevelopmental approach to smoking prevention In Bell C SBattjes R eds Prevention research Deterring Drug Abuse AmongChildren and Adolescents Rockville MD NIDA ResearchMonograph 63

Glynn T J (1989) Essential elements of school-based smokingprevention programs Journal of School Health 59181ndash188

Goodman R M Burdine J N Meehan E McLeroy K R eds(1993) Community coalitions for health promotion Special issue ofHealth Education Research Theory and Practice 8309ndash453

Goodyear R D Newcomb M D Locke T F (2002) PregnantLatina teenagers psychosocial and developmental determinants ofhow they select and perceive the men who father their childrenJournal of Counseling Psychology 49187ndash201

Gordon R (1987) An operational classification of disease preventionIn Steinberg J A Silverman M M eds Preventing MentalDisorders Rockville MD DHHS 20ndash26

Graham J W Johnson C A Hansen W B Flay B R Gee M(1990) Drug use prevention programs gender and ethnicityevaluation of three seventh-grade project SMART cohortsPreventive Medicine 19305ndash313

Griffin K W Botvin G J Nichols T R Doyal M M (2003)Effectiveness of a universal drug abuse prevention approach foryouth at high risk for substance use initiation Preventive Medicine36(1)1ndash7

Hamilton S (August 20 2000) Views slowly changing on alternativeschools The Sacramento Bee 1ndash3

Hansen W B (1992) School-based substance abuse prevention a reviewof the state of the art in curriculum 1980ndash1990 Health EducationResearch 7403ndash430

Motivation Skills and Decision Making 2007

ORDER REPRINTS

Hansen W B Johnson C A Flay B R Graham J W Sobel J(1988) Affective and social influences approaches to the preventionof multiple substance abuse among seventh grade students resultsfrom project SMART Preventive Medicine 17135ndash154

Hansen W B Graham J W (1991) Preventing alcohol marijuanaand cigarette use among adolescents peer pressure and resistancetraining versus establishing conservative norms PreventiveMedicine 20414ndash430

Hawkins D H Catalano R F Miller J Y (1992) Risk andprotective factors for alcohol and other drug problems inadolescence and early adulthood Implications for substanceabuse prevention Psychological Bulletin 11254ndash105

Hawkins J D Catalano R F Kosterman R Abbott R Hill K G(1999) Preventing adolescent health-risk behaviors by strengthen-ing protection during childhood Archives of Pediatric amp AdolescentMedicine 153226ndash234

Heider F (1958) The Psychology of Interpersonal Relations New YorkWiley

Henggeler S W Pickrel S G Brondino M J Crouch J L (1996)Eliminating (almost) treatment dropout of substance abusing ordependent delinquents through home-based multisystemic therapyAmerican Journal of Psychiatry 153(3)427ndash428

Henggeler S W Melton G B Brondino M J Scherer D GHanley J H (1997) Multisystemic therapy with violent andchronic juvenile offenders and their families the role of treatmentfidelity in successful dissemination Journal of Consulting andClinical Psychology 65(5)821ndash833

Henggeler S W Schoenwald S K Borduin C M Rowland M DCunningham P B (1998) Multisystemic treatment of antisocialbehavior in children and adolescents New York The Guilford Press

Henggeler S W Pickrel S G Brondino M J (1999) Multisystemictreatment of substance-abusing and dependent delinquents out-comes treatment fidelity and transportability Mental HealthServices Residual 1(3)171ndash84

Johnson C A Pentz M A Weber M D Dwyer J H Baer NMacKinnon D P Hansen W B Flay B R (1990) Relativeeffectiveness of comprehensive community programming for drugabuse prevention with high-risk and low-risk adolescents Journalof Consulting and Clinical Psychology 58447ndash456

Kaftarian S J Hansen W B eds (1994) CSAP special issuecommunity partnership program Journal of Community Psychologypages 205

2008 Sussman et al

ORDER REPRINTS

Karoly P (1993) Mechanisms in self-regulation A systems view AnnualReview of Psychology 4423ndash51

Karoly P (1980) Person variables in therapeutic change and develop-ment In Karoly P Steffen J J eds Improving the Long-TermEffects of Psychotherapy New York Gardner Press 195ndash261

Kendall P C Braswell L (1982) Cognitive-behavioral self-controltherapy for children a components analysis Journal of Consultingand Clinical Psychology 50672ndash689

Kerr M Tremblay R E Pagani L Vitaro F (1997) Boysrsquobehavioral inhibition and the risk of later delinquency Archivesof General Psychiatry 54809ndash816

Klein N C Alexander J F Parsons B V (1977) Impact of familysystems intervention on recidivism and sibling delinquency a modelof primary prevention and program evaluation Journal ofConsulting and Clinical Psychology 45(3)469ndash474

Kumpfer K L (1999) Outcomes measures of interventions in the studyof children of substance-abusing parents Pediatrics 1031128ndash1144

Lau R R Hartman K A Ware J E (1986) Health as a valuemethodological and theoretical considerations Health Psychology525ndash43

Lichtenstein E L Glasgow R E (1997) A pragmatic framework forsmoking cessation implications for clinical and public healthprograms Psychology of Addictive Behaviors 11142ndash151

Locke T F Newcomb M D (in press) Childhood maltreatmentparent drug problems polydrug problems and parenting practicesa test of gender differences and four theoretical perspectivesJournal of Family Psychology

McCreary D R Newcomb M D Sadava S W (1999) The male rolealcohol use and alcohol problems a structural modeling examina-tion in adult women and men Journal of Counseling Psychology46109ndash124

McGee L Newcomb M D (1992) General deviance syndromeexpanded hierarchical evaluations at four ages from earlyadolescence to adulthood Journal of Consulting amp ClinicalPsychology 60766ndash776

Miller W R Brown J M (1991) Self-regulation as a conceptual basisfor the prevention of addictive behaviours In Heather N MillerW R Greeley J eds Self-control and the Addictive BehavioursSydney Australia Maxwell Macmillan 3ndash79

Miller W R Leckman A L Delaney H D Tinkcom M (1993)Long-term follow-up of behavioral self-control training forproblem drinkers Journal of Studies on Alcohol 53249ndash261

Motivation Skills and Decision Making 2009

ORDER REPRINTS

Miller W R Rollnick S (1991) Motivational InterviewingPreparing People to Change Addictive Behavior New YorkGuilford Press

Moffitt T E Caspi A Harrington H Milne B J (2002) Males onthe life-course-persistent and adolescence-limited antisocial path-ways follow-up at age 26 years Development and Psychopathology14(1)179ndash207

National Institute on Drug Abuse (NIDA) (1997) Drug abuseprevention What works NIH Publication 97-4110 DHHSNational Institutes of Health National Institute on Drug AbuseOffice of Science Policy and Communications Rockville MD

Newcomb M D (1992a) Substance abuse and control in the UnitedStates ethical and legal issues Social Science and Medicine35471ndash479

Newcomb M D (1992b) Understanding the multidimensional nature ofdrug use and abuse The role of consumption risk factors andprotective factors In Glantz M D Pickens R eds Vulnerabilityto Drug Abuse Washington DC American PsychologicalAssociation 255ndash298

Newcomb M D (1996a) Pseudomaturity among adolescents constructvalidation sex differences and associations in adulthood Journalof Drug Issues 26477ndash504

Newcomb M D (1996b) Adolescence Pathologizing a normal processThe Counseling Psychologist 24482ndash490

Newcomb M D (1997) Psychosocial predictors and consequences ofdrug use a developmental perspective within a prospective studyJournal of Addictive Diseases 1651ndash89

Newcomb M D Bentler P M (1988) Consequences of Adolescent DrugUse Impact on the Lives of Young Adults Beverly Hills CA Sage

Newcomb M D Bentler P M (1989) Substance use and abuse amongchildren and teenagers American Psychologist 44242ndash248

Newcomb M D Harlow L L (1986) Life events and substance useamong adolescents Mediating effects of perceived loss of controland meaninglessness in life Journal of Personality and SocialPsychology 51564ndash577

Newcomb M D Chou C-P Bentler P M Huba G J (1988)Cognitive motivations for drug use among adolescents longitudinaltests of gender differences and predictors of change in drug useJournal of Counseling Psychology 35426ndash438

Newcomb M D Abbott R D Catalano R F Hawkins J DBattin-Pearson S R Hill K (2002) Mediational and deviancetheories of late high school failure Process roles of structural

2010 Sussman et al

ORDER REPRINTS

strains academic competence and general versus specific problem

behaviors Journal of Counseling Psychology 49172ndash186Nezami E Sussman S Pentz M A (2003) Motivation in tobacco use

cessation research Substance Use amp Misuse 3825ndash5Novak S P Clayton R R (2001) The influence of school environment

and self-regulation on transitions between stages of cigarette

smoking Health Psychology 20196ndash207Offord D R (2000) Selection of levels of prevention Addictive

Behaviors 25833ndash842Palinkas L A Atkins C J Miller C Ferreira D (1996) Social skills

training for drug prevention in high-risk female adolescents

Preventive Medicine 25692ndash701Patock-Peckham J A Cheong J-W Balhorn M E Nagoshi C T

(2001) A model of parenting styles self-regulation perceived

drinking control and alcohol use and problems Alcoholism

Experimental and Clinical Research 251284ndash1292Pentz M A (1994) Directions for future research in drug abuse

prevention Preventive Medicine 23646ndash652Pentz M A Dwyer J H MacKinnon D Flay B R Hansen W B

Wang E Y I Johnson C A (1989) A multi-community trial for

primary prevention of adolescent drug abuse effects on drug use

prevalence JAMA 2623259ndash3266Pentz M A Mares D Schinke S Rohrbach L (in press) Political

science public policy and drug abuse prevention Substance Use amp

MisuseProchaska J O DiClemente C C (1982) Transtheoretical therapy

toward a more integrative model of change Psychotherapy Theory

Research and Practice 19275ndash288Pulkkinen L Pitkanen T (1994) A prospective study of the precursors

to problem drinking in young adulthood Journal of Studies on

Alcohol 55578ndash587Rathus S A Nevid J S (1977) Behavior Therapy Strategies for

Solving Problems in Living New York Doubleday and Company

IncResnicow K Botvin G (1993) School-based substance use prevention

programs why do effects decay Preventive Medicine 22484ndash490Rutter M Dunn J Plomin R Simonoff E Pickles A Maughan

B Ormel J Meyer J Eaves L (1997) Integrating nature and

nurture implications of person-environment interactions for

developmental psychopathology Development and Psychopathology

9335ndash364

Motivation Skills and Decision Making 2011

ORDER REPRINTS

Salomon G Stein Y Eisenberg S Klein L (1984) Adolescent

smokers and nonsmokers profiles and their changing structure

Preventive Medicine 13446ndash461Sambrano S (1999) National cross-site evaluation of high risk youth

programs In Interim findings Bulletin Washington DC CSAP

SAMSHA US DHHS May 1ndash16Schinke S P Gilchrist L D (1985) Preventing substance abuse with

children and adolescents Journal of Consulting and Clinical

Psychology 53596ndash602Skara S N Sussman S (2003) A review of 25 long-term adolescent

tobacco and other drug use prevention program evaluations

Preventive MedicineSmith C Lizotte A J Thornberry T P Krohn M D (1995)

Resilient youth identifying factors that prevent high-risk youth

from engaging in delinquency and drug use Delinquency and

Disrepute in the Life Course Greenwich CT John Hagan JAI

press 217ndash247Sommers P V (1972) The Biology of Behavior Australia Pty ltd

Sydney John Wiley amp SonsSt Pierre T L Kaltreider D L Mark M M Aikin K J (1992)

Drug prevention in a community setting a longitudinal study of the

relative effectiveness of a three-year primary prevention program in

boys and girls clubs across the nation American Journal of

Community Psychology 20673ndash706Stein J A Newcomb M D Bentler P M (1987) An eight year study

of multiple influences on drug use and drug use consequences

Journal of Personality and Social Psychology 531094ndash1105Sully J (1884) Outlines of Psychology New York D Appleton amp CoSussman S (1989) Two social influence perspectives of tobacco use

development and prevention Health Education Research Theory

and Practice 4213ndash223Sussman S (1991) Curriculum development in school-based prevention

research Health Education Research Theory and Practice

6339ndash351Sussman S (1996) Development of a school-based drug abuse

prevention curriculum for high risk youth Journal of

Psychoactive Drugs 28169ndash182Sussman S Ames S L (2001) The social psychology of drug abuse

Buckingham GB Open University PressSussman S Unger J (2004) A drug abuse theoretical integration a

transdisciplinary speculation Substance Use amp Misuse

2012 Sussman et al

ORDER REPRINTS

Sussman S Dent C W Burton D Stacy A W Flay B R (1995a)

Developing school-based tobacco use prevention and cessation

programs Thousand Oaks CA Sage Publications IncSussman S Dent C W Simon T R Stacy A W Galaif E R

Moss M A Craig S Johnson C A (1995b) Effectiveness of

social influence substance abuse prevention curricula in compre-

hensive and continuation high schools Drugs and Society 865ndash81Sussman S Dent C W Galaif E R (1997) The correlates of

substance abuse and dependence among adolescents at high risk

for drug abuse Journal of Substance Abuse 9241ndash255Sussman S Dent C W Stacy A W (1996) The relation of pro-drug

use myths with self-reported drug use among youth at continuation

high schools Journal of Applied Social Psychology 26214ndash267Sussman S Dent C W Stacy A Craig S (1998) One-year outcomes

of project towards no drug abuse Preventive Medicine 27632ndash642

(erratum 766)Sussman S Dent C W Stacy S (2002) Project towards no drug

abuse a review of the findings and future directions American

Journal of Health Behavior 26354ndash365Sussman S McCuller W J Dent C W (2003) The associations of

social self-control personality disorders and demographics with

drug use among high risk youth Addictive Behaviors 281159ndash1166Sussman S Rohrbach L Patel R Holiday K (2003) A look at an

interactive classroom-based drug abuse prevention program

Interactive contents and suggestions for research Journal of Drug

Education 33355ndash368Sussman S Sun P McCuller W J Dent C W (2003) Project

towards no drug abuse two year outcomes of a trial that compares

health educator delivery to self-instruction Preventive Medicine

37155ndash162Tarter R E Vanyukov M (1994) Alcoholism a developmental disorder

Journal of Consulting and Clinical Psychology 621096ndash1107Thornton T N Craft C A Dahlberg L L Lynch B S Baer K

(2000) Best Practices of Youth Violence Prevention A Sourcebook

for Community Action Atlanta GA Division of Violence

Prevention Centers for Disease Control and PreventionTobler N S (1986) Meta-analysis of 143 adolescent drug prevention

programs quantitative outcome of program participants compared to

a control or comparison group Journal of Drug Issues 16537ndash567Tobler N S Roona M R Ochshorn P Marshall D G Streke

A V Stackpole K M (2000) School-based adolescent drug

Motivation Skills and Decision Making 2013

ORDER REPRINTS

prevention programs 1998 Meta-analysis The Journal of Primary

Prevention 20275ndash336US Department of Health and Human Services (USDHHS) (2003)

Substance Abuse andMental Health Services Administration Center

for Substance Abuse Prevention Science-based prevention programs and

principles 2002 Rockville MD US DHHS (SMA)03-3764 Also

see httpmodelprogramssamhsagovUnger J Baezconde-Garbanati L Shakib S Palmer P H Nezami

E Mora J (2004) What are the implications of structuralcultural

theory for drug abuse prevention Substance Use amp MisuseUpshaw H S Ostrom T M (1984) Psychological perspective in

attitude research In Eiser J R ed Attitudinal Judgment New

York Springer-Verlag 23ndash42Valente T W Gallaher P Mouttapa M (2004) Using social network

theory to understand and prevent substance use a transdisciplinary

perspective Substance Use amp MisuseVorrath H Brendtro L (1985) Positive peer culture 2nd edn Aldine

ChicagoWaldron H B Slesnick N Brody J L Turner C W Peterson T R

(2001) Treatment outcomes for adolescent substance abuse at 4-

and 7-month assessments Journal of Consulting amp Clinical

Psychology 69(5)802ndash813Watson D L Tharp R G (2002) Self-directed behavior Self-

modification for personal adjustment 8th edn Belmont CA

WadsworthWeissberg R P Caplan M Z Sivo P J (1989) A new conceptual

framework for establishing school-based social competence promo-

tion programs In Bond L A Compas B E eds Primary

Prevention amp Promotion in the Schools Newbury Park CA Sage

255ndash296Wills T A (1986) Stress and coping in early adolescence relationships

to substance use in urban school samples Health Psychology

5503ndash529Wills T A Cleary S D (1995) Stress-coping model for alcohol-

tobacco interactions in adolescence In Fertig J B Allen J P

eds Alcohol and Tobacco From Basic Science to Clinical Practice

Bethesda MD National Institute on Alcohol Abuse and

Alcoholism 107ndash128Wills T A Cleary S D (1999) Peer and adolescent substance use

among 6thndash9th graders Latent growth analyses of influence versus

selection mechanisms Health Psychology 18453ndash463

2014 Sussman et al

ORDER REPRINTS

Wills T A Hirky A E (1996) Coping and substance abuse InZeidner M Endler N S eds Handbook of Coping TheoryResearch and Applications New York Wiley 279ndash302

Wills T A Stoolmiller M (2002) The role of self-control in earlyescalation of substance use a time-varying analysis Journal ofConsulting and Clinical Psychology 70986ndash997

Wills T A Baker E Botvin G J (1989) Dimensions of assertivenessdifferential relationships to substance use in early adolescenceJournal of Consulting and Clinical Psychology 57(4)473ndash478

Wills T A Vaccaro D McNamara G (1994) Novelty seeking risktaking and related constructs as predictors of adolescent substanceuse an application of Cloningerrsquos theory Journal of SubstanceAbuse 61ndash20

Wills T A McNamara G Vaccaro D Hirky A E (1996a)Escalated substance use a longitudinal grouping analysis fromearly to middle adolescence Journal of Abnormal Psychology105166ndash180

Wills T A Pierce J P Evans R I (1996b) Large-scale environmentalrisk factors for substance use American Behavioral Scientist39808ndash822

Wills T A Windle M Cleary S D (1998) Role of temperamentnovelty-seeking and self-control in adolescent substance useJournal of Personality and Social Psychology 74387ndash406

Wills T A Sandy J M Shinar O (1999) Substance use level andproblems in late adolescence a mediational model based on self-control and coping motives Experimental and ClinicalPsychopharmacology 7122ndash134

Wills T A Cleary S D Filer M Shinar O Mariani J Spera K(2001) Temperament and self-control related to early-onsetsubstance use test of a developmental model Prevention Science2145ndash163

Wills T A Sandy J M Yaeger A (2002) Moderators of therelationship between substance use level and problems test of aself-regulation model in adolescence Journal of AbnormalPsychology 1113ndash21

Wills T A Gibbons F X Gerrard M Murry V Brody G (in press-a) Family communication and religiosity related to substance useand sexual behavior in early adolescence Psychology of AddictiveBehaviors

Wills T A Resko J Ainette M Mendoza D (in press-b) The role ofparent and peer support in adolescent substance use a test ofmediated effects Psychology of Addictive Behaviors

Motivation Skills and Decision Making 2015

ORDER REPRINTS

Young P T (1936) Motivation of Behavior New York John Wiley andSons

Zimmerman B J (2000) Attaining self-regulation a social cognitivemodel In Boekaerts M Pintrich P R eds Handbook of Self-Regulation San Diego Academic Press 13ndash39

2016 Sussman et al

Request PermissionOrder Reprints

Reprints of this article can also be ordered at

httpwwwdekkercomservletproductDOI101081JA200034769

Request Permission or Order Reprints Instantly

Interested in copying and sharing this article In most cases US Copyright Law requires that you get permission from the articlersquos rightsholder before using copyrighted content

All information and materials found in this article including but not limited to text trademarks patents logos graphics and images (the Materials) are the copyrighted works and other forms of intellectual property of Marcel Dekker Inc or its licensors All rights not expressly granted are reserved

Get permission to lawfully reproduce and distribute the Materials or order reprints quickly and painlessly Simply click on the Request Permission Order Reprints link below and follow the instructions Visit the US Copyright Office for information on Fair Use limitations of US copyright law Please refer to The Association of American Publishersrsquo (AAP) website for guidelines on Fair Use in the Classroom

The Materials are for your personal use only and cannot be reformatted reposted resold or distributed by electronic means or otherwise without permission from Marcel Dekker Inc Marcel Dekker Inc grants you the limited right to display the Materials only on your personal computer or personal wireless device and to copy and download single copies of such Materials provided that any copyright trademark or other notice appearing on such Materials is also retained by displayed copied or downloaded as part of the Materials and is not removed or obscured and provided you do not edit modify alter or enhance the Materials Please refer to our Website User Agreement for more details

ORDER REPRINTS

maximize program effectiveness Careful program development can helpdetermine the best mix (Sussman et al 2002)

Summary of Evidence-based Targeted Drug Abuse Prevention

At present approximately 29 drug-use prevention programs havebeen evaluated favorably for their effects on drug use or other problembehavior (see Table 1) These 29 programs have been identified throughtwo sources Blueprints for Violence Prevention (Elliott 2003) and theSubstance Abuse and Mental Health Services Administrationrsquos(SAMSHA) science-based prevention programsrsquo guide (USDHHS2003) PsycINFO and MEDLINE searches of drug abuse preventionstudies since 1970 supplemented searches through these two guides (seeTable 1) Nine definitions of high-risk were used across these programsEleven programs focused on economic deprivation as the definition Sixprograms focused on delinquent behavior as the identifying characteristicto target Two programs each identified single-parent homes drug use orexposure to drug use family problems alternative high school attendanceor being at risk for dropout at a regular high school as the characteristicsto target subjects Finally one program each identified new immigrantstatus or residential facility placement as the defining characteristic ofbeing at high risk for drug use

Among these programs eight focused on preteens For example theEarly Risers program defined its high-risk youth as those 6ndash10 year-oldsthat suffered economic deprivation and exhibited aggressive or opposi-tional behavior Another five programs focused on a young teen agegroup For example Preventive Intervention defined its high-risk youthas those seventh to eighth graders who exhibited poor school andacademic discipline and reported family problems Another sevenprograms focused on an older teen age group For example ProjectTND defined its high-risk youth as those youth that attended alternativehigh schools Finally nine programs encompassed wide age ranges Forinstance Big Brothers Big Sisters of America defined its high-risk youthas 6ndash18 year-olds that lived in single-parent homes

Of these programs 10 involved multiple often flexible settings ofimplementation Another 13 programs focused on the school settingFour programs focused on the home setting Finally two programsfocused on a community agency setting In general these programsinvolved implementation by highly trained personnel Eighteen of theseprograms involved some motivation aspect generally motivationenhancement but sometimes including extrinsic reinforcement strategies

Motivation Skills and Decision Making 1997

ORDER REPRINTS

Twenty-six of these programs provided skills training Finally 18programs provided instruction in decision making Thus the MSDmodel tends to appear in a majority of these programs however all threecomponents were included together in only nine of these programs

Twenty of these programs involved at least one replication of theprogram and 14 involved three or more replications Further 14 of theseprograms were tested through use of experimental designs and nineinvolved use of only quasi-experimental designs Effects on drug use wereassessed and found in 22 of these programs For example theReconnecting Youth program was implemented to youth at risk fordropout This program involved 90 sessions within a comprehensive highschool class delivered generally over a semester with small studentgroups and a highly trained teacher Instruction included use of groupsupport and providing life skills training (norm setting self-esteem moodmanagement communication skills self-monitoring monitoring goalsschool bonding and social activities) with feedback to parents Programgoals were achieved through use of a quasi-experimental design showingeffects for school performance (18 improvement in grades) drug use(54 decrease in hard drug use) and suicide risk (32 decline inperceived stress) This programrsquos results have been replicated numeroustimes in numerous locations This program involved all three componentsof the MSD model except that motivation was provided through peergroup support not through provision motivation enhancement strate-gies These targeted programs present an optimistic picture for drug-useprevention that is focused on at-risk youth (see Table 1)

Not all targeted prevention programs have been found to beeffective One published program that failed to find positive effects wasProject PALS (Palinkas et al 1996) This project was developed for teengirls who were pregnant or at risk for pregnancy and drug use Theprogram consisted of school-based delivery of 16 sessions once a weekin a class The goal was to decrease drug use The PALS Skills TrainingProgram involved instruction in assertiveness providing and receivingfeedback social conversation handling requests and asking for help andmood management This program was tested against a normativeeducation program (called Facts of Life or FOL) which instructedvalues and decision making sexuality issues and contraception sexuallytransmitted diseases (STDs) drug use risks sexual assault prevalenceand norms material An experimental evaluation with a seven-monthspost-baseline was used The results indicated that the PALS programsubjects reported 29 times greater marijuana use than FOL amongbaseline nonusers No other differences were found It is possible that theprogram was not targeted to the right population that the mix of skills

1998 Sussman et al

ORDER REPRINTS

instructed was not appropriate or that skill training alone (withoutappropriate motivation material) may not be effective in drug useprevention Researchers should examine these possibilities and others tofurther understand program failures as well as program successes

Potential Limitations of Targeted Prevention

Dishion and colleagues (1995) suggest from various findings thatgrouping high-risk youth may lead to increased drug use This outcomecan result if youth come to learn deviant behavior from each other Theycan learn deviant behavior from each other in a program if they haveunstructured or unsupervised time together An essential feature ofseveral targeted programs (eg the RY and TND programs) is building apositive peer culture with group norms that decrease drug involvementand drug-use control problems The RYrsquos findings suggest that a positivepeer group component carefully fostered by a well-trained and competentRY group leader can direct the group toward lower risk behaviorSimilarly classroom management in Project TND involves developmentof positive norms of classroom behavior Further interaction betweenyouth is encouraged but is primarily teacher-directed and highlystructured (Sussman et al 2003) In both RY and Project TND theteacherrsquos role is to actively develop and maintain peer group support inthe class by modeling support positively reinforcing it among groupmembers and negatively reinforcing deviant peer bonds and activities(Eggert and Herting 1991 Vorrath and Brendtro 1985) The teachercreates and structures interactions among youth in prosocial directions(Sussman et al 2003)

Multiple Problem Behaviors of Adolescents

Acknowledging the relationship of drug use to other commonadolescent problems may facilitate identification of effective methods ofreducing drug use Researchers on tobacco alcohol and other drug useantisocial behavior high-risk sexual behavior and depression increas-ingly recognize that these problems are interrelated (McGee andNewcomb 1992) and stem to a large extent from the same environ-mental and biological factors (Biglan et al in press Eggert et al 1995Sussman and Ames 2001 Wills and Cleary 1995) Clearly it is necessaryto have strategies that address the entire range of problems and thecontext that influences those problems Indeed further reductions in

Motivation Skills and Decision Making 1999

ORDER REPRINTS

many problems require that we comprehensively target youth withmultiple problem behaviors

Biglan and colleagues (in press) provide a comprehensive review ofthe relationships among antisocial behavior tobacco alcohol and otherdrug use and high-risk sexual behavior It is clear that the same youngpeople are prone to the development of the entire range of problems In arecent review Moffitt and colleagues (2002) found that antisocialbehavior in early adolescence (rather than late adolescence) is a greaterrisk factor for developing multiple problems These findings point to theimportance of early intervention before youth develop serious problemsMoreover these different problems largely result from the same set ofenvironmental and biological factors

One implication is that disciplines dealing with these problemsother than drug abuse may contribute to dealing with the problem ofdrug use (Newcomb 1996b 1997) In particular research by dev-elopmental psychologists family social workers and sociologists onthe influence of parents on adolescent problem development and oninterventions to alter parenting practices contributes to our understandingof how to prevent or ameliorate drug abuse and other problems Onealso should note that nonsubstance use is not a guarantee for problemimmunity for the entire age range of people whatever their genderethnicity religiosity socioeconomic status (SEC) domicility etc It maybe argued that the most promising programs are those targeting thesemultiple levels of influence Several multidisciplinary programs haveachieved promising results We describe three of these empiricallyevaluated programs tested in various settings

Functional Family Therapy (FFT)FFT is an indicated intervention involving family treatment designed

for delinquent teenagers (also see Table 1) Developed in the early 1970sby Alexander and colleagues (1973) FFT focuses on family commu-nication and the establishment of rules and consequences Several studiesprovide encouraging reports of the programrsquos effectiveness (Alexander etal 1976 Barton et al 1985 Klein et al 1977 Waldron et al 2001) Inthe Waldron et al (2001) study researchers used FFT and anintervention with cognitive behavior therapy on teens referred formarijuana use Each of the interventions produced significant resultson marijuana use by the teens at four months but only the twointerventions combined maintained these results at seven months Theearlier studies found a greater number of results For example in the twoAlexander studies (1973 1976) improvement in family communicationposttreatment led to reduced delinquency Note that all the teens in these

2000 Sussman et al

ORDER REPRINTS

studies had histories of serious antisocial or delinquent behavior Thusachieving positive outcomes even if only short-term should encouragefurther research into the efficacy of FFT

Multisystemic Therapy (MST)As its name suggestsMST targets individual family peer school and

community influences of those youth offenders with serious problems thatmay include violence substance use and severe emotional problems (alsosee Table 1) Numerous researchers have published the results ofrandomized trials of MST (Henggeler et al 1996 1997 1998 Thorntonet al 2000) The most consistent findings across studies are decreased (1)drug use (2) re-arrest (3) self-reported criminal offense and (4) days inout-of-home placements Other consistent findings are improved familyrelations school attendance and psychiatric functioning One cautionarynote the programrsquos effectiveness lowers considerably if not implementedwith fidelity (Hengler et al 1997 1999) In other words all or key lessonsneed to be delivered as written by educators who are well-trained in usingthe strategies employed and youth need to be able to receive all material inan atmosphere conducive to learning the material The programdevelopers have instituted training strategies that address these fidelityissues thus shaping MST to be a very promising program for at-riskyouth

Multidimensional Treatment Foster Care (MTFC)MTFC targets family and peer factors influencing adolescents with a

pattern of repeat criminal offending (see Table 1) (Chamberlain 1994)This intervention includes placement of the youth into a foster homewith a foster parent trained in behavior management who receivessupport from intervention staff After the adolescent has begun torespond to the intervention in the foster home and after the parents havereceived the same training and support as the foster parents did theadolescent returns home Chamberlain and Reid (1998) tested theintervention with 85 boys with felony and other criminal histories andfound substantial benefits of the program Following treatment the boysassigned to MTFC (compared to those receiving community-based groupcare) showed fewer days in detention or lock-up twice as much timeliving with parents fewer misdemeanor and felony arrests and fewer self-reported index crimes felony arrests and general delinquency TheMTFC is a cost-effective alternative to incarceration however staffrequirements are extensive which may influence the ability of some

Motivation Skills and Decision Making 2001

ORDER REPRINTS

groups to apply the program with fidelity However as with each of theprograms described here the results of the randomized trials areencouraging

Future Research Needs in Targeted Prevention

Future research can help discern when and where targeted preventionprogramming will tend to work rather than produce potentiallydeleterious negative group effects or results that are irrelevant for pro-social healthy adaptation as well as what the critical necessary conditionsare for their effective operation within given de facto realities Comparedto the breadth of evaluated universal drug use prevention programs(Tobler et al 2000) relatively few targeted prevention programs havereceived empirical support Yet previous research suggests that universalschool-based drug use prevention programs implemented in junior highschool have relatively less chance of long-term success especially for thoseyouth that began using drugs before the prevention program wasimplemented Of course there are notable exceptions (eg effects lastedfor one and a half years effects lasted for six years) (Chou et al 1998Griffin et al 2003 Skara and Sussman 2003) Almost no research existsregarding maximization of booster programming with high-risk youthMore research on booster programs would help the field

While continuing to engage in this work there will be numerousissues to manage that go well beyond the scope of this article There willbe a need to avoid producing negative labeling effects while providingprogramming for those who are at risk for drug use It is possible thatcessation information needs to be included in the mix with preventionmaterial to provide better targeted-prevention effects There may be aneed to develop a teacher selection instrument to help select out teacherswho can deliver drug abuse prevention programming adequatelyCertainly definition of outcome variables needs continued explorationincluding analysis to ascertain the effects of programming on drug abusevs drug use and identification of the variables that are most closelylinked to change by targeted prevention components

A transdisciplinary approach helps to better understand the lifesituation of high-risk youth as based to some extent on both constitutionaland environmental factors (Fuqua et al 2004 Rutter et al 1997 Wills etal 1996b) From the transactional perspective their situation is in partconstitutional they may have temperamental characteristics that arepartly heritable and that have set the stage at earlier ages for decrements inself-control ability and academic performance that then increase risk for

2002 Sussman et al

ORDER REPRINTS

drug use However their situation is also part environmental based in parton family socialization and in part on the types of peers they have as well asthe type and quality of the physical and cultural environment-at-largeThere are many points at which a potential chain of failures can beinterrupted and the individualrsquos trajectory turned in a better directionProblems are not inevitable from starting level (Tarter and Vanyukov1994) and environmental modifications to support good self-controlability can help to avert an adverse impact from earlier experiences orcurrent difficulties (Brody et al 2002 Novak and Clayton 2001 Patock-Peckham et al 2001 Rutter et al 1997 Wills et al 2002)

The problems and needs of high-risk youth in our nationrsquos highschools demand our attention for designing and rigorously testingtargeted prevention approaches Substantial evidence shows that theseyouth are at greater risk for drug involvement and co-occurring problemssuch as aggression depression and suicidal behaviors as we previouslydiscussed It is hoped that the information presented in this article willstimulate others to join in extending this work including testing othermodels of targeted prevention

GLOSSARY

Universal programs Programs that aim to influence all subjects in acontext

Selective drug-abuse prevention programs Programs that servegroups at greater risk of ATOD usemdashfor example children of alcoholicparents They are at psychosocial risk for drug use and abuse

Indicated drug-abuse prevention programs Programs that attemptto benefit individuals who already show signs of drug involvement orrelated risk factors In indicated prevention programs the primary goal isto stem the progression of ATOD use or reduce drug involvementamong the high-risk youth

Targeted programming Programming that subsumes selective andindicated programming sometimes the other two types of programs thattarget specific groups lsquolsquoat riskrsquorsquo are considered together

ACKNOWLEDGMENTS

This research was supported by grants from the National Institute onDrug Abuse (DA01070 DA07601 DA13814 and DA16094) and by aResearch Scientist Development Award K02 DA00252 from theNational Institute on Drug Abuse

Motivation Skills and Decision Making 2003

ORDER REPRINTS

REFERENCES

Alexander J F Barton C Schiaro R S Parsons B V (1976)

Systems-behavioral intervention with families of delinquents

therapist characteristics family behavior and outcome Journal of

Consulting and Clinical Psychology 44(4)656ndash664Alexander J F Parsons B V (1973) Short-term behavioral interven-

tion with delinquent families impact on family process and

recidivism Journal of Abnormal Psychology 3219ndash225American psychiatric association (APA) (1994) Diagnostic and

Statistical Manual of Mental Disorders 4th edn (DSM-IV)

Washington DC American Psychiatric AssociationAmes S L Sussman S Dent C W (1999) Pro-drug-use myths and

competing constructs in the prediction of substance use among

youth at continuation high schools a one-year prospective study

Personality and Individual Differences 26987ndash1003Bachman S G Wadsworth K N OrsquoMalley P M Johnston L D

Schulenberg J E (1997) Smoking drinking and drug use in young

adulthood Mahwah NJ Lawrence Erlbaum Associates 8ndash25

153ndash190Bandura A (1986) Social Foundations of Thought and Action A Social

Cognitive Theory Englewood Cliffs NJ Prentice HallBarton C Alexander J F Waldron H Turner C W Warburton J

(1985) Generalizing treatment effects of functional family therapy

Three replications The American Journal of Family Therapy

13(3)16ndash26Battin-Pearson S R Newcomb M D Abbott R D Hill K G

Catalano R F Hawkins J D (2000) Predicting early high school

dropout Journal of Educational Psychology 92568ndash582Biglan A Brennan P A Foster S L Holder H D Miller T L

Cunningham P B et al (in press) Helping Adolescents at Risk

Prevention of Multiple Problem Behaviors New York NY Guilford

PressBindra D Stewart J (1996) Motivation Baltimore MD Penguin

BooksBlanton H Gibbons F X Gerrard M Conger K J Smith G E

(1998) The role of family and peers in the development of

prototypes associated with substance use Journal of Family

Psychology 11271ndash288

2004 Sussman et al

ORDER REPRINTS

Botvin G J (1993) School-based drug abuse prevention Long-termfollow-up results In First Annual Meeting of the Society forPrevention Research Kentuck Lexington Society for PreventionResearch

Botvin G J Baker E Dusenbury L Botvin E M Diaz T (1995)Long-term follow-up results of a randomized drug abuse preven-tion trial in a white middle-class population Journal of theAmerican Medical Association 2731106ndash1012

Brody G H Dorsey S Forehand R Armistead L (2002) Uniquecontributions of parenting and classroom processes to the self-control of AfricanndashAmerican children Child Development73274ndash286

Carroll M E (1996) Reducing drug abuse by enriching the environmentwith alternative nondrug reinforcers In Green L Kagel J Heds Advances in Behavioral Economics Norwood NJ NorwoodPublishing Corp 37ndash68

Carver C S Scheier M F (1998) On the Self-Regulation of BehaviorNew York Cambridge University Press

Catalano R F Hawkins J D (1996) The social developmental modela theory of antisocial behavior In Hawkins J D ed Delinquencyand Crime Current Theories New York Cambridge UniversityPress

Centers for Disease Control (CDC) (October 1999) Youth risk BehaviorSurveillancemdashNational Alternative High School Youth RiskBehavior Survey 1998 Morbidity and Mortality Weekly Report48 No SS-7

Chamberlain P (1994) Family connections A treatment foster caremodel for adolescents with delinquency Eugene OR CastaliaPublishing Company

Chamberlain P Reid J B (1998) Comparison of two communityalternatives to incarceration for chronic juvenile offenders Journalof Consulting and Clinical Psychology 66(4)624ndash633

Chassin L A Presson C C Sherman S J (1985) Stepping backwardin order to step forward an acquisition-oriented approach toprimary prevention Journal of Consulting and Clinical Psychology53612ndash622

Chou C-P Montgomery S Pentz M A Rohrbach L A JohnsonC A Flay B R MacKinnon D P (1998) Effects of acommunity-based prevention program on decreasing drug use inhigh-risk adolescentsAmerican Journal of Public Health 88944ndash948

Conducts Problems Prevention Research Group (CPPRG) (1999) Initialimpact of the fast track prevention trial for conduct problems I

Motivation Skills and Decision Making 2005

ORDER REPRINTS

The high-risk sample Journal of Consulting and Clinical Psychology

67631ndash647Conducts Problems Prevention Research Group (CPPRG) (2000)

Merging universal and indicated prevention programs the fast

track model Addictive Behaviors 25913ndash927Council of Philosophical Studies (1981) Psychology and the Philosophy

of Mind in the Philosophy Curriculum San Francisco San Francisco

State UniversityCummings K M Hellmann R Emont S L (1988) Correlates of

participation in a worksite stop smoking program Journal of

Behavioral Medicine 11267ndash277Curry S Wagner E H Gothaus L C (1990) Intrinsic and extrinsic

motivation for smoking cessation Journal of Consulting and

Clinical Psychology 58310ndash316Dent C W Sussman S McCuller W J Stacy A W (2001) Drug

abuse prevention among youth at comprehensive high schools

Preventive Medicine 32514ndash520Dewey J (1886) Psychology New York HarperDishion T J French D C Patterson G R (1995) The development

and ecology of antisocial behavior In Cicchetti D Cohen D

eds Manual of developmental psychopathology New York John

Wiley 421ndash471Eggert L L Herting J R (1991) Preventing teenage drug abuse

exploratory effects of network social support Youth and Society

22482ndash534 [Reprinted National Prevention Evaluation Research

CollectionRockville MD Aspen 1993]Eggert L L Herting J R Thompson E A Nicholas L J Dicker

B G (1994) Preventing adolescent drug abuse and high school

dropout through an intensive school-based social network devel-

opment program American Journal of Health Promotion

8202ndash214Eggert L L Thompson E A Herting J R Nicholas L J (1995)

Reducing suicide potential among high-risk youth tests of a school-

based prevention program Suicide amp Life-Threatening Behavior

25276ndash296Ellickson P L Bell R M (1990) Drug prevention in junior high a

multi-site longitudinal test Science 2471299ndash1305Elliott D S (Series ed) (2003) Blueprints for violence prevention

Boulder CO Institute of Behavioral Science Regents of the

University of Colorado wwwcoloradoeducspvblueprints

2006 Sussman et al

ORDER REPRINTS

Farrell A D Danish S J (1993) Peer drug associations and emotionalrestraint Causes or consequences of adolescent drug use Journal ofConsulting and Clinical Psychology 61327ndash334

Festinger L A (1957) A Theory of Cognitive Dissonance New YorkHarper amp Row

Fuqua J Stokols D Gress J Phillips K Harvey R (2004)Transdisciplinary collaboration as a basis for enhancing the scienceand prevention of substance use and abuse Substance Use ampMisuse

Giuliano J D (1994) A peer education program to promote the use ofconflict resolution skills among at-risk school-age males PublicHealth Reports 109158ndash169

Glynn K Levanthal H Hirschman R (1985) A cognitivedevelopmental approach to smoking prevention In Bell C SBattjes R eds Prevention research Deterring Drug Abuse AmongChildren and Adolescents Rockville MD NIDA ResearchMonograph 63

Glynn T J (1989) Essential elements of school-based smokingprevention programs Journal of School Health 59181ndash188

Goodman R M Burdine J N Meehan E McLeroy K R eds(1993) Community coalitions for health promotion Special issue ofHealth Education Research Theory and Practice 8309ndash453

Goodyear R D Newcomb M D Locke T F (2002) PregnantLatina teenagers psychosocial and developmental determinants ofhow they select and perceive the men who father their childrenJournal of Counseling Psychology 49187ndash201

Gordon R (1987) An operational classification of disease preventionIn Steinberg J A Silverman M M eds Preventing MentalDisorders Rockville MD DHHS 20ndash26

Graham J W Johnson C A Hansen W B Flay B R Gee M(1990) Drug use prevention programs gender and ethnicityevaluation of three seventh-grade project SMART cohortsPreventive Medicine 19305ndash313

Griffin K W Botvin G J Nichols T R Doyal M M (2003)Effectiveness of a universal drug abuse prevention approach foryouth at high risk for substance use initiation Preventive Medicine36(1)1ndash7

Hamilton S (August 20 2000) Views slowly changing on alternativeschools The Sacramento Bee 1ndash3

Hansen W B (1992) School-based substance abuse prevention a reviewof the state of the art in curriculum 1980ndash1990 Health EducationResearch 7403ndash430

Motivation Skills and Decision Making 2007

ORDER REPRINTS

Hansen W B Johnson C A Flay B R Graham J W Sobel J(1988) Affective and social influences approaches to the preventionof multiple substance abuse among seventh grade students resultsfrom project SMART Preventive Medicine 17135ndash154

Hansen W B Graham J W (1991) Preventing alcohol marijuanaand cigarette use among adolescents peer pressure and resistancetraining versus establishing conservative norms PreventiveMedicine 20414ndash430

Hawkins D H Catalano R F Miller J Y (1992) Risk andprotective factors for alcohol and other drug problems inadolescence and early adulthood Implications for substanceabuse prevention Psychological Bulletin 11254ndash105

Hawkins J D Catalano R F Kosterman R Abbott R Hill K G(1999) Preventing adolescent health-risk behaviors by strengthen-ing protection during childhood Archives of Pediatric amp AdolescentMedicine 153226ndash234

Heider F (1958) The Psychology of Interpersonal Relations New YorkWiley

Henggeler S W Pickrel S G Brondino M J Crouch J L (1996)Eliminating (almost) treatment dropout of substance abusing ordependent delinquents through home-based multisystemic therapyAmerican Journal of Psychiatry 153(3)427ndash428

Henggeler S W Melton G B Brondino M J Scherer D GHanley J H (1997) Multisystemic therapy with violent andchronic juvenile offenders and their families the role of treatmentfidelity in successful dissemination Journal of Consulting andClinical Psychology 65(5)821ndash833

Henggeler S W Schoenwald S K Borduin C M Rowland M DCunningham P B (1998) Multisystemic treatment of antisocialbehavior in children and adolescents New York The Guilford Press

Henggeler S W Pickrel S G Brondino M J (1999) Multisystemictreatment of substance-abusing and dependent delinquents out-comes treatment fidelity and transportability Mental HealthServices Residual 1(3)171ndash84

Johnson C A Pentz M A Weber M D Dwyer J H Baer NMacKinnon D P Hansen W B Flay B R (1990) Relativeeffectiveness of comprehensive community programming for drugabuse prevention with high-risk and low-risk adolescents Journalof Consulting and Clinical Psychology 58447ndash456

Kaftarian S J Hansen W B eds (1994) CSAP special issuecommunity partnership program Journal of Community Psychologypages 205

2008 Sussman et al

ORDER REPRINTS

Karoly P (1993) Mechanisms in self-regulation A systems view AnnualReview of Psychology 4423ndash51

Karoly P (1980) Person variables in therapeutic change and develop-ment In Karoly P Steffen J J eds Improving the Long-TermEffects of Psychotherapy New York Gardner Press 195ndash261

Kendall P C Braswell L (1982) Cognitive-behavioral self-controltherapy for children a components analysis Journal of Consultingand Clinical Psychology 50672ndash689

Kerr M Tremblay R E Pagani L Vitaro F (1997) Boysrsquobehavioral inhibition and the risk of later delinquency Archivesof General Psychiatry 54809ndash816

Klein N C Alexander J F Parsons B V (1977) Impact of familysystems intervention on recidivism and sibling delinquency a modelof primary prevention and program evaluation Journal ofConsulting and Clinical Psychology 45(3)469ndash474

Kumpfer K L (1999) Outcomes measures of interventions in the studyof children of substance-abusing parents Pediatrics 1031128ndash1144

Lau R R Hartman K A Ware J E (1986) Health as a valuemethodological and theoretical considerations Health Psychology525ndash43

Lichtenstein E L Glasgow R E (1997) A pragmatic framework forsmoking cessation implications for clinical and public healthprograms Psychology of Addictive Behaviors 11142ndash151

Locke T F Newcomb M D (in press) Childhood maltreatmentparent drug problems polydrug problems and parenting practicesa test of gender differences and four theoretical perspectivesJournal of Family Psychology

McCreary D R Newcomb M D Sadava S W (1999) The male rolealcohol use and alcohol problems a structural modeling examina-tion in adult women and men Journal of Counseling Psychology46109ndash124

McGee L Newcomb M D (1992) General deviance syndromeexpanded hierarchical evaluations at four ages from earlyadolescence to adulthood Journal of Consulting amp ClinicalPsychology 60766ndash776

Miller W R Brown J M (1991) Self-regulation as a conceptual basisfor the prevention of addictive behaviours In Heather N MillerW R Greeley J eds Self-control and the Addictive BehavioursSydney Australia Maxwell Macmillan 3ndash79

Miller W R Leckman A L Delaney H D Tinkcom M (1993)Long-term follow-up of behavioral self-control training forproblem drinkers Journal of Studies on Alcohol 53249ndash261

Motivation Skills and Decision Making 2009

ORDER REPRINTS

Miller W R Rollnick S (1991) Motivational InterviewingPreparing People to Change Addictive Behavior New YorkGuilford Press

Moffitt T E Caspi A Harrington H Milne B J (2002) Males onthe life-course-persistent and adolescence-limited antisocial path-ways follow-up at age 26 years Development and Psychopathology14(1)179ndash207

National Institute on Drug Abuse (NIDA) (1997) Drug abuseprevention What works NIH Publication 97-4110 DHHSNational Institutes of Health National Institute on Drug AbuseOffice of Science Policy and Communications Rockville MD

Newcomb M D (1992a) Substance abuse and control in the UnitedStates ethical and legal issues Social Science and Medicine35471ndash479

Newcomb M D (1992b) Understanding the multidimensional nature ofdrug use and abuse The role of consumption risk factors andprotective factors In Glantz M D Pickens R eds Vulnerabilityto Drug Abuse Washington DC American PsychologicalAssociation 255ndash298

Newcomb M D (1996a) Pseudomaturity among adolescents constructvalidation sex differences and associations in adulthood Journalof Drug Issues 26477ndash504

Newcomb M D (1996b) Adolescence Pathologizing a normal processThe Counseling Psychologist 24482ndash490

Newcomb M D (1997) Psychosocial predictors and consequences ofdrug use a developmental perspective within a prospective studyJournal of Addictive Diseases 1651ndash89

Newcomb M D Bentler P M (1988) Consequences of Adolescent DrugUse Impact on the Lives of Young Adults Beverly Hills CA Sage

Newcomb M D Bentler P M (1989) Substance use and abuse amongchildren and teenagers American Psychologist 44242ndash248

Newcomb M D Harlow L L (1986) Life events and substance useamong adolescents Mediating effects of perceived loss of controland meaninglessness in life Journal of Personality and SocialPsychology 51564ndash577

Newcomb M D Chou C-P Bentler P M Huba G J (1988)Cognitive motivations for drug use among adolescents longitudinaltests of gender differences and predictors of change in drug useJournal of Counseling Psychology 35426ndash438

Newcomb M D Abbott R D Catalano R F Hawkins J DBattin-Pearson S R Hill K (2002) Mediational and deviancetheories of late high school failure Process roles of structural

2010 Sussman et al

ORDER REPRINTS

strains academic competence and general versus specific problem

behaviors Journal of Counseling Psychology 49172ndash186Nezami E Sussman S Pentz M A (2003) Motivation in tobacco use

cessation research Substance Use amp Misuse 3825ndash5Novak S P Clayton R R (2001) The influence of school environment

and self-regulation on transitions between stages of cigarette

smoking Health Psychology 20196ndash207Offord D R (2000) Selection of levels of prevention Addictive

Behaviors 25833ndash842Palinkas L A Atkins C J Miller C Ferreira D (1996) Social skills

training for drug prevention in high-risk female adolescents

Preventive Medicine 25692ndash701Patock-Peckham J A Cheong J-W Balhorn M E Nagoshi C T

(2001) A model of parenting styles self-regulation perceived

drinking control and alcohol use and problems Alcoholism

Experimental and Clinical Research 251284ndash1292Pentz M A (1994) Directions for future research in drug abuse

prevention Preventive Medicine 23646ndash652Pentz M A Dwyer J H MacKinnon D Flay B R Hansen W B

Wang E Y I Johnson C A (1989) A multi-community trial for

primary prevention of adolescent drug abuse effects on drug use

prevalence JAMA 2623259ndash3266Pentz M A Mares D Schinke S Rohrbach L (in press) Political

science public policy and drug abuse prevention Substance Use amp

MisuseProchaska J O DiClemente C C (1982) Transtheoretical therapy

toward a more integrative model of change Psychotherapy Theory

Research and Practice 19275ndash288Pulkkinen L Pitkanen T (1994) A prospective study of the precursors

to problem drinking in young adulthood Journal of Studies on

Alcohol 55578ndash587Rathus S A Nevid J S (1977) Behavior Therapy Strategies for

Solving Problems in Living New York Doubleday and Company

IncResnicow K Botvin G (1993) School-based substance use prevention

programs why do effects decay Preventive Medicine 22484ndash490Rutter M Dunn J Plomin R Simonoff E Pickles A Maughan

B Ormel J Meyer J Eaves L (1997) Integrating nature and

nurture implications of person-environment interactions for

developmental psychopathology Development and Psychopathology

9335ndash364

Motivation Skills and Decision Making 2011

ORDER REPRINTS

Salomon G Stein Y Eisenberg S Klein L (1984) Adolescent

smokers and nonsmokers profiles and their changing structure

Preventive Medicine 13446ndash461Sambrano S (1999) National cross-site evaluation of high risk youth

programs In Interim findings Bulletin Washington DC CSAP

SAMSHA US DHHS May 1ndash16Schinke S P Gilchrist L D (1985) Preventing substance abuse with

children and adolescents Journal of Consulting and Clinical

Psychology 53596ndash602Skara S N Sussman S (2003) A review of 25 long-term adolescent

tobacco and other drug use prevention program evaluations

Preventive MedicineSmith C Lizotte A J Thornberry T P Krohn M D (1995)

Resilient youth identifying factors that prevent high-risk youth

from engaging in delinquency and drug use Delinquency and

Disrepute in the Life Course Greenwich CT John Hagan JAI

press 217ndash247Sommers P V (1972) The Biology of Behavior Australia Pty ltd

Sydney John Wiley amp SonsSt Pierre T L Kaltreider D L Mark M M Aikin K J (1992)

Drug prevention in a community setting a longitudinal study of the

relative effectiveness of a three-year primary prevention program in

boys and girls clubs across the nation American Journal of

Community Psychology 20673ndash706Stein J A Newcomb M D Bentler P M (1987) An eight year study

of multiple influences on drug use and drug use consequences

Journal of Personality and Social Psychology 531094ndash1105Sully J (1884) Outlines of Psychology New York D Appleton amp CoSussman S (1989) Two social influence perspectives of tobacco use

development and prevention Health Education Research Theory

and Practice 4213ndash223Sussman S (1991) Curriculum development in school-based prevention

research Health Education Research Theory and Practice

6339ndash351Sussman S (1996) Development of a school-based drug abuse

prevention curriculum for high risk youth Journal of

Psychoactive Drugs 28169ndash182Sussman S Ames S L (2001) The social psychology of drug abuse

Buckingham GB Open University PressSussman S Unger J (2004) A drug abuse theoretical integration a

transdisciplinary speculation Substance Use amp Misuse

2012 Sussman et al

ORDER REPRINTS

Sussman S Dent C W Burton D Stacy A W Flay B R (1995a)

Developing school-based tobacco use prevention and cessation

programs Thousand Oaks CA Sage Publications IncSussman S Dent C W Simon T R Stacy A W Galaif E R

Moss M A Craig S Johnson C A (1995b) Effectiveness of

social influence substance abuse prevention curricula in compre-

hensive and continuation high schools Drugs and Society 865ndash81Sussman S Dent C W Galaif E R (1997) The correlates of

substance abuse and dependence among adolescents at high risk

for drug abuse Journal of Substance Abuse 9241ndash255Sussman S Dent C W Stacy A W (1996) The relation of pro-drug

use myths with self-reported drug use among youth at continuation

high schools Journal of Applied Social Psychology 26214ndash267Sussman S Dent C W Stacy A Craig S (1998) One-year outcomes

of project towards no drug abuse Preventive Medicine 27632ndash642

(erratum 766)Sussman S Dent C W Stacy S (2002) Project towards no drug

abuse a review of the findings and future directions American

Journal of Health Behavior 26354ndash365Sussman S McCuller W J Dent C W (2003) The associations of

social self-control personality disorders and demographics with

drug use among high risk youth Addictive Behaviors 281159ndash1166Sussman S Rohrbach L Patel R Holiday K (2003) A look at an

interactive classroom-based drug abuse prevention program

Interactive contents and suggestions for research Journal of Drug

Education 33355ndash368Sussman S Sun P McCuller W J Dent C W (2003) Project

towards no drug abuse two year outcomes of a trial that compares

health educator delivery to self-instruction Preventive Medicine

37155ndash162Tarter R E Vanyukov M (1994) Alcoholism a developmental disorder

Journal of Consulting and Clinical Psychology 621096ndash1107Thornton T N Craft C A Dahlberg L L Lynch B S Baer K

(2000) Best Practices of Youth Violence Prevention A Sourcebook

for Community Action Atlanta GA Division of Violence

Prevention Centers for Disease Control and PreventionTobler N S (1986) Meta-analysis of 143 adolescent drug prevention

programs quantitative outcome of program participants compared to

a control or comparison group Journal of Drug Issues 16537ndash567Tobler N S Roona M R Ochshorn P Marshall D G Streke

A V Stackpole K M (2000) School-based adolescent drug

Motivation Skills and Decision Making 2013

ORDER REPRINTS

prevention programs 1998 Meta-analysis The Journal of Primary

Prevention 20275ndash336US Department of Health and Human Services (USDHHS) (2003)

Substance Abuse andMental Health Services Administration Center

for Substance Abuse Prevention Science-based prevention programs and

principles 2002 Rockville MD US DHHS (SMA)03-3764 Also

see httpmodelprogramssamhsagovUnger J Baezconde-Garbanati L Shakib S Palmer P H Nezami

E Mora J (2004) What are the implications of structuralcultural

theory for drug abuse prevention Substance Use amp MisuseUpshaw H S Ostrom T M (1984) Psychological perspective in

attitude research In Eiser J R ed Attitudinal Judgment New

York Springer-Verlag 23ndash42Valente T W Gallaher P Mouttapa M (2004) Using social network

theory to understand and prevent substance use a transdisciplinary

perspective Substance Use amp MisuseVorrath H Brendtro L (1985) Positive peer culture 2nd edn Aldine

ChicagoWaldron H B Slesnick N Brody J L Turner C W Peterson T R

(2001) Treatment outcomes for adolescent substance abuse at 4-

and 7-month assessments Journal of Consulting amp Clinical

Psychology 69(5)802ndash813Watson D L Tharp R G (2002) Self-directed behavior Self-

modification for personal adjustment 8th edn Belmont CA

WadsworthWeissberg R P Caplan M Z Sivo P J (1989) A new conceptual

framework for establishing school-based social competence promo-

tion programs In Bond L A Compas B E eds Primary

Prevention amp Promotion in the Schools Newbury Park CA Sage

255ndash296Wills T A (1986) Stress and coping in early adolescence relationships

to substance use in urban school samples Health Psychology

5503ndash529Wills T A Cleary S D (1995) Stress-coping model for alcohol-

tobacco interactions in adolescence In Fertig J B Allen J P

eds Alcohol and Tobacco From Basic Science to Clinical Practice

Bethesda MD National Institute on Alcohol Abuse and

Alcoholism 107ndash128Wills T A Cleary S D (1999) Peer and adolescent substance use

among 6thndash9th graders Latent growth analyses of influence versus

selection mechanisms Health Psychology 18453ndash463

2014 Sussman et al

ORDER REPRINTS

Wills T A Hirky A E (1996) Coping and substance abuse InZeidner M Endler N S eds Handbook of Coping TheoryResearch and Applications New York Wiley 279ndash302

Wills T A Stoolmiller M (2002) The role of self-control in earlyescalation of substance use a time-varying analysis Journal ofConsulting and Clinical Psychology 70986ndash997

Wills T A Baker E Botvin G J (1989) Dimensions of assertivenessdifferential relationships to substance use in early adolescenceJournal of Consulting and Clinical Psychology 57(4)473ndash478

Wills T A Vaccaro D McNamara G (1994) Novelty seeking risktaking and related constructs as predictors of adolescent substanceuse an application of Cloningerrsquos theory Journal of SubstanceAbuse 61ndash20

Wills T A McNamara G Vaccaro D Hirky A E (1996a)Escalated substance use a longitudinal grouping analysis fromearly to middle adolescence Journal of Abnormal Psychology105166ndash180

Wills T A Pierce J P Evans R I (1996b) Large-scale environmentalrisk factors for substance use American Behavioral Scientist39808ndash822

Wills T A Windle M Cleary S D (1998) Role of temperamentnovelty-seeking and self-control in adolescent substance useJournal of Personality and Social Psychology 74387ndash406

Wills T A Sandy J M Shinar O (1999) Substance use level andproblems in late adolescence a mediational model based on self-control and coping motives Experimental and ClinicalPsychopharmacology 7122ndash134

Wills T A Cleary S D Filer M Shinar O Mariani J Spera K(2001) Temperament and self-control related to early-onsetsubstance use test of a developmental model Prevention Science2145ndash163

Wills T A Sandy J M Yaeger A (2002) Moderators of therelationship between substance use level and problems test of aself-regulation model in adolescence Journal of AbnormalPsychology 1113ndash21

Wills T A Gibbons F X Gerrard M Murry V Brody G (in press-a) Family communication and religiosity related to substance useand sexual behavior in early adolescence Psychology of AddictiveBehaviors

Wills T A Resko J Ainette M Mendoza D (in press-b) The role ofparent and peer support in adolescent substance use a test ofmediated effects Psychology of Addictive Behaviors

Motivation Skills and Decision Making 2015

ORDER REPRINTS

Young P T (1936) Motivation of Behavior New York John Wiley andSons

Zimmerman B J (2000) Attaining self-regulation a social cognitivemodel In Boekaerts M Pintrich P R eds Handbook of Self-Regulation San Diego Academic Press 13ndash39

2016 Sussman et al

Request PermissionOrder Reprints

Reprints of this article can also be ordered at

httpwwwdekkercomservletproductDOI101081JA200034769

Request Permission or Order Reprints Instantly

Interested in copying and sharing this article In most cases US Copyright Law requires that you get permission from the articlersquos rightsholder before using copyrighted content

All information and materials found in this article including but not limited to text trademarks patents logos graphics and images (the Materials) are the copyrighted works and other forms of intellectual property of Marcel Dekker Inc or its licensors All rights not expressly granted are reserved

Get permission to lawfully reproduce and distribute the Materials or order reprints quickly and painlessly Simply click on the Request Permission Order Reprints link below and follow the instructions Visit the US Copyright Office for information on Fair Use limitations of US copyright law Please refer to The Association of American Publishersrsquo (AAP) website for guidelines on Fair Use in the Classroom

The Materials are for your personal use only and cannot be reformatted reposted resold or distributed by electronic means or otherwise without permission from Marcel Dekker Inc Marcel Dekker Inc grants you the limited right to display the Materials only on your personal computer or personal wireless device and to copy and download single copies of such Materials provided that any copyright trademark or other notice appearing on such Materials is also retained by displayed copied or downloaded as part of the Materials and is not removed or obscured and provided you do not edit modify alter or enhance the Materials Please refer to our Website User Agreement for more details

ORDER REPRINTS

Twenty-six of these programs provided skills training Finally 18programs provided instruction in decision making Thus the MSDmodel tends to appear in a majority of these programs however all threecomponents were included together in only nine of these programs

Twenty of these programs involved at least one replication of theprogram and 14 involved three or more replications Further 14 of theseprograms were tested through use of experimental designs and nineinvolved use of only quasi-experimental designs Effects on drug use wereassessed and found in 22 of these programs For example theReconnecting Youth program was implemented to youth at risk fordropout This program involved 90 sessions within a comprehensive highschool class delivered generally over a semester with small studentgroups and a highly trained teacher Instruction included use of groupsupport and providing life skills training (norm setting self-esteem moodmanagement communication skills self-monitoring monitoring goalsschool bonding and social activities) with feedback to parents Programgoals were achieved through use of a quasi-experimental design showingeffects for school performance (18 improvement in grades) drug use(54 decrease in hard drug use) and suicide risk (32 decline inperceived stress) This programrsquos results have been replicated numeroustimes in numerous locations This program involved all three componentsof the MSD model except that motivation was provided through peergroup support not through provision motivation enhancement strate-gies These targeted programs present an optimistic picture for drug-useprevention that is focused on at-risk youth (see Table 1)

Not all targeted prevention programs have been found to beeffective One published program that failed to find positive effects wasProject PALS (Palinkas et al 1996) This project was developed for teengirls who were pregnant or at risk for pregnancy and drug use Theprogram consisted of school-based delivery of 16 sessions once a weekin a class The goal was to decrease drug use The PALS Skills TrainingProgram involved instruction in assertiveness providing and receivingfeedback social conversation handling requests and asking for help andmood management This program was tested against a normativeeducation program (called Facts of Life or FOL) which instructedvalues and decision making sexuality issues and contraception sexuallytransmitted diseases (STDs) drug use risks sexual assault prevalenceand norms material An experimental evaluation with a seven-monthspost-baseline was used The results indicated that the PALS programsubjects reported 29 times greater marijuana use than FOL amongbaseline nonusers No other differences were found It is possible that theprogram was not targeted to the right population that the mix of skills

1998 Sussman et al

ORDER REPRINTS

instructed was not appropriate or that skill training alone (withoutappropriate motivation material) may not be effective in drug useprevention Researchers should examine these possibilities and others tofurther understand program failures as well as program successes

Potential Limitations of Targeted Prevention

Dishion and colleagues (1995) suggest from various findings thatgrouping high-risk youth may lead to increased drug use This outcomecan result if youth come to learn deviant behavior from each other Theycan learn deviant behavior from each other in a program if they haveunstructured or unsupervised time together An essential feature ofseveral targeted programs (eg the RY and TND programs) is building apositive peer culture with group norms that decrease drug involvementand drug-use control problems The RYrsquos findings suggest that a positivepeer group component carefully fostered by a well-trained and competentRY group leader can direct the group toward lower risk behaviorSimilarly classroom management in Project TND involves developmentof positive norms of classroom behavior Further interaction betweenyouth is encouraged but is primarily teacher-directed and highlystructured (Sussman et al 2003) In both RY and Project TND theteacherrsquos role is to actively develop and maintain peer group support inthe class by modeling support positively reinforcing it among groupmembers and negatively reinforcing deviant peer bonds and activities(Eggert and Herting 1991 Vorrath and Brendtro 1985) The teachercreates and structures interactions among youth in prosocial directions(Sussman et al 2003)

Multiple Problem Behaviors of Adolescents

Acknowledging the relationship of drug use to other commonadolescent problems may facilitate identification of effective methods ofreducing drug use Researchers on tobacco alcohol and other drug useantisocial behavior high-risk sexual behavior and depression increas-ingly recognize that these problems are interrelated (McGee andNewcomb 1992) and stem to a large extent from the same environ-mental and biological factors (Biglan et al in press Eggert et al 1995Sussman and Ames 2001 Wills and Cleary 1995) Clearly it is necessaryto have strategies that address the entire range of problems and thecontext that influences those problems Indeed further reductions in

Motivation Skills and Decision Making 1999

ORDER REPRINTS

many problems require that we comprehensively target youth withmultiple problem behaviors

Biglan and colleagues (in press) provide a comprehensive review ofthe relationships among antisocial behavior tobacco alcohol and otherdrug use and high-risk sexual behavior It is clear that the same youngpeople are prone to the development of the entire range of problems In arecent review Moffitt and colleagues (2002) found that antisocialbehavior in early adolescence (rather than late adolescence) is a greaterrisk factor for developing multiple problems These findings point to theimportance of early intervention before youth develop serious problemsMoreover these different problems largely result from the same set ofenvironmental and biological factors

One implication is that disciplines dealing with these problemsother than drug abuse may contribute to dealing with the problem ofdrug use (Newcomb 1996b 1997) In particular research by dev-elopmental psychologists family social workers and sociologists onthe influence of parents on adolescent problem development and oninterventions to alter parenting practices contributes to our understandingof how to prevent or ameliorate drug abuse and other problems Onealso should note that nonsubstance use is not a guarantee for problemimmunity for the entire age range of people whatever their genderethnicity religiosity socioeconomic status (SEC) domicility etc It maybe argued that the most promising programs are those targeting thesemultiple levels of influence Several multidisciplinary programs haveachieved promising results We describe three of these empiricallyevaluated programs tested in various settings

Functional Family Therapy (FFT)FFT is an indicated intervention involving family treatment designed

for delinquent teenagers (also see Table 1) Developed in the early 1970sby Alexander and colleagues (1973) FFT focuses on family commu-nication and the establishment of rules and consequences Several studiesprovide encouraging reports of the programrsquos effectiveness (Alexander etal 1976 Barton et al 1985 Klein et al 1977 Waldron et al 2001) Inthe Waldron et al (2001) study researchers used FFT and anintervention with cognitive behavior therapy on teens referred formarijuana use Each of the interventions produced significant resultson marijuana use by the teens at four months but only the twointerventions combined maintained these results at seven months Theearlier studies found a greater number of results For example in the twoAlexander studies (1973 1976) improvement in family communicationposttreatment led to reduced delinquency Note that all the teens in these

2000 Sussman et al

ORDER REPRINTS

studies had histories of serious antisocial or delinquent behavior Thusachieving positive outcomes even if only short-term should encouragefurther research into the efficacy of FFT

Multisystemic Therapy (MST)As its name suggestsMST targets individual family peer school and

community influences of those youth offenders with serious problems thatmay include violence substance use and severe emotional problems (alsosee Table 1) Numerous researchers have published the results ofrandomized trials of MST (Henggeler et al 1996 1997 1998 Thorntonet al 2000) The most consistent findings across studies are decreased (1)drug use (2) re-arrest (3) self-reported criminal offense and (4) days inout-of-home placements Other consistent findings are improved familyrelations school attendance and psychiatric functioning One cautionarynote the programrsquos effectiveness lowers considerably if not implementedwith fidelity (Hengler et al 1997 1999) In other words all or key lessonsneed to be delivered as written by educators who are well-trained in usingthe strategies employed and youth need to be able to receive all material inan atmosphere conducive to learning the material The programdevelopers have instituted training strategies that address these fidelityissues thus shaping MST to be a very promising program for at-riskyouth

Multidimensional Treatment Foster Care (MTFC)MTFC targets family and peer factors influencing adolescents with a

pattern of repeat criminal offending (see Table 1) (Chamberlain 1994)This intervention includes placement of the youth into a foster homewith a foster parent trained in behavior management who receivessupport from intervention staff After the adolescent has begun torespond to the intervention in the foster home and after the parents havereceived the same training and support as the foster parents did theadolescent returns home Chamberlain and Reid (1998) tested theintervention with 85 boys with felony and other criminal histories andfound substantial benefits of the program Following treatment the boysassigned to MTFC (compared to those receiving community-based groupcare) showed fewer days in detention or lock-up twice as much timeliving with parents fewer misdemeanor and felony arrests and fewer self-reported index crimes felony arrests and general delinquency TheMTFC is a cost-effective alternative to incarceration however staffrequirements are extensive which may influence the ability of some

Motivation Skills and Decision Making 2001

ORDER REPRINTS

groups to apply the program with fidelity However as with each of theprograms described here the results of the randomized trials areencouraging

Future Research Needs in Targeted Prevention

Future research can help discern when and where targeted preventionprogramming will tend to work rather than produce potentiallydeleterious negative group effects or results that are irrelevant for pro-social healthy adaptation as well as what the critical necessary conditionsare for their effective operation within given de facto realities Comparedto the breadth of evaluated universal drug use prevention programs(Tobler et al 2000) relatively few targeted prevention programs havereceived empirical support Yet previous research suggests that universalschool-based drug use prevention programs implemented in junior highschool have relatively less chance of long-term success especially for thoseyouth that began using drugs before the prevention program wasimplemented Of course there are notable exceptions (eg effects lastedfor one and a half years effects lasted for six years) (Chou et al 1998Griffin et al 2003 Skara and Sussman 2003) Almost no research existsregarding maximization of booster programming with high-risk youthMore research on booster programs would help the field

While continuing to engage in this work there will be numerousissues to manage that go well beyond the scope of this article There willbe a need to avoid producing negative labeling effects while providingprogramming for those who are at risk for drug use It is possible thatcessation information needs to be included in the mix with preventionmaterial to provide better targeted-prevention effects There may be aneed to develop a teacher selection instrument to help select out teacherswho can deliver drug abuse prevention programming adequatelyCertainly definition of outcome variables needs continued explorationincluding analysis to ascertain the effects of programming on drug abusevs drug use and identification of the variables that are most closelylinked to change by targeted prevention components

A transdisciplinary approach helps to better understand the lifesituation of high-risk youth as based to some extent on both constitutionaland environmental factors (Fuqua et al 2004 Rutter et al 1997 Wills etal 1996b) From the transactional perspective their situation is in partconstitutional they may have temperamental characteristics that arepartly heritable and that have set the stage at earlier ages for decrements inself-control ability and academic performance that then increase risk for

2002 Sussman et al

ORDER REPRINTS

drug use However their situation is also part environmental based in parton family socialization and in part on the types of peers they have as well asthe type and quality of the physical and cultural environment-at-largeThere are many points at which a potential chain of failures can beinterrupted and the individualrsquos trajectory turned in a better directionProblems are not inevitable from starting level (Tarter and Vanyukov1994) and environmental modifications to support good self-controlability can help to avert an adverse impact from earlier experiences orcurrent difficulties (Brody et al 2002 Novak and Clayton 2001 Patock-Peckham et al 2001 Rutter et al 1997 Wills et al 2002)

The problems and needs of high-risk youth in our nationrsquos highschools demand our attention for designing and rigorously testingtargeted prevention approaches Substantial evidence shows that theseyouth are at greater risk for drug involvement and co-occurring problemssuch as aggression depression and suicidal behaviors as we previouslydiscussed It is hoped that the information presented in this article willstimulate others to join in extending this work including testing othermodels of targeted prevention

GLOSSARY

Universal programs Programs that aim to influence all subjects in acontext

Selective drug-abuse prevention programs Programs that servegroups at greater risk of ATOD usemdashfor example children of alcoholicparents They are at psychosocial risk for drug use and abuse

Indicated drug-abuse prevention programs Programs that attemptto benefit individuals who already show signs of drug involvement orrelated risk factors In indicated prevention programs the primary goal isto stem the progression of ATOD use or reduce drug involvementamong the high-risk youth

Targeted programming Programming that subsumes selective andindicated programming sometimes the other two types of programs thattarget specific groups lsquolsquoat riskrsquorsquo are considered together

ACKNOWLEDGMENTS

This research was supported by grants from the National Institute onDrug Abuse (DA01070 DA07601 DA13814 and DA16094) and by aResearch Scientist Development Award K02 DA00252 from theNational Institute on Drug Abuse

Motivation Skills and Decision Making 2003

ORDER REPRINTS

REFERENCES

Alexander J F Barton C Schiaro R S Parsons B V (1976)

Systems-behavioral intervention with families of delinquents

therapist characteristics family behavior and outcome Journal of

Consulting and Clinical Psychology 44(4)656ndash664Alexander J F Parsons B V (1973) Short-term behavioral interven-

tion with delinquent families impact on family process and

recidivism Journal of Abnormal Psychology 3219ndash225American psychiatric association (APA) (1994) Diagnostic and

Statistical Manual of Mental Disorders 4th edn (DSM-IV)

Washington DC American Psychiatric AssociationAmes S L Sussman S Dent C W (1999) Pro-drug-use myths and

competing constructs in the prediction of substance use among

youth at continuation high schools a one-year prospective study

Personality and Individual Differences 26987ndash1003Bachman S G Wadsworth K N OrsquoMalley P M Johnston L D

Schulenberg J E (1997) Smoking drinking and drug use in young

adulthood Mahwah NJ Lawrence Erlbaum Associates 8ndash25

153ndash190Bandura A (1986) Social Foundations of Thought and Action A Social

Cognitive Theory Englewood Cliffs NJ Prentice HallBarton C Alexander J F Waldron H Turner C W Warburton J

(1985) Generalizing treatment effects of functional family therapy

Three replications The American Journal of Family Therapy

13(3)16ndash26Battin-Pearson S R Newcomb M D Abbott R D Hill K G

Catalano R F Hawkins J D (2000) Predicting early high school

dropout Journal of Educational Psychology 92568ndash582Biglan A Brennan P A Foster S L Holder H D Miller T L

Cunningham P B et al (in press) Helping Adolescents at Risk

Prevention of Multiple Problem Behaviors New York NY Guilford

PressBindra D Stewart J (1996) Motivation Baltimore MD Penguin

BooksBlanton H Gibbons F X Gerrard M Conger K J Smith G E

(1998) The role of family and peers in the development of

prototypes associated with substance use Journal of Family

Psychology 11271ndash288

2004 Sussman et al

ORDER REPRINTS

Botvin G J (1993) School-based drug abuse prevention Long-termfollow-up results In First Annual Meeting of the Society forPrevention Research Kentuck Lexington Society for PreventionResearch

Botvin G J Baker E Dusenbury L Botvin E M Diaz T (1995)Long-term follow-up results of a randomized drug abuse preven-tion trial in a white middle-class population Journal of theAmerican Medical Association 2731106ndash1012

Brody G H Dorsey S Forehand R Armistead L (2002) Uniquecontributions of parenting and classroom processes to the self-control of AfricanndashAmerican children Child Development73274ndash286

Carroll M E (1996) Reducing drug abuse by enriching the environmentwith alternative nondrug reinforcers In Green L Kagel J Heds Advances in Behavioral Economics Norwood NJ NorwoodPublishing Corp 37ndash68

Carver C S Scheier M F (1998) On the Self-Regulation of BehaviorNew York Cambridge University Press

Catalano R F Hawkins J D (1996) The social developmental modela theory of antisocial behavior In Hawkins J D ed Delinquencyand Crime Current Theories New York Cambridge UniversityPress

Centers for Disease Control (CDC) (October 1999) Youth risk BehaviorSurveillancemdashNational Alternative High School Youth RiskBehavior Survey 1998 Morbidity and Mortality Weekly Report48 No SS-7

Chamberlain P (1994) Family connections A treatment foster caremodel for adolescents with delinquency Eugene OR CastaliaPublishing Company

Chamberlain P Reid J B (1998) Comparison of two communityalternatives to incarceration for chronic juvenile offenders Journalof Consulting and Clinical Psychology 66(4)624ndash633

Chassin L A Presson C C Sherman S J (1985) Stepping backwardin order to step forward an acquisition-oriented approach toprimary prevention Journal of Consulting and Clinical Psychology53612ndash622

Chou C-P Montgomery S Pentz M A Rohrbach L A JohnsonC A Flay B R MacKinnon D P (1998) Effects of acommunity-based prevention program on decreasing drug use inhigh-risk adolescentsAmerican Journal of Public Health 88944ndash948

Conducts Problems Prevention Research Group (CPPRG) (1999) Initialimpact of the fast track prevention trial for conduct problems I

Motivation Skills and Decision Making 2005

ORDER REPRINTS

The high-risk sample Journal of Consulting and Clinical Psychology

67631ndash647Conducts Problems Prevention Research Group (CPPRG) (2000)

Merging universal and indicated prevention programs the fast

track model Addictive Behaviors 25913ndash927Council of Philosophical Studies (1981) Psychology and the Philosophy

of Mind in the Philosophy Curriculum San Francisco San Francisco

State UniversityCummings K M Hellmann R Emont S L (1988) Correlates of

participation in a worksite stop smoking program Journal of

Behavioral Medicine 11267ndash277Curry S Wagner E H Gothaus L C (1990) Intrinsic and extrinsic

motivation for smoking cessation Journal of Consulting and

Clinical Psychology 58310ndash316Dent C W Sussman S McCuller W J Stacy A W (2001) Drug

abuse prevention among youth at comprehensive high schools

Preventive Medicine 32514ndash520Dewey J (1886) Psychology New York HarperDishion T J French D C Patterson G R (1995) The development

and ecology of antisocial behavior In Cicchetti D Cohen D

eds Manual of developmental psychopathology New York John

Wiley 421ndash471Eggert L L Herting J R (1991) Preventing teenage drug abuse

exploratory effects of network social support Youth and Society

22482ndash534 [Reprinted National Prevention Evaluation Research

CollectionRockville MD Aspen 1993]Eggert L L Herting J R Thompson E A Nicholas L J Dicker

B G (1994) Preventing adolescent drug abuse and high school

dropout through an intensive school-based social network devel-

opment program American Journal of Health Promotion

8202ndash214Eggert L L Thompson E A Herting J R Nicholas L J (1995)

Reducing suicide potential among high-risk youth tests of a school-

based prevention program Suicide amp Life-Threatening Behavior

25276ndash296Ellickson P L Bell R M (1990) Drug prevention in junior high a

multi-site longitudinal test Science 2471299ndash1305Elliott D S (Series ed) (2003) Blueprints for violence prevention

Boulder CO Institute of Behavioral Science Regents of the

University of Colorado wwwcoloradoeducspvblueprints

2006 Sussman et al

ORDER REPRINTS

Farrell A D Danish S J (1993) Peer drug associations and emotionalrestraint Causes or consequences of adolescent drug use Journal ofConsulting and Clinical Psychology 61327ndash334

Festinger L A (1957) A Theory of Cognitive Dissonance New YorkHarper amp Row

Fuqua J Stokols D Gress J Phillips K Harvey R (2004)Transdisciplinary collaboration as a basis for enhancing the scienceand prevention of substance use and abuse Substance Use ampMisuse

Giuliano J D (1994) A peer education program to promote the use ofconflict resolution skills among at-risk school-age males PublicHealth Reports 109158ndash169

Glynn K Levanthal H Hirschman R (1985) A cognitivedevelopmental approach to smoking prevention In Bell C SBattjes R eds Prevention research Deterring Drug Abuse AmongChildren and Adolescents Rockville MD NIDA ResearchMonograph 63

Glynn T J (1989) Essential elements of school-based smokingprevention programs Journal of School Health 59181ndash188

Goodman R M Burdine J N Meehan E McLeroy K R eds(1993) Community coalitions for health promotion Special issue ofHealth Education Research Theory and Practice 8309ndash453

Goodyear R D Newcomb M D Locke T F (2002) PregnantLatina teenagers psychosocial and developmental determinants ofhow they select and perceive the men who father their childrenJournal of Counseling Psychology 49187ndash201

Gordon R (1987) An operational classification of disease preventionIn Steinberg J A Silverman M M eds Preventing MentalDisorders Rockville MD DHHS 20ndash26

Graham J W Johnson C A Hansen W B Flay B R Gee M(1990) Drug use prevention programs gender and ethnicityevaluation of three seventh-grade project SMART cohortsPreventive Medicine 19305ndash313

Griffin K W Botvin G J Nichols T R Doyal M M (2003)Effectiveness of a universal drug abuse prevention approach foryouth at high risk for substance use initiation Preventive Medicine36(1)1ndash7

Hamilton S (August 20 2000) Views slowly changing on alternativeschools The Sacramento Bee 1ndash3

Hansen W B (1992) School-based substance abuse prevention a reviewof the state of the art in curriculum 1980ndash1990 Health EducationResearch 7403ndash430

Motivation Skills and Decision Making 2007

ORDER REPRINTS

Hansen W B Johnson C A Flay B R Graham J W Sobel J(1988) Affective and social influences approaches to the preventionof multiple substance abuse among seventh grade students resultsfrom project SMART Preventive Medicine 17135ndash154

Hansen W B Graham J W (1991) Preventing alcohol marijuanaand cigarette use among adolescents peer pressure and resistancetraining versus establishing conservative norms PreventiveMedicine 20414ndash430

Hawkins D H Catalano R F Miller J Y (1992) Risk andprotective factors for alcohol and other drug problems inadolescence and early adulthood Implications for substanceabuse prevention Psychological Bulletin 11254ndash105

Hawkins J D Catalano R F Kosterman R Abbott R Hill K G(1999) Preventing adolescent health-risk behaviors by strengthen-ing protection during childhood Archives of Pediatric amp AdolescentMedicine 153226ndash234

Heider F (1958) The Psychology of Interpersonal Relations New YorkWiley

Henggeler S W Pickrel S G Brondino M J Crouch J L (1996)Eliminating (almost) treatment dropout of substance abusing ordependent delinquents through home-based multisystemic therapyAmerican Journal of Psychiatry 153(3)427ndash428

Henggeler S W Melton G B Brondino M J Scherer D GHanley J H (1997) Multisystemic therapy with violent andchronic juvenile offenders and their families the role of treatmentfidelity in successful dissemination Journal of Consulting andClinical Psychology 65(5)821ndash833

Henggeler S W Schoenwald S K Borduin C M Rowland M DCunningham P B (1998) Multisystemic treatment of antisocialbehavior in children and adolescents New York The Guilford Press

Henggeler S W Pickrel S G Brondino M J (1999) Multisystemictreatment of substance-abusing and dependent delinquents out-comes treatment fidelity and transportability Mental HealthServices Residual 1(3)171ndash84

Johnson C A Pentz M A Weber M D Dwyer J H Baer NMacKinnon D P Hansen W B Flay B R (1990) Relativeeffectiveness of comprehensive community programming for drugabuse prevention with high-risk and low-risk adolescents Journalof Consulting and Clinical Psychology 58447ndash456

Kaftarian S J Hansen W B eds (1994) CSAP special issuecommunity partnership program Journal of Community Psychologypages 205

2008 Sussman et al

ORDER REPRINTS

Karoly P (1993) Mechanisms in self-regulation A systems view AnnualReview of Psychology 4423ndash51

Karoly P (1980) Person variables in therapeutic change and develop-ment In Karoly P Steffen J J eds Improving the Long-TermEffects of Psychotherapy New York Gardner Press 195ndash261

Kendall P C Braswell L (1982) Cognitive-behavioral self-controltherapy for children a components analysis Journal of Consultingand Clinical Psychology 50672ndash689

Kerr M Tremblay R E Pagani L Vitaro F (1997) Boysrsquobehavioral inhibition and the risk of later delinquency Archivesof General Psychiatry 54809ndash816

Klein N C Alexander J F Parsons B V (1977) Impact of familysystems intervention on recidivism and sibling delinquency a modelof primary prevention and program evaluation Journal ofConsulting and Clinical Psychology 45(3)469ndash474

Kumpfer K L (1999) Outcomes measures of interventions in the studyof children of substance-abusing parents Pediatrics 1031128ndash1144

Lau R R Hartman K A Ware J E (1986) Health as a valuemethodological and theoretical considerations Health Psychology525ndash43

Lichtenstein E L Glasgow R E (1997) A pragmatic framework forsmoking cessation implications for clinical and public healthprograms Psychology of Addictive Behaviors 11142ndash151

Locke T F Newcomb M D (in press) Childhood maltreatmentparent drug problems polydrug problems and parenting practicesa test of gender differences and four theoretical perspectivesJournal of Family Psychology

McCreary D R Newcomb M D Sadava S W (1999) The male rolealcohol use and alcohol problems a structural modeling examina-tion in adult women and men Journal of Counseling Psychology46109ndash124

McGee L Newcomb M D (1992) General deviance syndromeexpanded hierarchical evaluations at four ages from earlyadolescence to adulthood Journal of Consulting amp ClinicalPsychology 60766ndash776

Miller W R Brown J M (1991) Self-regulation as a conceptual basisfor the prevention of addictive behaviours In Heather N MillerW R Greeley J eds Self-control and the Addictive BehavioursSydney Australia Maxwell Macmillan 3ndash79

Miller W R Leckman A L Delaney H D Tinkcom M (1993)Long-term follow-up of behavioral self-control training forproblem drinkers Journal of Studies on Alcohol 53249ndash261

Motivation Skills and Decision Making 2009

ORDER REPRINTS

Miller W R Rollnick S (1991) Motivational InterviewingPreparing People to Change Addictive Behavior New YorkGuilford Press

Moffitt T E Caspi A Harrington H Milne B J (2002) Males onthe life-course-persistent and adolescence-limited antisocial path-ways follow-up at age 26 years Development and Psychopathology14(1)179ndash207

National Institute on Drug Abuse (NIDA) (1997) Drug abuseprevention What works NIH Publication 97-4110 DHHSNational Institutes of Health National Institute on Drug AbuseOffice of Science Policy and Communications Rockville MD

Newcomb M D (1992a) Substance abuse and control in the UnitedStates ethical and legal issues Social Science and Medicine35471ndash479

Newcomb M D (1992b) Understanding the multidimensional nature ofdrug use and abuse The role of consumption risk factors andprotective factors In Glantz M D Pickens R eds Vulnerabilityto Drug Abuse Washington DC American PsychologicalAssociation 255ndash298

Newcomb M D (1996a) Pseudomaturity among adolescents constructvalidation sex differences and associations in adulthood Journalof Drug Issues 26477ndash504

Newcomb M D (1996b) Adolescence Pathologizing a normal processThe Counseling Psychologist 24482ndash490

Newcomb M D (1997) Psychosocial predictors and consequences ofdrug use a developmental perspective within a prospective studyJournal of Addictive Diseases 1651ndash89

Newcomb M D Bentler P M (1988) Consequences of Adolescent DrugUse Impact on the Lives of Young Adults Beverly Hills CA Sage

Newcomb M D Bentler P M (1989) Substance use and abuse amongchildren and teenagers American Psychologist 44242ndash248

Newcomb M D Harlow L L (1986) Life events and substance useamong adolescents Mediating effects of perceived loss of controland meaninglessness in life Journal of Personality and SocialPsychology 51564ndash577

Newcomb M D Chou C-P Bentler P M Huba G J (1988)Cognitive motivations for drug use among adolescents longitudinaltests of gender differences and predictors of change in drug useJournal of Counseling Psychology 35426ndash438

Newcomb M D Abbott R D Catalano R F Hawkins J DBattin-Pearson S R Hill K (2002) Mediational and deviancetheories of late high school failure Process roles of structural

2010 Sussman et al

ORDER REPRINTS

strains academic competence and general versus specific problem

behaviors Journal of Counseling Psychology 49172ndash186Nezami E Sussman S Pentz M A (2003) Motivation in tobacco use

cessation research Substance Use amp Misuse 3825ndash5Novak S P Clayton R R (2001) The influence of school environment

and self-regulation on transitions between stages of cigarette

smoking Health Psychology 20196ndash207Offord D R (2000) Selection of levels of prevention Addictive

Behaviors 25833ndash842Palinkas L A Atkins C J Miller C Ferreira D (1996) Social skills

training for drug prevention in high-risk female adolescents

Preventive Medicine 25692ndash701Patock-Peckham J A Cheong J-W Balhorn M E Nagoshi C T

(2001) A model of parenting styles self-regulation perceived

drinking control and alcohol use and problems Alcoholism

Experimental and Clinical Research 251284ndash1292Pentz M A (1994) Directions for future research in drug abuse

prevention Preventive Medicine 23646ndash652Pentz M A Dwyer J H MacKinnon D Flay B R Hansen W B

Wang E Y I Johnson C A (1989) A multi-community trial for

primary prevention of adolescent drug abuse effects on drug use

prevalence JAMA 2623259ndash3266Pentz M A Mares D Schinke S Rohrbach L (in press) Political

science public policy and drug abuse prevention Substance Use amp

MisuseProchaska J O DiClemente C C (1982) Transtheoretical therapy

toward a more integrative model of change Psychotherapy Theory

Research and Practice 19275ndash288Pulkkinen L Pitkanen T (1994) A prospective study of the precursors

to problem drinking in young adulthood Journal of Studies on

Alcohol 55578ndash587Rathus S A Nevid J S (1977) Behavior Therapy Strategies for

Solving Problems in Living New York Doubleday and Company

IncResnicow K Botvin G (1993) School-based substance use prevention

programs why do effects decay Preventive Medicine 22484ndash490Rutter M Dunn J Plomin R Simonoff E Pickles A Maughan

B Ormel J Meyer J Eaves L (1997) Integrating nature and

nurture implications of person-environment interactions for

developmental psychopathology Development and Psychopathology

9335ndash364

Motivation Skills and Decision Making 2011

ORDER REPRINTS

Salomon G Stein Y Eisenberg S Klein L (1984) Adolescent

smokers and nonsmokers profiles and their changing structure

Preventive Medicine 13446ndash461Sambrano S (1999) National cross-site evaluation of high risk youth

programs In Interim findings Bulletin Washington DC CSAP

SAMSHA US DHHS May 1ndash16Schinke S P Gilchrist L D (1985) Preventing substance abuse with

children and adolescents Journal of Consulting and Clinical

Psychology 53596ndash602Skara S N Sussman S (2003) A review of 25 long-term adolescent

tobacco and other drug use prevention program evaluations

Preventive MedicineSmith C Lizotte A J Thornberry T P Krohn M D (1995)

Resilient youth identifying factors that prevent high-risk youth

from engaging in delinquency and drug use Delinquency and

Disrepute in the Life Course Greenwich CT John Hagan JAI

press 217ndash247Sommers P V (1972) The Biology of Behavior Australia Pty ltd

Sydney John Wiley amp SonsSt Pierre T L Kaltreider D L Mark M M Aikin K J (1992)

Drug prevention in a community setting a longitudinal study of the

relative effectiveness of a three-year primary prevention program in

boys and girls clubs across the nation American Journal of

Community Psychology 20673ndash706Stein J A Newcomb M D Bentler P M (1987) An eight year study

of multiple influences on drug use and drug use consequences

Journal of Personality and Social Psychology 531094ndash1105Sully J (1884) Outlines of Psychology New York D Appleton amp CoSussman S (1989) Two social influence perspectives of tobacco use

development and prevention Health Education Research Theory

and Practice 4213ndash223Sussman S (1991) Curriculum development in school-based prevention

research Health Education Research Theory and Practice

6339ndash351Sussman S (1996) Development of a school-based drug abuse

prevention curriculum for high risk youth Journal of

Psychoactive Drugs 28169ndash182Sussman S Ames S L (2001) The social psychology of drug abuse

Buckingham GB Open University PressSussman S Unger J (2004) A drug abuse theoretical integration a

transdisciplinary speculation Substance Use amp Misuse

2012 Sussman et al

ORDER REPRINTS

Sussman S Dent C W Burton D Stacy A W Flay B R (1995a)

Developing school-based tobacco use prevention and cessation

programs Thousand Oaks CA Sage Publications IncSussman S Dent C W Simon T R Stacy A W Galaif E R

Moss M A Craig S Johnson C A (1995b) Effectiveness of

social influence substance abuse prevention curricula in compre-

hensive and continuation high schools Drugs and Society 865ndash81Sussman S Dent C W Galaif E R (1997) The correlates of

substance abuse and dependence among adolescents at high risk

for drug abuse Journal of Substance Abuse 9241ndash255Sussman S Dent C W Stacy A W (1996) The relation of pro-drug

use myths with self-reported drug use among youth at continuation

high schools Journal of Applied Social Psychology 26214ndash267Sussman S Dent C W Stacy A Craig S (1998) One-year outcomes

of project towards no drug abuse Preventive Medicine 27632ndash642

(erratum 766)Sussman S Dent C W Stacy S (2002) Project towards no drug

abuse a review of the findings and future directions American

Journal of Health Behavior 26354ndash365Sussman S McCuller W J Dent C W (2003) The associations of

social self-control personality disorders and demographics with

drug use among high risk youth Addictive Behaviors 281159ndash1166Sussman S Rohrbach L Patel R Holiday K (2003) A look at an

interactive classroom-based drug abuse prevention program

Interactive contents and suggestions for research Journal of Drug

Education 33355ndash368Sussman S Sun P McCuller W J Dent C W (2003) Project

towards no drug abuse two year outcomes of a trial that compares

health educator delivery to self-instruction Preventive Medicine

37155ndash162Tarter R E Vanyukov M (1994) Alcoholism a developmental disorder

Journal of Consulting and Clinical Psychology 621096ndash1107Thornton T N Craft C A Dahlberg L L Lynch B S Baer K

(2000) Best Practices of Youth Violence Prevention A Sourcebook

for Community Action Atlanta GA Division of Violence

Prevention Centers for Disease Control and PreventionTobler N S (1986) Meta-analysis of 143 adolescent drug prevention

programs quantitative outcome of program participants compared to

a control or comparison group Journal of Drug Issues 16537ndash567Tobler N S Roona M R Ochshorn P Marshall D G Streke

A V Stackpole K M (2000) School-based adolescent drug

Motivation Skills and Decision Making 2013

ORDER REPRINTS

prevention programs 1998 Meta-analysis The Journal of Primary

Prevention 20275ndash336US Department of Health and Human Services (USDHHS) (2003)

Substance Abuse andMental Health Services Administration Center

for Substance Abuse Prevention Science-based prevention programs and

principles 2002 Rockville MD US DHHS (SMA)03-3764 Also

see httpmodelprogramssamhsagovUnger J Baezconde-Garbanati L Shakib S Palmer P H Nezami

E Mora J (2004) What are the implications of structuralcultural

theory for drug abuse prevention Substance Use amp MisuseUpshaw H S Ostrom T M (1984) Psychological perspective in

attitude research In Eiser J R ed Attitudinal Judgment New

York Springer-Verlag 23ndash42Valente T W Gallaher P Mouttapa M (2004) Using social network

theory to understand and prevent substance use a transdisciplinary

perspective Substance Use amp MisuseVorrath H Brendtro L (1985) Positive peer culture 2nd edn Aldine

ChicagoWaldron H B Slesnick N Brody J L Turner C W Peterson T R

(2001) Treatment outcomes for adolescent substance abuse at 4-

and 7-month assessments Journal of Consulting amp Clinical

Psychology 69(5)802ndash813Watson D L Tharp R G (2002) Self-directed behavior Self-

modification for personal adjustment 8th edn Belmont CA

WadsworthWeissberg R P Caplan M Z Sivo P J (1989) A new conceptual

framework for establishing school-based social competence promo-

tion programs In Bond L A Compas B E eds Primary

Prevention amp Promotion in the Schools Newbury Park CA Sage

255ndash296Wills T A (1986) Stress and coping in early adolescence relationships

to substance use in urban school samples Health Psychology

5503ndash529Wills T A Cleary S D (1995) Stress-coping model for alcohol-

tobacco interactions in adolescence In Fertig J B Allen J P

eds Alcohol and Tobacco From Basic Science to Clinical Practice

Bethesda MD National Institute on Alcohol Abuse and

Alcoholism 107ndash128Wills T A Cleary S D (1999) Peer and adolescent substance use

among 6thndash9th graders Latent growth analyses of influence versus

selection mechanisms Health Psychology 18453ndash463

2014 Sussman et al

ORDER REPRINTS

Wills T A Hirky A E (1996) Coping and substance abuse InZeidner M Endler N S eds Handbook of Coping TheoryResearch and Applications New York Wiley 279ndash302

Wills T A Stoolmiller M (2002) The role of self-control in earlyescalation of substance use a time-varying analysis Journal ofConsulting and Clinical Psychology 70986ndash997

Wills T A Baker E Botvin G J (1989) Dimensions of assertivenessdifferential relationships to substance use in early adolescenceJournal of Consulting and Clinical Psychology 57(4)473ndash478

Wills T A Vaccaro D McNamara G (1994) Novelty seeking risktaking and related constructs as predictors of adolescent substanceuse an application of Cloningerrsquos theory Journal of SubstanceAbuse 61ndash20

Wills T A McNamara G Vaccaro D Hirky A E (1996a)Escalated substance use a longitudinal grouping analysis fromearly to middle adolescence Journal of Abnormal Psychology105166ndash180

Wills T A Pierce J P Evans R I (1996b) Large-scale environmentalrisk factors for substance use American Behavioral Scientist39808ndash822

Wills T A Windle M Cleary S D (1998) Role of temperamentnovelty-seeking and self-control in adolescent substance useJournal of Personality and Social Psychology 74387ndash406

Wills T A Sandy J M Shinar O (1999) Substance use level andproblems in late adolescence a mediational model based on self-control and coping motives Experimental and ClinicalPsychopharmacology 7122ndash134

Wills T A Cleary S D Filer M Shinar O Mariani J Spera K(2001) Temperament and self-control related to early-onsetsubstance use test of a developmental model Prevention Science2145ndash163

Wills T A Sandy J M Yaeger A (2002) Moderators of therelationship between substance use level and problems test of aself-regulation model in adolescence Journal of AbnormalPsychology 1113ndash21

Wills T A Gibbons F X Gerrard M Murry V Brody G (in press-a) Family communication and religiosity related to substance useand sexual behavior in early adolescence Psychology of AddictiveBehaviors

Wills T A Resko J Ainette M Mendoza D (in press-b) The role ofparent and peer support in adolescent substance use a test ofmediated effects Psychology of Addictive Behaviors

Motivation Skills and Decision Making 2015

ORDER REPRINTS

Young P T (1936) Motivation of Behavior New York John Wiley andSons

Zimmerman B J (2000) Attaining self-regulation a social cognitivemodel In Boekaerts M Pintrich P R eds Handbook of Self-Regulation San Diego Academic Press 13ndash39

2016 Sussman et al

Request PermissionOrder Reprints

Reprints of this article can also be ordered at

httpwwwdekkercomservletproductDOI101081JA200034769

Request Permission or Order Reprints Instantly

Interested in copying and sharing this article In most cases US Copyright Law requires that you get permission from the articlersquos rightsholder before using copyrighted content

All information and materials found in this article including but not limited to text trademarks patents logos graphics and images (the Materials) are the copyrighted works and other forms of intellectual property of Marcel Dekker Inc or its licensors All rights not expressly granted are reserved

Get permission to lawfully reproduce and distribute the Materials or order reprints quickly and painlessly Simply click on the Request Permission Order Reprints link below and follow the instructions Visit the US Copyright Office for information on Fair Use limitations of US copyright law Please refer to The Association of American Publishersrsquo (AAP) website for guidelines on Fair Use in the Classroom

The Materials are for your personal use only and cannot be reformatted reposted resold or distributed by electronic means or otherwise without permission from Marcel Dekker Inc Marcel Dekker Inc grants you the limited right to display the Materials only on your personal computer or personal wireless device and to copy and download single copies of such Materials provided that any copyright trademark or other notice appearing on such Materials is also retained by displayed copied or downloaded as part of the Materials and is not removed or obscured and provided you do not edit modify alter or enhance the Materials Please refer to our Website User Agreement for more details

ORDER REPRINTS

instructed was not appropriate or that skill training alone (withoutappropriate motivation material) may not be effective in drug useprevention Researchers should examine these possibilities and others tofurther understand program failures as well as program successes

Potential Limitations of Targeted Prevention

Dishion and colleagues (1995) suggest from various findings thatgrouping high-risk youth may lead to increased drug use This outcomecan result if youth come to learn deviant behavior from each other Theycan learn deviant behavior from each other in a program if they haveunstructured or unsupervised time together An essential feature ofseveral targeted programs (eg the RY and TND programs) is building apositive peer culture with group norms that decrease drug involvementand drug-use control problems The RYrsquos findings suggest that a positivepeer group component carefully fostered by a well-trained and competentRY group leader can direct the group toward lower risk behaviorSimilarly classroom management in Project TND involves developmentof positive norms of classroom behavior Further interaction betweenyouth is encouraged but is primarily teacher-directed and highlystructured (Sussman et al 2003) In both RY and Project TND theteacherrsquos role is to actively develop and maintain peer group support inthe class by modeling support positively reinforcing it among groupmembers and negatively reinforcing deviant peer bonds and activities(Eggert and Herting 1991 Vorrath and Brendtro 1985) The teachercreates and structures interactions among youth in prosocial directions(Sussman et al 2003)

Multiple Problem Behaviors of Adolescents

Acknowledging the relationship of drug use to other commonadolescent problems may facilitate identification of effective methods ofreducing drug use Researchers on tobacco alcohol and other drug useantisocial behavior high-risk sexual behavior and depression increas-ingly recognize that these problems are interrelated (McGee andNewcomb 1992) and stem to a large extent from the same environ-mental and biological factors (Biglan et al in press Eggert et al 1995Sussman and Ames 2001 Wills and Cleary 1995) Clearly it is necessaryto have strategies that address the entire range of problems and thecontext that influences those problems Indeed further reductions in

Motivation Skills and Decision Making 1999

ORDER REPRINTS

many problems require that we comprehensively target youth withmultiple problem behaviors

Biglan and colleagues (in press) provide a comprehensive review ofthe relationships among antisocial behavior tobacco alcohol and otherdrug use and high-risk sexual behavior It is clear that the same youngpeople are prone to the development of the entire range of problems In arecent review Moffitt and colleagues (2002) found that antisocialbehavior in early adolescence (rather than late adolescence) is a greaterrisk factor for developing multiple problems These findings point to theimportance of early intervention before youth develop serious problemsMoreover these different problems largely result from the same set ofenvironmental and biological factors

One implication is that disciplines dealing with these problemsother than drug abuse may contribute to dealing with the problem ofdrug use (Newcomb 1996b 1997) In particular research by dev-elopmental psychologists family social workers and sociologists onthe influence of parents on adolescent problem development and oninterventions to alter parenting practices contributes to our understandingof how to prevent or ameliorate drug abuse and other problems Onealso should note that nonsubstance use is not a guarantee for problemimmunity for the entire age range of people whatever their genderethnicity religiosity socioeconomic status (SEC) domicility etc It maybe argued that the most promising programs are those targeting thesemultiple levels of influence Several multidisciplinary programs haveachieved promising results We describe three of these empiricallyevaluated programs tested in various settings

Functional Family Therapy (FFT)FFT is an indicated intervention involving family treatment designed

for delinquent teenagers (also see Table 1) Developed in the early 1970sby Alexander and colleagues (1973) FFT focuses on family commu-nication and the establishment of rules and consequences Several studiesprovide encouraging reports of the programrsquos effectiveness (Alexander etal 1976 Barton et al 1985 Klein et al 1977 Waldron et al 2001) Inthe Waldron et al (2001) study researchers used FFT and anintervention with cognitive behavior therapy on teens referred formarijuana use Each of the interventions produced significant resultson marijuana use by the teens at four months but only the twointerventions combined maintained these results at seven months Theearlier studies found a greater number of results For example in the twoAlexander studies (1973 1976) improvement in family communicationposttreatment led to reduced delinquency Note that all the teens in these

2000 Sussman et al

ORDER REPRINTS

studies had histories of serious antisocial or delinquent behavior Thusachieving positive outcomes even if only short-term should encouragefurther research into the efficacy of FFT

Multisystemic Therapy (MST)As its name suggestsMST targets individual family peer school and

community influences of those youth offenders with serious problems thatmay include violence substance use and severe emotional problems (alsosee Table 1) Numerous researchers have published the results ofrandomized trials of MST (Henggeler et al 1996 1997 1998 Thorntonet al 2000) The most consistent findings across studies are decreased (1)drug use (2) re-arrest (3) self-reported criminal offense and (4) days inout-of-home placements Other consistent findings are improved familyrelations school attendance and psychiatric functioning One cautionarynote the programrsquos effectiveness lowers considerably if not implementedwith fidelity (Hengler et al 1997 1999) In other words all or key lessonsneed to be delivered as written by educators who are well-trained in usingthe strategies employed and youth need to be able to receive all material inan atmosphere conducive to learning the material The programdevelopers have instituted training strategies that address these fidelityissues thus shaping MST to be a very promising program for at-riskyouth

Multidimensional Treatment Foster Care (MTFC)MTFC targets family and peer factors influencing adolescents with a

pattern of repeat criminal offending (see Table 1) (Chamberlain 1994)This intervention includes placement of the youth into a foster homewith a foster parent trained in behavior management who receivessupport from intervention staff After the adolescent has begun torespond to the intervention in the foster home and after the parents havereceived the same training and support as the foster parents did theadolescent returns home Chamberlain and Reid (1998) tested theintervention with 85 boys with felony and other criminal histories andfound substantial benefits of the program Following treatment the boysassigned to MTFC (compared to those receiving community-based groupcare) showed fewer days in detention or lock-up twice as much timeliving with parents fewer misdemeanor and felony arrests and fewer self-reported index crimes felony arrests and general delinquency TheMTFC is a cost-effective alternative to incarceration however staffrequirements are extensive which may influence the ability of some

Motivation Skills and Decision Making 2001

ORDER REPRINTS

groups to apply the program with fidelity However as with each of theprograms described here the results of the randomized trials areencouraging

Future Research Needs in Targeted Prevention

Future research can help discern when and where targeted preventionprogramming will tend to work rather than produce potentiallydeleterious negative group effects or results that are irrelevant for pro-social healthy adaptation as well as what the critical necessary conditionsare for their effective operation within given de facto realities Comparedto the breadth of evaluated universal drug use prevention programs(Tobler et al 2000) relatively few targeted prevention programs havereceived empirical support Yet previous research suggests that universalschool-based drug use prevention programs implemented in junior highschool have relatively less chance of long-term success especially for thoseyouth that began using drugs before the prevention program wasimplemented Of course there are notable exceptions (eg effects lastedfor one and a half years effects lasted for six years) (Chou et al 1998Griffin et al 2003 Skara and Sussman 2003) Almost no research existsregarding maximization of booster programming with high-risk youthMore research on booster programs would help the field

While continuing to engage in this work there will be numerousissues to manage that go well beyond the scope of this article There willbe a need to avoid producing negative labeling effects while providingprogramming for those who are at risk for drug use It is possible thatcessation information needs to be included in the mix with preventionmaterial to provide better targeted-prevention effects There may be aneed to develop a teacher selection instrument to help select out teacherswho can deliver drug abuse prevention programming adequatelyCertainly definition of outcome variables needs continued explorationincluding analysis to ascertain the effects of programming on drug abusevs drug use and identification of the variables that are most closelylinked to change by targeted prevention components

A transdisciplinary approach helps to better understand the lifesituation of high-risk youth as based to some extent on both constitutionaland environmental factors (Fuqua et al 2004 Rutter et al 1997 Wills etal 1996b) From the transactional perspective their situation is in partconstitutional they may have temperamental characteristics that arepartly heritable and that have set the stage at earlier ages for decrements inself-control ability and academic performance that then increase risk for

2002 Sussman et al

ORDER REPRINTS

drug use However their situation is also part environmental based in parton family socialization and in part on the types of peers they have as well asthe type and quality of the physical and cultural environment-at-largeThere are many points at which a potential chain of failures can beinterrupted and the individualrsquos trajectory turned in a better directionProblems are not inevitable from starting level (Tarter and Vanyukov1994) and environmental modifications to support good self-controlability can help to avert an adverse impact from earlier experiences orcurrent difficulties (Brody et al 2002 Novak and Clayton 2001 Patock-Peckham et al 2001 Rutter et al 1997 Wills et al 2002)

The problems and needs of high-risk youth in our nationrsquos highschools demand our attention for designing and rigorously testingtargeted prevention approaches Substantial evidence shows that theseyouth are at greater risk for drug involvement and co-occurring problemssuch as aggression depression and suicidal behaviors as we previouslydiscussed It is hoped that the information presented in this article willstimulate others to join in extending this work including testing othermodels of targeted prevention

GLOSSARY

Universal programs Programs that aim to influence all subjects in acontext

Selective drug-abuse prevention programs Programs that servegroups at greater risk of ATOD usemdashfor example children of alcoholicparents They are at psychosocial risk for drug use and abuse

Indicated drug-abuse prevention programs Programs that attemptto benefit individuals who already show signs of drug involvement orrelated risk factors In indicated prevention programs the primary goal isto stem the progression of ATOD use or reduce drug involvementamong the high-risk youth

Targeted programming Programming that subsumes selective andindicated programming sometimes the other two types of programs thattarget specific groups lsquolsquoat riskrsquorsquo are considered together

ACKNOWLEDGMENTS

This research was supported by grants from the National Institute onDrug Abuse (DA01070 DA07601 DA13814 and DA16094) and by aResearch Scientist Development Award K02 DA00252 from theNational Institute on Drug Abuse

Motivation Skills and Decision Making 2003

ORDER REPRINTS

REFERENCES

Alexander J F Barton C Schiaro R S Parsons B V (1976)

Systems-behavioral intervention with families of delinquents

therapist characteristics family behavior and outcome Journal of

Consulting and Clinical Psychology 44(4)656ndash664Alexander J F Parsons B V (1973) Short-term behavioral interven-

tion with delinquent families impact on family process and

recidivism Journal of Abnormal Psychology 3219ndash225American psychiatric association (APA) (1994) Diagnostic and

Statistical Manual of Mental Disorders 4th edn (DSM-IV)

Washington DC American Psychiatric AssociationAmes S L Sussman S Dent C W (1999) Pro-drug-use myths and

competing constructs in the prediction of substance use among

youth at continuation high schools a one-year prospective study

Personality and Individual Differences 26987ndash1003Bachman S G Wadsworth K N OrsquoMalley P M Johnston L D

Schulenberg J E (1997) Smoking drinking and drug use in young

adulthood Mahwah NJ Lawrence Erlbaum Associates 8ndash25

153ndash190Bandura A (1986) Social Foundations of Thought and Action A Social

Cognitive Theory Englewood Cliffs NJ Prentice HallBarton C Alexander J F Waldron H Turner C W Warburton J

(1985) Generalizing treatment effects of functional family therapy

Three replications The American Journal of Family Therapy

13(3)16ndash26Battin-Pearson S R Newcomb M D Abbott R D Hill K G

Catalano R F Hawkins J D (2000) Predicting early high school

dropout Journal of Educational Psychology 92568ndash582Biglan A Brennan P A Foster S L Holder H D Miller T L

Cunningham P B et al (in press) Helping Adolescents at Risk

Prevention of Multiple Problem Behaviors New York NY Guilford

PressBindra D Stewart J (1996) Motivation Baltimore MD Penguin

BooksBlanton H Gibbons F X Gerrard M Conger K J Smith G E

(1998) The role of family and peers in the development of

prototypes associated with substance use Journal of Family

Psychology 11271ndash288

2004 Sussman et al

ORDER REPRINTS

Botvin G J (1993) School-based drug abuse prevention Long-termfollow-up results In First Annual Meeting of the Society forPrevention Research Kentuck Lexington Society for PreventionResearch

Botvin G J Baker E Dusenbury L Botvin E M Diaz T (1995)Long-term follow-up results of a randomized drug abuse preven-tion trial in a white middle-class population Journal of theAmerican Medical Association 2731106ndash1012

Brody G H Dorsey S Forehand R Armistead L (2002) Uniquecontributions of parenting and classroom processes to the self-control of AfricanndashAmerican children Child Development73274ndash286

Carroll M E (1996) Reducing drug abuse by enriching the environmentwith alternative nondrug reinforcers In Green L Kagel J Heds Advances in Behavioral Economics Norwood NJ NorwoodPublishing Corp 37ndash68

Carver C S Scheier M F (1998) On the Self-Regulation of BehaviorNew York Cambridge University Press

Catalano R F Hawkins J D (1996) The social developmental modela theory of antisocial behavior In Hawkins J D ed Delinquencyand Crime Current Theories New York Cambridge UniversityPress

Centers for Disease Control (CDC) (October 1999) Youth risk BehaviorSurveillancemdashNational Alternative High School Youth RiskBehavior Survey 1998 Morbidity and Mortality Weekly Report48 No SS-7

Chamberlain P (1994) Family connections A treatment foster caremodel for adolescents with delinquency Eugene OR CastaliaPublishing Company

Chamberlain P Reid J B (1998) Comparison of two communityalternatives to incarceration for chronic juvenile offenders Journalof Consulting and Clinical Psychology 66(4)624ndash633

Chassin L A Presson C C Sherman S J (1985) Stepping backwardin order to step forward an acquisition-oriented approach toprimary prevention Journal of Consulting and Clinical Psychology53612ndash622

Chou C-P Montgomery S Pentz M A Rohrbach L A JohnsonC A Flay B R MacKinnon D P (1998) Effects of acommunity-based prevention program on decreasing drug use inhigh-risk adolescentsAmerican Journal of Public Health 88944ndash948

Conducts Problems Prevention Research Group (CPPRG) (1999) Initialimpact of the fast track prevention trial for conduct problems I

Motivation Skills and Decision Making 2005

ORDER REPRINTS

The high-risk sample Journal of Consulting and Clinical Psychology

67631ndash647Conducts Problems Prevention Research Group (CPPRG) (2000)

Merging universal and indicated prevention programs the fast

track model Addictive Behaviors 25913ndash927Council of Philosophical Studies (1981) Psychology and the Philosophy

of Mind in the Philosophy Curriculum San Francisco San Francisco

State UniversityCummings K M Hellmann R Emont S L (1988) Correlates of

participation in a worksite stop smoking program Journal of

Behavioral Medicine 11267ndash277Curry S Wagner E H Gothaus L C (1990) Intrinsic and extrinsic

motivation for smoking cessation Journal of Consulting and

Clinical Psychology 58310ndash316Dent C W Sussman S McCuller W J Stacy A W (2001) Drug

abuse prevention among youth at comprehensive high schools

Preventive Medicine 32514ndash520Dewey J (1886) Psychology New York HarperDishion T J French D C Patterson G R (1995) The development

and ecology of antisocial behavior In Cicchetti D Cohen D

eds Manual of developmental psychopathology New York John

Wiley 421ndash471Eggert L L Herting J R (1991) Preventing teenage drug abuse

exploratory effects of network social support Youth and Society

22482ndash534 [Reprinted National Prevention Evaluation Research

CollectionRockville MD Aspen 1993]Eggert L L Herting J R Thompson E A Nicholas L J Dicker

B G (1994) Preventing adolescent drug abuse and high school

dropout through an intensive school-based social network devel-

opment program American Journal of Health Promotion

8202ndash214Eggert L L Thompson E A Herting J R Nicholas L J (1995)

Reducing suicide potential among high-risk youth tests of a school-

based prevention program Suicide amp Life-Threatening Behavior

25276ndash296Ellickson P L Bell R M (1990) Drug prevention in junior high a

multi-site longitudinal test Science 2471299ndash1305Elliott D S (Series ed) (2003) Blueprints for violence prevention

Boulder CO Institute of Behavioral Science Regents of the

University of Colorado wwwcoloradoeducspvblueprints

2006 Sussman et al

ORDER REPRINTS

Farrell A D Danish S J (1993) Peer drug associations and emotionalrestraint Causes or consequences of adolescent drug use Journal ofConsulting and Clinical Psychology 61327ndash334

Festinger L A (1957) A Theory of Cognitive Dissonance New YorkHarper amp Row

Fuqua J Stokols D Gress J Phillips K Harvey R (2004)Transdisciplinary collaboration as a basis for enhancing the scienceand prevention of substance use and abuse Substance Use ampMisuse

Giuliano J D (1994) A peer education program to promote the use ofconflict resolution skills among at-risk school-age males PublicHealth Reports 109158ndash169

Glynn K Levanthal H Hirschman R (1985) A cognitivedevelopmental approach to smoking prevention In Bell C SBattjes R eds Prevention research Deterring Drug Abuse AmongChildren and Adolescents Rockville MD NIDA ResearchMonograph 63

Glynn T J (1989) Essential elements of school-based smokingprevention programs Journal of School Health 59181ndash188

Goodman R M Burdine J N Meehan E McLeroy K R eds(1993) Community coalitions for health promotion Special issue ofHealth Education Research Theory and Practice 8309ndash453

Goodyear R D Newcomb M D Locke T F (2002) PregnantLatina teenagers psychosocial and developmental determinants ofhow they select and perceive the men who father their childrenJournal of Counseling Psychology 49187ndash201

Gordon R (1987) An operational classification of disease preventionIn Steinberg J A Silverman M M eds Preventing MentalDisorders Rockville MD DHHS 20ndash26

Graham J W Johnson C A Hansen W B Flay B R Gee M(1990) Drug use prevention programs gender and ethnicityevaluation of three seventh-grade project SMART cohortsPreventive Medicine 19305ndash313

Griffin K W Botvin G J Nichols T R Doyal M M (2003)Effectiveness of a universal drug abuse prevention approach foryouth at high risk for substance use initiation Preventive Medicine36(1)1ndash7

Hamilton S (August 20 2000) Views slowly changing on alternativeschools The Sacramento Bee 1ndash3

Hansen W B (1992) School-based substance abuse prevention a reviewof the state of the art in curriculum 1980ndash1990 Health EducationResearch 7403ndash430

Motivation Skills and Decision Making 2007

ORDER REPRINTS

Hansen W B Johnson C A Flay B R Graham J W Sobel J(1988) Affective and social influences approaches to the preventionof multiple substance abuse among seventh grade students resultsfrom project SMART Preventive Medicine 17135ndash154

Hansen W B Graham J W (1991) Preventing alcohol marijuanaand cigarette use among adolescents peer pressure and resistancetraining versus establishing conservative norms PreventiveMedicine 20414ndash430

Hawkins D H Catalano R F Miller J Y (1992) Risk andprotective factors for alcohol and other drug problems inadolescence and early adulthood Implications for substanceabuse prevention Psychological Bulletin 11254ndash105

Hawkins J D Catalano R F Kosterman R Abbott R Hill K G(1999) Preventing adolescent health-risk behaviors by strengthen-ing protection during childhood Archives of Pediatric amp AdolescentMedicine 153226ndash234

Heider F (1958) The Psychology of Interpersonal Relations New YorkWiley

Henggeler S W Pickrel S G Brondino M J Crouch J L (1996)Eliminating (almost) treatment dropout of substance abusing ordependent delinquents through home-based multisystemic therapyAmerican Journal of Psychiatry 153(3)427ndash428

Henggeler S W Melton G B Brondino M J Scherer D GHanley J H (1997) Multisystemic therapy with violent andchronic juvenile offenders and their families the role of treatmentfidelity in successful dissemination Journal of Consulting andClinical Psychology 65(5)821ndash833

Henggeler S W Schoenwald S K Borduin C M Rowland M DCunningham P B (1998) Multisystemic treatment of antisocialbehavior in children and adolescents New York The Guilford Press

Henggeler S W Pickrel S G Brondino M J (1999) Multisystemictreatment of substance-abusing and dependent delinquents out-comes treatment fidelity and transportability Mental HealthServices Residual 1(3)171ndash84

Johnson C A Pentz M A Weber M D Dwyer J H Baer NMacKinnon D P Hansen W B Flay B R (1990) Relativeeffectiveness of comprehensive community programming for drugabuse prevention with high-risk and low-risk adolescents Journalof Consulting and Clinical Psychology 58447ndash456

Kaftarian S J Hansen W B eds (1994) CSAP special issuecommunity partnership program Journal of Community Psychologypages 205

2008 Sussman et al

ORDER REPRINTS

Karoly P (1993) Mechanisms in self-regulation A systems view AnnualReview of Psychology 4423ndash51

Karoly P (1980) Person variables in therapeutic change and develop-ment In Karoly P Steffen J J eds Improving the Long-TermEffects of Psychotherapy New York Gardner Press 195ndash261

Kendall P C Braswell L (1982) Cognitive-behavioral self-controltherapy for children a components analysis Journal of Consultingand Clinical Psychology 50672ndash689

Kerr M Tremblay R E Pagani L Vitaro F (1997) Boysrsquobehavioral inhibition and the risk of later delinquency Archivesof General Psychiatry 54809ndash816

Klein N C Alexander J F Parsons B V (1977) Impact of familysystems intervention on recidivism and sibling delinquency a modelof primary prevention and program evaluation Journal ofConsulting and Clinical Psychology 45(3)469ndash474

Kumpfer K L (1999) Outcomes measures of interventions in the studyof children of substance-abusing parents Pediatrics 1031128ndash1144

Lau R R Hartman K A Ware J E (1986) Health as a valuemethodological and theoretical considerations Health Psychology525ndash43

Lichtenstein E L Glasgow R E (1997) A pragmatic framework forsmoking cessation implications for clinical and public healthprograms Psychology of Addictive Behaviors 11142ndash151

Locke T F Newcomb M D (in press) Childhood maltreatmentparent drug problems polydrug problems and parenting practicesa test of gender differences and four theoretical perspectivesJournal of Family Psychology

McCreary D R Newcomb M D Sadava S W (1999) The male rolealcohol use and alcohol problems a structural modeling examina-tion in adult women and men Journal of Counseling Psychology46109ndash124

McGee L Newcomb M D (1992) General deviance syndromeexpanded hierarchical evaluations at four ages from earlyadolescence to adulthood Journal of Consulting amp ClinicalPsychology 60766ndash776

Miller W R Brown J M (1991) Self-regulation as a conceptual basisfor the prevention of addictive behaviours In Heather N MillerW R Greeley J eds Self-control and the Addictive BehavioursSydney Australia Maxwell Macmillan 3ndash79

Miller W R Leckman A L Delaney H D Tinkcom M (1993)Long-term follow-up of behavioral self-control training forproblem drinkers Journal of Studies on Alcohol 53249ndash261

Motivation Skills and Decision Making 2009

ORDER REPRINTS

Miller W R Rollnick S (1991) Motivational InterviewingPreparing People to Change Addictive Behavior New YorkGuilford Press

Moffitt T E Caspi A Harrington H Milne B J (2002) Males onthe life-course-persistent and adolescence-limited antisocial path-ways follow-up at age 26 years Development and Psychopathology14(1)179ndash207

National Institute on Drug Abuse (NIDA) (1997) Drug abuseprevention What works NIH Publication 97-4110 DHHSNational Institutes of Health National Institute on Drug AbuseOffice of Science Policy and Communications Rockville MD

Newcomb M D (1992a) Substance abuse and control in the UnitedStates ethical and legal issues Social Science and Medicine35471ndash479

Newcomb M D (1992b) Understanding the multidimensional nature ofdrug use and abuse The role of consumption risk factors andprotective factors In Glantz M D Pickens R eds Vulnerabilityto Drug Abuse Washington DC American PsychologicalAssociation 255ndash298

Newcomb M D (1996a) Pseudomaturity among adolescents constructvalidation sex differences and associations in adulthood Journalof Drug Issues 26477ndash504

Newcomb M D (1996b) Adolescence Pathologizing a normal processThe Counseling Psychologist 24482ndash490

Newcomb M D (1997) Psychosocial predictors and consequences ofdrug use a developmental perspective within a prospective studyJournal of Addictive Diseases 1651ndash89

Newcomb M D Bentler P M (1988) Consequences of Adolescent DrugUse Impact on the Lives of Young Adults Beverly Hills CA Sage

Newcomb M D Bentler P M (1989) Substance use and abuse amongchildren and teenagers American Psychologist 44242ndash248

Newcomb M D Harlow L L (1986) Life events and substance useamong adolescents Mediating effects of perceived loss of controland meaninglessness in life Journal of Personality and SocialPsychology 51564ndash577

Newcomb M D Chou C-P Bentler P M Huba G J (1988)Cognitive motivations for drug use among adolescents longitudinaltests of gender differences and predictors of change in drug useJournal of Counseling Psychology 35426ndash438

Newcomb M D Abbott R D Catalano R F Hawkins J DBattin-Pearson S R Hill K (2002) Mediational and deviancetheories of late high school failure Process roles of structural

2010 Sussman et al

ORDER REPRINTS

strains academic competence and general versus specific problem

behaviors Journal of Counseling Psychology 49172ndash186Nezami E Sussman S Pentz M A (2003) Motivation in tobacco use

cessation research Substance Use amp Misuse 3825ndash5Novak S P Clayton R R (2001) The influence of school environment

and self-regulation on transitions between stages of cigarette

smoking Health Psychology 20196ndash207Offord D R (2000) Selection of levels of prevention Addictive

Behaviors 25833ndash842Palinkas L A Atkins C J Miller C Ferreira D (1996) Social skills

training for drug prevention in high-risk female adolescents

Preventive Medicine 25692ndash701Patock-Peckham J A Cheong J-W Balhorn M E Nagoshi C T

(2001) A model of parenting styles self-regulation perceived

drinking control and alcohol use and problems Alcoholism

Experimental and Clinical Research 251284ndash1292Pentz M A (1994) Directions for future research in drug abuse

prevention Preventive Medicine 23646ndash652Pentz M A Dwyer J H MacKinnon D Flay B R Hansen W B

Wang E Y I Johnson C A (1989) A multi-community trial for

primary prevention of adolescent drug abuse effects on drug use

prevalence JAMA 2623259ndash3266Pentz M A Mares D Schinke S Rohrbach L (in press) Political

science public policy and drug abuse prevention Substance Use amp

MisuseProchaska J O DiClemente C C (1982) Transtheoretical therapy

toward a more integrative model of change Psychotherapy Theory

Research and Practice 19275ndash288Pulkkinen L Pitkanen T (1994) A prospective study of the precursors

to problem drinking in young adulthood Journal of Studies on

Alcohol 55578ndash587Rathus S A Nevid J S (1977) Behavior Therapy Strategies for

Solving Problems in Living New York Doubleday and Company

IncResnicow K Botvin G (1993) School-based substance use prevention

programs why do effects decay Preventive Medicine 22484ndash490Rutter M Dunn J Plomin R Simonoff E Pickles A Maughan

B Ormel J Meyer J Eaves L (1997) Integrating nature and

nurture implications of person-environment interactions for

developmental psychopathology Development and Psychopathology

9335ndash364

Motivation Skills and Decision Making 2011

ORDER REPRINTS

Salomon G Stein Y Eisenberg S Klein L (1984) Adolescent

smokers and nonsmokers profiles and their changing structure

Preventive Medicine 13446ndash461Sambrano S (1999) National cross-site evaluation of high risk youth

programs In Interim findings Bulletin Washington DC CSAP

SAMSHA US DHHS May 1ndash16Schinke S P Gilchrist L D (1985) Preventing substance abuse with

children and adolescents Journal of Consulting and Clinical

Psychology 53596ndash602Skara S N Sussman S (2003) A review of 25 long-term adolescent

tobacco and other drug use prevention program evaluations

Preventive MedicineSmith C Lizotte A J Thornberry T P Krohn M D (1995)

Resilient youth identifying factors that prevent high-risk youth

from engaging in delinquency and drug use Delinquency and

Disrepute in the Life Course Greenwich CT John Hagan JAI

press 217ndash247Sommers P V (1972) The Biology of Behavior Australia Pty ltd

Sydney John Wiley amp SonsSt Pierre T L Kaltreider D L Mark M M Aikin K J (1992)

Drug prevention in a community setting a longitudinal study of the

relative effectiveness of a three-year primary prevention program in

boys and girls clubs across the nation American Journal of

Community Psychology 20673ndash706Stein J A Newcomb M D Bentler P M (1987) An eight year study

of multiple influences on drug use and drug use consequences

Journal of Personality and Social Psychology 531094ndash1105Sully J (1884) Outlines of Psychology New York D Appleton amp CoSussman S (1989) Two social influence perspectives of tobacco use

development and prevention Health Education Research Theory

and Practice 4213ndash223Sussman S (1991) Curriculum development in school-based prevention

research Health Education Research Theory and Practice

6339ndash351Sussman S (1996) Development of a school-based drug abuse

prevention curriculum for high risk youth Journal of

Psychoactive Drugs 28169ndash182Sussman S Ames S L (2001) The social psychology of drug abuse

Buckingham GB Open University PressSussman S Unger J (2004) A drug abuse theoretical integration a

transdisciplinary speculation Substance Use amp Misuse

2012 Sussman et al

ORDER REPRINTS

Sussman S Dent C W Burton D Stacy A W Flay B R (1995a)

Developing school-based tobacco use prevention and cessation

programs Thousand Oaks CA Sage Publications IncSussman S Dent C W Simon T R Stacy A W Galaif E R

Moss M A Craig S Johnson C A (1995b) Effectiveness of

social influence substance abuse prevention curricula in compre-

hensive and continuation high schools Drugs and Society 865ndash81Sussman S Dent C W Galaif E R (1997) The correlates of

substance abuse and dependence among adolescents at high risk

for drug abuse Journal of Substance Abuse 9241ndash255Sussman S Dent C W Stacy A W (1996) The relation of pro-drug

use myths with self-reported drug use among youth at continuation

high schools Journal of Applied Social Psychology 26214ndash267Sussman S Dent C W Stacy A Craig S (1998) One-year outcomes

of project towards no drug abuse Preventive Medicine 27632ndash642

(erratum 766)Sussman S Dent C W Stacy S (2002) Project towards no drug

abuse a review of the findings and future directions American

Journal of Health Behavior 26354ndash365Sussman S McCuller W J Dent C W (2003) The associations of

social self-control personality disorders and demographics with

drug use among high risk youth Addictive Behaviors 281159ndash1166Sussman S Rohrbach L Patel R Holiday K (2003) A look at an

interactive classroom-based drug abuse prevention program

Interactive contents and suggestions for research Journal of Drug

Education 33355ndash368Sussman S Sun P McCuller W J Dent C W (2003) Project

towards no drug abuse two year outcomes of a trial that compares

health educator delivery to self-instruction Preventive Medicine

37155ndash162Tarter R E Vanyukov M (1994) Alcoholism a developmental disorder

Journal of Consulting and Clinical Psychology 621096ndash1107Thornton T N Craft C A Dahlberg L L Lynch B S Baer K

(2000) Best Practices of Youth Violence Prevention A Sourcebook

for Community Action Atlanta GA Division of Violence

Prevention Centers for Disease Control and PreventionTobler N S (1986) Meta-analysis of 143 adolescent drug prevention

programs quantitative outcome of program participants compared to

a control or comparison group Journal of Drug Issues 16537ndash567Tobler N S Roona M R Ochshorn P Marshall D G Streke

A V Stackpole K M (2000) School-based adolescent drug

Motivation Skills and Decision Making 2013

ORDER REPRINTS

prevention programs 1998 Meta-analysis The Journal of Primary

Prevention 20275ndash336US Department of Health and Human Services (USDHHS) (2003)

Substance Abuse andMental Health Services Administration Center

for Substance Abuse Prevention Science-based prevention programs and

principles 2002 Rockville MD US DHHS (SMA)03-3764 Also

see httpmodelprogramssamhsagovUnger J Baezconde-Garbanati L Shakib S Palmer P H Nezami

E Mora J (2004) What are the implications of structuralcultural

theory for drug abuse prevention Substance Use amp MisuseUpshaw H S Ostrom T M (1984) Psychological perspective in

attitude research In Eiser J R ed Attitudinal Judgment New

York Springer-Verlag 23ndash42Valente T W Gallaher P Mouttapa M (2004) Using social network

theory to understand and prevent substance use a transdisciplinary

perspective Substance Use amp MisuseVorrath H Brendtro L (1985) Positive peer culture 2nd edn Aldine

ChicagoWaldron H B Slesnick N Brody J L Turner C W Peterson T R

(2001) Treatment outcomes for adolescent substance abuse at 4-

and 7-month assessments Journal of Consulting amp Clinical

Psychology 69(5)802ndash813Watson D L Tharp R G (2002) Self-directed behavior Self-

modification for personal adjustment 8th edn Belmont CA

WadsworthWeissberg R P Caplan M Z Sivo P J (1989) A new conceptual

framework for establishing school-based social competence promo-

tion programs In Bond L A Compas B E eds Primary

Prevention amp Promotion in the Schools Newbury Park CA Sage

255ndash296Wills T A (1986) Stress and coping in early adolescence relationships

to substance use in urban school samples Health Psychology

5503ndash529Wills T A Cleary S D (1995) Stress-coping model for alcohol-

tobacco interactions in adolescence In Fertig J B Allen J P

eds Alcohol and Tobacco From Basic Science to Clinical Practice

Bethesda MD National Institute on Alcohol Abuse and

Alcoholism 107ndash128Wills T A Cleary S D (1999) Peer and adolescent substance use

among 6thndash9th graders Latent growth analyses of influence versus

selection mechanisms Health Psychology 18453ndash463

2014 Sussman et al

ORDER REPRINTS

Wills T A Hirky A E (1996) Coping and substance abuse InZeidner M Endler N S eds Handbook of Coping TheoryResearch and Applications New York Wiley 279ndash302

Wills T A Stoolmiller M (2002) The role of self-control in earlyescalation of substance use a time-varying analysis Journal ofConsulting and Clinical Psychology 70986ndash997

Wills T A Baker E Botvin G J (1989) Dimensions of assertivenessdifferential relationships to substance use in early adolescenceJournal of Consulting and Clinical Psychology 57(4)473ndash478

Wills T A Vaccaro D McNamara G (1994) Novelty seeking risktaking and related constructs as predictors of adolescent substanceuse an application of Cloningerrsquos theory Journal of SubstanceAbuse 61ndash20

Wills T A McNamara G Vaccaro D Hirky A E (1996a)Escalated substance use a longitudinal grouping analysis fromearly to middle adolescence Journal of Abnormal Psychology105166ndash180

Wills T A Pierce J P Evans R I (1996b) Large-scale environmentalrisk factors for substance use American Behavioral Scientist39808ndash822

Wills T A Windle M Cleary S D (1998) Role of temperamentnovelty-seeking and self-control in adolescent substance useJournal of Personality and Social Psychology 74387ndash406

Wills T A Sandy J M Shinar O (1999) Substance use level andproblems in late adolescence a mediational model based on self-control and coping motives Experimental and ClinicalPsychopharmacology 7122ndash134

Wills T A Cleary S D Filer M Shinar O Mariani J Spera K(2001) Temperament and self-control related to early-onsetsubstance use test of a developmental model Prevention Science2145ndash163

Wills T A Sandy J M Yaeger A (2002) Moderators of therelationship between substance use level and problems test of aself-regulation model in adolescence Journal of AbnormalPsychology 1113ndash21

Wills T A Gibbons F X Gerrard M Murry V Brody G (in press-a) Family communication and religiosity related to substance useand sexual behavior in early adolescence Psychology of AddictiveBehaviors

Wills T A Resko J Ainette M Mendoza D (in press-b) The role ofparent and peer support in adolescent substance use a test ofmediated effects Psychology of Addictive Behaviors

Motivation Skills and Decision Making 2015

ORDER REPRINTS

Young P T (1936) Motivation of Behavior New York John Wiley andSons

Zimmerman B J (2000) Attaining self-regulation a social cognitivemodel In Boekaerts M Pintrich P R eds Handbook of Self-Regulation San Diego Academic Press 13ndash39

2016 Sussman et al

Request PermissionOrder Reprints

Reprints of this article can also be ordered at

httpwwwdekkercomservletproductDOI101081JA200034769

Request Permission or Order Reprints Instantly

Interested in copying and sharing this article In most cases US Copyright Law requires that you get permission from the articlersquos rightsholder before using copyrighted content

All information and materials found in this article including but not limited to text trademarks patents logos graphics and images (the Materials) are the copyrighted works and other forms of intellectual property of Marcel Dekker Inc or its licensors All rights not expressly granted are reserved

Get permission to lawfully reproduce and distribute the Materials or order reprints quickly and painlessly Simply click on the Request Permission Order Reprints link below and follow the instructions Visit the US Copyright Office for information on Fair Use limitations of US copyright law Please refer to The Association of American Publishersrsquo (AAP) website for guidelines on Fair Use in the Classroom

The Materials are for your personal use only and cannot be reformatted reposted resold or distributed by electronic means or otherwise without permission from Marcel Dekker Inc Marcel Dekker Inc grants you the limited right to display the Materials only on your personal computer or personal wireless device and to copy and download single copies of such Materials provided that any copyright trademark or other notice appearing on such Materials is also retained by displayed copied or downloaded as part of the Materials and is not removed or obscured and provided you do not edit modify alter or enhance the Materials Please refer to our Website User Agreement for more details

ORDER REPRINTS

many problems require that we comprehensively target youth withmultiple problem behaviors

Biglan and colleagues (in press) provide a comprehensive review ofthe relationships among antisocial behavior tobacco alcohol and otherdrug use and high-risk sexual behavior It is clear that the same youngpeople are prone to the development of the entire range of problems In arecent review Moffitt and colleagues (2002) found that antisocialbehavior in early adolescence (rather than late adolescence) is a greaterrisk factor for developing multiple problems These findings point to theimportance of early intervention before youth develop serious problemsMoreover these different problems largely result from the same set ofenvironmental and biological factors

One implication is that disciplines dealing with these problemsother than drug abuse may contribute to dealing with the problem ofdrug use (Newcomb 1996b 1997) In particular research by dev-elopmental psychologists family social workers and sociologists onthe influence of parents on adolescent problem development and oninterventions to alter parenting practices contributes to our understandingof how to prevent or ameliorate drug abuse and other problems Onealso should note that nonsubstance use is not a guarantee for problemimmunity for the entire age range of people whatever their genderethnicity religiosity socioeconomic status (SEC) domicility etc It maybe argued that the most promising programs are those targeting thesemultiple levels of influence Several multidisciplinary programs haveachieved promising results We describe three of these empiricallyevaluated programs tested in various settings

Functional Family Therapy (FFT)FFT is an indicated intervention involving family treatment designed

for delinquent teenagers (also see Table 1) Developed in the early 1970sby Alexander and colleagues (1973) FFT focuses on family commu-nication and the establishment of rules and consequences Several studiesprovide encouraging reports of the programrsquos effectiveness (Alexander etal 1976 Barton et al 1985 Klein et al 1977 Waldron et al 2001) Inthe Waldron et al (2001) study researchers used FFT and anintervention with cognitive behavior therapy on teens referred formarijuana use Each of the interventions produced significant resultson marijuana use by the teens at four months but only the twointerventions combined maintained these results at seven months Theearlier studies found a greater number of results For example in the twoAlexander studies (1973 1976) improvement in family communicationposttreatment led to reduced delinquency Note that all the teens in these

2000 Sussman et al

ORDER REPRINTS

studies had histories of serious antisocial or delinquent behavior Thusachieving positive outcomes even if only short-term should encouragefurther research into the efficacy of FFT

Multisystemic Therapy (MST)As its name suggestsMST targets individual family peer school and

community influences of those youth offenders with serious problems thatmay include violence substance use and severe emotional problems (alsosee Table 1) Numerous researchers have published the results ofrandomized trials of MST (Henggeler et al 1996 1997 1998 Thorntonet al 2000) The most consistent findings across studies are decreased (1)drug use (2) re-arrest (3) self-reported criminal offense and (4) days inout-of-home placements Other consistent findings are improved familyrelations school attendance and psychiatric functioning One cautionarynote the programrsquos effectiveness lowers considerably if not implementedwith fidelity (Hengler et al 1997 1999) In other words all or key lessonsneed to be delivered as written by educators who are well-trained in usingthe strategies employed and youth need to be able to receive all material inan atmosphere conducive to learning the material The programdevelopers have instituted training strategies that address these fidelityissues thus shaping MST to be a very promising program for at-riskyouth

Multidimensional Treatment Foster Care (MTFC)MTFC targets family and peer factors influencing adolescents with a

pattern of repeat criminal offending (see Table 1) (Chamberlain 1994)This intervention includes placement of the youth into a foster homewith a foster parent trained in behavior management who receivessupport from intervention staff After the adolescent has begun torespond to the intervention in the foster home and after the parents havereceived the same training and support as the foster parents did theadolescent returns home Chamberlain and Reid (1998) tested theintervention with 85 boys with felony and other criminal histories andfound substantial benefits of the program Following treatment the boysassigned to MTFC (compared to those receiving community-based groupcare) showed fewer days in detention or lock-up twice as much timeliving with parents fewer misdemeanor and felony arrests and fewer self-reported index crimes felony arrests and general delinquency TheMTFC is a cost-effective alternative to incarceration however staffrequirements are extensive which may influence the ability of some

Motivation Skills and Decision Making 2001

ORDER REPRINTS

groups to apply the program with fidelity However as with each of theprograms described here the results of the randomized trials areencouraging

Future Research Needs in Targeted Prevention

Future research can help discern when and where targeted preventionprogramming will tend to work rather than produce potentiallydeleterious negative group effects or results that are irrelevant for pro-social healthy adaptation as well as what the critical necessary conditionsare for their effective operation within given de facto realities Comparedto the breadth of evaluated universal drug use prevention programs(Tobler et al 2000) relatively few targeted prevention programs havereceived empirical support Yet previous research suggests that universalschool-based drug use prevention programs implemented in junior highschool have relatively less chance of long-term success especially for thoseyouth that began using drugs before the prevention program wasimplemented Of course there are notable exceptions (eg effects lastedfor one and a half years effects lasted for six years) (Chou et al 1998Griffin et al 2003 Skara and Sussman 2003) Almost no research existsregarding maximization of booster programming with high-risk youthMore research on booster programs would help the field

While continuing to engage in this work there will be numerousissues to manage that go well beyond the scope of this article There willbe a need to avoid producing negative labeling effects while providingprogramming for those who are at risk for drug use It is possible thatcessation information needs to be included in the mix with preventionmaterial to provide better targeted-prevention effects There may be aneed to develop a teacher selection instrument to help select out teacherswho can deliver drug abuse prevention programming adequatelyCertainly definition of outcome variables needs continued explorationincluding analysis to ascertain the effects of programming on drug abusevs drug use and identification of the variables that are most closelylinked to change by targeted prevention components

A transdisciplinary approach helps to better understand the lifesituation of high-risk youth as based to some extent on both constitutionaland environmental factors (Fuqua et al 2004 Rutter et al 1997 Wills etal 1996b) From the transactional perspective their situation is in partconstitutional they may have temperamental characteristics that arepartly heritable and that have set the stage at earlier ages for decrements inself-control ability and academic performance that then increase risk for

2002 Sussman et al

ORDER REPRINTS

drug use However their situation is also part environmental based in parton family socialization and in part on the types of peers they have as well asthe type and quality of the physical and cultural environment-at-largeThere are many points at which a potential chain of failures can beinterrupted and the individualrsquos trajectory turned in a better directionProblems are not inevitable from starting level (Tarter and Vanyukov1994) and environmental modifications to support good self-controlability can help to avert an adverse impact from earlier experiences orcurrent difficulties (Brody et al 2002 Novak and Clayton 2001 Patock-Peckham et al 2001 Rutter et al 1997 Wills et al 2002)

The problems and needs of high-risk youth in our nationrsquos highschools demand our attention for designing and rigorously testingtargeted prevention approaches Substantial evidence shows that theseyouth are at greater risk for drug involvement and co-occurring problemssuch as aggression depression and suicidal behaviors as we previouslydiscussed It is hoped that the information presented in this article willstimulate others to join in extending this work including testing othermodels of targeted prevention

GLOSSARY

Universal programs Programs that aim to influence all subjects in acontext

Selective drug-abuse prevention programs Programs that servegroups at greater risk of ATOD usemdashfor example children of alcoholicparents They are at psychosocial risk for drug use and abuse

Indicated drug-abuse prevention programs Programs that attemptto benefit individuals who already show signs of drug involvement orrelated risk factors In indicated prevention programs the primary goal isto stem the progression of ATOD use or reduce drug involvementamong the high-risk youth

Targeted programming Programming that subsumes selective andindicated programming sometimes the other two types of programs thattarget specific groups lsquolsquoat riskrsquorsquo are considered together

ACKNOWLEDGMENTS

This research was supported by grants from the National Institute onDrug Abuse (DA01070 DA07601 DA13814 and DA16094) and by aResearch Scientist Development Award K02 DA00252 from theNational Institute on Drug Abuse

Motivation Skills and Decision Making 2003

ORDER REPRINTS

REFERENCES

Alexander J F Barton C Schiaro R S Parsons B V (1976)

Systems-behavioral intervention with families of delinquents

therapist characteristics family behavior and outcome Journal of

Consulting and Clinical Psychology 44(4)656ndash664Alexander J F Parsons B V (1973) Short-term behavioral interven-

tion with delinquent families impact on family process and

recidivism Journal of Abnormal Psychology 3219ndash225American psychiatric association (APA) (1994) Diagnostic and

Statistical Manual of Mental Disorders 4th edn (DSM-IV)

Washington DC American Psychiatric AssociationAmes S L Sussman S Dent C W (1999) Pro-drug-use myths and

competing constructs in the prediction of substance use among

youth at continuation high schools a one-year prospective study

Personality and Individual Differences 26987ndash1003Bachman S G Wadsworth K N OrsquoMalley P M Johnston L D

Schulenberg J E (1997) Smoking drinking and drug use in young

adulthood Mahwah NJ Lawrence Erlbaum Associates 8ndash25

153ndash190Bandura A (1986) Social Foundations of Thought and Action A Social

Cognitive Theory Englewood Cliffs NJ Prentice HallBarton C Alexander J F Waldron H Turner C W Warburton J

(1985) Generalizing treatment effects of functional family therapy

Three replications The American Journal of Family Therapy

13(3)16ndash26Battin-Pearson S R Newcomb M D Abbott R D Hill K G

Catalano R F Hawkins J D (2000) Predicting early high school

dropout Journal of Educational Psychology 92568ndash582Biglan A Brennan P A Foster S L Holder H D Miller T L

Cunningham P B et al (in press) Helping Adolescents at Risk

Prevention of Multiple Problem Behaviors New York NY Guilford

PressBindra D Stewart J (1996) Motivation Baltimore MD Penguin

BooksBlanton H Gibbons F X Gerrard M Conger K J Smith G E

(1998) The role of family and peers in the development of

prototypes associated with substance use Journal of Family

Psychology 11271ndash288

2004 Sussman et al

ORDER REPRINTS

Botvin G J (1993) School-based drug abuse prevention Long-termfollow-up results In First Annual Meeting of the Society forPrevention Research Kentuck Lexington Society for PreventionResearch

Botvin G J Baker E Dusenbury L Botvin E M Diaz T (1995)Long-term follow-up results of a randomized drug abuse preven-tion trial in a white middle-class population Journal of theAmerican Medical Association 2731106ndash1012

Brody G H Dorsey S Forehand R Armistead L (2002) Uniquecontributions of parenting and classroom processes to the self-control of AfricanndashAmerican children Child Development73274ndash286

Carroll M E (1996) Reducing drug abuse by enriching the environmentwith alternative nondrug reinforcers In Green L Kagel J Heds Advances in Behavioral Economics Norwood NJ NorwoodPublishing Corp 37ndash68

Carver C S Scheier M F (1998) On the Self-Regulation of BehaviorNew York Cambridge University Press

Catalano R F Hawkins J D (1996) The social developmental modela theory of antisocial behavior In Hawkins J D ed Delinquencyand Crime Current Theories New York Cambridge UniversityPress

Centers for Disease Control (CDC) (October 1999) Youth risk BehaviorSurveillancemdashNational Alternative High School Youth RiskBehavior Survey 1998 Morbidity and Mortality Weekly Report48 No SS-7

Chamberlain P (1994) Family connections A treatment foster caremodel for adolescents with delinquency Eugene OR CastaliaPublishing Company

Chamberlain P Reid J B (1998) Comparison of two communityalternatives to incarceration for chronic juvenile offenders Journalof Consulting and Clinical Psychology 66(4)624ndash633

Chassin L A Presson C C Sherman S J (1985) Stepping backwardin order to step forward an acquisition-oriented approach toprimary prevention Journal of Consulting and Clinical Psychology53612ndash622

Chou C-P Montgomery S Pentz M A Rohrbach L A JohnsonC A Flay B R MacKinnon D P (1998) Effects of acommunity-based prevention program on decreasing drug use inhigh-risk adolescentsAmerican Journal of Public Health 88944ndash948

Conducts Problems Prevention Research Group (CPPRG) (1999) Initialimpact of the fast track prevention trial for conduct problems I

Motivation Skills and Decision Making 2005

ORDER REPRINTS

The high-risk sample Journal of Consulting and Clinical Psychology

67631ndash647Conducts Problems Prevention Research Group (CPPRG) (2000)

Merging universal and indicated prevention programs the fast

track model Addictive Behaviors 25913ndash927Council of Philosophical Studies (1981) Psychology and the Philosophy

of Mind in the Philosophy Curriculum San Francisco San Francisco

State UniversityCummings K M Hellmann R Emont S L (1988) Correlates of

participation in a worksite stop smoking program Journal of

Behavioral Medicine 11267ndash277Curry S Wagner E H Gothaus L C (1990) Intrinsic and extrinsic

motivation for smoking cessation Journal of Consulting and

Clinical Psychology 58310ndash316Dent C W Sussman S McCuller W J Stacy A W (2001) Drug

abuse prevention among youth at comprehensive high schools

Preventive Medicine 32514ndash520Dewey J (1886) Psychology New York HarperDishion T J French D C Patterson G R (1995) The development

and ecology of antisocial behavior In Cicchetti D Cohen D

eds Manual of developmental psychopathology New York John

Wiley 421ndash471Eggert L L Herting J R (1991) Preventing teenage drug abuse

exploratory effects of network social support Youth and Society

22482ndash534 [Reprinted National Prevention Evaluation Research

CollectionRockville MD Aspen 1993]Eggert L L Herting J R Thompson E A Nicholas L J Dicker

B G (1994) Preventing adolescent drug abuse and high school

dropout through an intensive school-based social network devel-

opment program American Journal of Health Promotion

8202ndash214Eggert L L Thompson E A Herting J R Nicholas L J (1995)

Reducing suicide potential among high-risk youth tests of a school-

based prevention program Suicide amp Life-Threatening Behavior

25276ndash296Ellickson P L Bell R M (1990) Drug prevention in junior high a

multi-site longitudinal test Science 2471299ndash1305Elliott D S (Series ed) (2003) Blueprints for violence prevention

Boulder CO Institute of Behavioral Science Regents of the

University of Colorado wwwcoloradoeducspvblueprints

2006 Sussman et al

ORDER REPRINTS

Farrell A D Danish S J (1993) Peer drug associations and emotionalrestraint Causes or consequences of adolescent drug use Journal ofConsulting and Clinical Psychology 61327ndash334

Festinger L A (1957) A Theory of Cognitive Dissonance New YorkHarper amp Row

Fuqua J Stokols D Gress J Phillips K Harvey R (2004)Transdisciplinary collaboration as a basis for enhancing the scienceand prevention of substance use and abuse Substance Use ampMisuse

Giuliano J D (1994) A peer education program to promote the use ofconflict resolution skills among at-risk school-age males PublicHealth Reports 109158ndash169

Glynn K Levanthal H Hirschman R (1985) A cognitivedevelopmental approach to smoking prevention In Bell C SBattjes R eds Prevention research Deterring Drug Abuse AmongChildren and Adolescents Rockville MD NIDA ResearchMonograph 63

Glynn T J (1989) Essential elements of school-based smokingprevention programs Journal of School Health 59181ndash188

Goodman R M Burdine J N Meehan E McLeroy K R eds(1993) Community coalitions for health promotion Special issue ofHealth Education Research Theory and Practice 8309ndash453

Goodyear R D Newcomb M D Locke T F (2002) PregnantLatina teenagers psychosocial and developmental determinants ofhow they select and perceive the men who father their childrenJournal of Counseling Psychology 49187ndash201

Gordon R (1987) An operational classification of disease preventionIn Steinberg J A Silverman M M eds Preventing MentalDisorders Rockville MD DHHS 20ndash26

Graham J W Johnson C A Hansen W B Flay B R Gee M(1990) Drug use prevention programs gender and ethnicityevaluation of three seventh-grade project SMART cohortsPreventive Medicine 19305ndash313

Griffin K W Botvin G J Nichols T R Doyal M M (2003)Effectiveness of a universal drug abuse prevention approach foryouth at high risk for substance use initiation Preventive Medicine36(1)1ndash7

Hamilton S (August 20 2000) Views slowly changing on alternativeschools The Sacramento Bee 1ndash3

Hansen W B (1992) School-based substance abuse prevention a reviewof the state of the art in curriculum 1980ndash1990 Health EducationResearch 7403ndash430

Motivation Skills and Decision Making 2007

ORDER REPRINTS

Hansen W B Johnson C A Flay B R Graham J W Sobel J(1988) Affective and social influences approaches to the preventionof multiple substance abuse among seventh grade students resultsfrom project SMART Preventive Medicine 17135ndash154

Hansen W B Graham J W (1991) Preventing alcohol marijuanaand cigarette use among adolescents peer pressure and resistancetraining versus establishing conservative norms PreventiveMedicine 20414ndash430

Hawkins D H Catalano R F Miller J Y (1992) Risk andprotective factors for alcohol and other drug problems inadolescence and early adulthood Implications for substanceabuse prevention Psychological Bulletin 11254ndash105

Hawkins J D Catalano R F Kosterman R Abbott R Hill K G(1999) Preventing adolescent health-risk behaviors by strengthen-ing protection during childhood Archives of Pediatric amp AdolescentMedicine 153226ndash234

Heider F (1958) The Psychology of Interpersonal Relations New YorkWiley

Henggeler S W Pickrel S G Brondino M J Crouch J L (1996)Eliminating (almost) treatment dropout of substance abusing ordependent delinquents through home-based multisystemic therapyAmerican Journal of Psychiatry 153(3)427ndash428

Henggeler S W Melton G B Brondino M J Scherer D GHanley J H (1997) Multisystemic therapy with violent andchronic juvenile offenders and their families the role of treatmentfidelity in successful dissemination Journal of Consulting andClinical Psychology 65(5)821ndash833

Henggeler S W Schoenwald S K Borduin C M Rowland M DCunningham P B (1998) Multisystemic treatment of antisocialbehavior in children and adolescents New York The Guilford Press

Henggeler S W Pickrel S G Brondino M J (1999) Multisystemictreatment of substance-abusing and dependent delinquents out-comes treatment fidelity and transportability Mental HealthServices Residual 1(3)171ndash84

Johnson C A Pentz M A Weber M D Dwyer J H Baer NMacKinnon D P Hansen W B Flay B R (1990) Relativeeffectiveness of comprehensive community programming for drugabuse prevention with high-risk and low-risk adolescents Journalof Consulting and Clinical Psychology 58447ndash456

Kaftarian S J Hansen W B eds (1994) CSAP special issuecommunity partnership program Journal of Community Psychologypages 205

2008 Sussman et al

ORDER REPRINTS

Karoly P (1993) Mechanisms in self-regulation A systems view AnnualReview of Psychology 4423ndash51

Karoly P (1980) Person variables in therapeutic change and develop-ment In Karoly P Steffen J J eds Improving the Long-TermEffects of Psychotherapy New York Gardner Press 195ndash261

Kendall P C Braswell L (1982) Cognitive-behavioral self-controltherapy for children a components analysis Journal of Consultingand Clinical Psychology 50672ndash689

Kerr M Tremblay R E Pagani L Vitaro F (1997) Boysrsquobehavioral inhibition and the risk of later delinquency Archivesof General Psychiatry 54809ndash816

Klein N C Alexander J F Parsons B V (1977) Impact of familysystems intervention on recidivism and sibling delinquency a modelof primary prevention and program evaluation Journal ofConsulting and Clinical Psychology 45(3)469ndash474

Kumpfer K L (1999) Outcomes measures of interventions in the studyof children of substance-abusing parents Pediatrics 1031128ndash1144

Lau R R Hartman K A Ware J E (1986) Health as a valuemethodological and theoretical considerations Health Psychology525ndash43

Lichtenstein E L Glasgow R E (1997) A pragmatic framework forsmoking cessation implications for clinical and public healthprograms Psychology of Addictive Behaviors 11142ndash151

Locke T F Newcomb M D (in press) Childhood maltreatmentparent drug problems polydrug problems and parenting practicesa test of gender differences and four theoretical perspectivesJournal of Family Psychology

McCreary D R Newcomb M D Sadava S W (1999) The male rolealcohol use and alcohol problems a structural modeling examina-tion in adult women and men Journal of Counseling Psychology46109ndash124

McGee L Newcomb M D (1992) General deviance syndromeexpanded hierarchical evaluations at four ages from earlyadolescence to adulthood Journal of Consulting amp ClinicalPsychology 60766ndash776

Miller W R Brown J M (1991) Self-regulation as a conceptual basisfor the prevention of addictive behaviours In Heather N MillerW R Greeley J eds Self-control and the Addictive BehavioursSydney Australia Maxwell Macmillan 3ndash79

Miller W R Leckman A L Delaney H D Tinkcom M (1993)Long-term follow-up of behavioral self-control training forproblem drinkers Journal of Studies on Alcohol 53249ndash261

Motivation Skills and Decision Making 2009

ORDER REPRINTS

Miller W R Rollnick S (1991) Motivational InterviewingPreparing People to Change Addictive Behavior New YorkGuilford Press

Moffitt T E Caspi A Harrington H Milne B J (2002) Males onthe life-course-persistent and adolescence-limited antisocial path-ways follow-up at age 26 years Development and Psychopathology14(1)179ndash207

National Institute on Drug Abuse (NIDA) (1997) Drug abuseprevention What works NIH Publication 97-4110 DHHSNational Institutes of Health National Institute on Drug AbuseOffice of Science Policy and Communications Rockville MD

Newcomb M D (1992a) Substance abuse and control in the UnitedStates ethical and legal issues Social Science and Medicine35471ndash479

Newcomb M D (1992b) Understanding the multidimensional nature ofdrug use and abuse The role of consumption risk factors andprotective factors In Glantz M D Pickens R eds Vulnerabilityto Drug Abuse Washington DC American PsychologicalAssociation 255ndash298

Newcomb M D (1996a) Pseudomaturity among adolescents constructvalidation sex differences and associations in adulthood Journalof Drug Issues 26477ndash504

Newcomb M D (1996b) Adolescence Pathologizing a normal processThe Counseling Psychologist 24482ndash490

Newcomb M D (1997) Psychosocial predictors and consequences ofdrug use a developmental perspective within a prospective studyJournal of Addictive Diseases 1651ndash89

Newcomb M D Bentler P M (1988) Consequences of Adolescent DrugUse Impact on the Lives of Young Adults Beverly Hills CA Sage

Newcomb M D Bentler P M (1989) Substance use and abuse amongchildren and teenagers American Psychologist 44242ndash248

Newcomb M D Harlow L L (1986) Life events and substance useamong adolescents Mediating effects of perceived loss of controland meaninglessness in life Journal of Personality and SocialPsychology 51564ndash577

Newcomb M D Chou C-P Bentler P M Huba G J (1988)Cognitive motivations for drug use among adolescents longitudinaltests of gender differences and predictors of change in drug useJournal of Counseling Psychology 35426ndash438

Newcomb M D Abbott R D Catalano R F Hawkins J DBattin-Pearson S R Hill K (2002) Mediational and deviancetheories of late high school failure Process roles of structural

2010 Sussman et al

ORDER REPRINTS

strains academic competence and general versus specific problem

behaviors Journal of Counseling Psychology 49172ndash186Nezami E Sussman S Pentz M A (2003) Motivation in tobacco use

cessation research Substance Use amp Misuse 3825ndash5Novak S P Clayton R R (2001) The influence of school environment

and self-regulation on transitions between stages of cigarette

smoking Health Psychology 20196ndash207Offord D R (2000) Selection of levels of prevention Addictive

Behaviors 25833ndash842Palinkas L A Atkins C J Miller C Ferreira D (1996) Social skills

training for drug prevention in high-risk female adolescents

Preventive Medicine 25692ndash701Patock-Peckham J A Cheong J-W Balhorn M E Nagoshi C T

(2001) A model of parenting styles self-regulation perceived

drinking control and alcohol use and problems Alcoholism

Experimental and Clinical Research 251284ndash1292Pentz M A (1994) Directions for future research in drug abuse

prevention Preventive Medicine 23646ndash652Pentz M A Dwyer J H MacKinnon D Flay B R Hansen W B

Wang E Y I Johnson C A (1989) A multi-community trial for

primary prevention of adolescent drug abuse effects on drug use

prevalence JAMA 2623259ndash3266Pentz M A Mares D Schinke S Rohrbach L (in press) Political

science public policy and drug abuse prevention Substance Use amp

MisuseProchaska J O DiClemente C C (1982) Transtheoretical therapy

toward a more integrative model of change Psychotherapy Theory

Research and Practice 19275ndash288Pulkkinen L Pitkanen T (1994) A prospective study of the precursors

to problem drinking in young adulthood Journal of Studies on

Alcohol 55578ndash587Rathus S A Nevid J S (1977) Behavior Therapy Strategies for

Solving Problems in Living New York Doubleday and Company

IncResnicow K Botvin G (1993) School-based substance use prevention

programs why do effects decay Preventive Medicine 22484ndash490Rutter M Dunn J Plomin R Simonoff E Pickles A Maughan

B Ormel J Meyer J Eaves L (1997) Integrating nature and

nurture implications of person-environment interactions for

developmental psychopathology Development and Psychopathology

9335ndash364

Motivation Skills and Decision Making 2011

ORDER REPRINTS

Salomon G Stein Y Eisenberg S Klein L (1984) Adolescent

smokers and nonsmokers profiles and their changing structure

Preventive Medicine 13446ndash461Sambrano S (1999) National cross-site evaluation of high risk youth

programs In Interim findings Bulletin Washington DC CSAP

SAMSHA US DHHS May 1ndash16Schinke S P Gilchrist L D (1985) Preventing substance abuse with

children and adolescents Journal of Consulting and Clinical

Psychology 53596ndash602Skara S N Sussman S (2003) A review of 25 long-term adolescent

tobacco and other drug use prevention program evaluations

Preventive MedicineSmith C Lizotte A J Thornberry T P Krohn M D (1995)

Resilient youth identifying factors that prevent high-risk youth

from engaging in delinquency and drug use Delinquency and

Disrepute in the Life Course Greenwich CT John Hagan JAI

press 217ndash247Sommers P V (1972) The Biology of Behavior Australia Pty ltd

Sydney John Wiley amp SonsSt Pierre T L Kaltreider D L Mark M M Aikin K J (1992)

Drug prevention in a community setting a longitudinal study of the

relative effectiveness of a three-year primary prevention program in

boys and girls clubs across the nation American Journal of

Community Psychology 20673ndash706Stein J A Newcomb M D Bentler P M (1987) An eight year study

of multiple influences on drug use and drug use consequences

Journal of Personality and Social Psychology 531094ndash1105Sully J (1884) Outlines of Psychology New York D Appleton amp CoSussman S (1989) Two social influence perspectives of tobacco use

development and prevention Health Education Research Theory

and Practice 4213ndash223Sussman S (1991) Curriculum development in school-based prevention

research Health Education Research Theory and Practice

6339ndash351Sussman S (1996) Development of a school-based drug abuse

prevention curriculum for high risk youth Journal of

Psychoactive Drugs 28169ndash182Sussman S Ames S L (2001) The social psychology of drug abuse

Buckingham GB Open University PressSussman S Unger J (2004) A drug abuse theoretical integration a

transdisciplinary speculation Substance Use amp Misuse

2012 Sussman et al

ORDER REPRINTS

Sussman S Dent C W Burton D Stacy A W Flay B R (1995a)

Developing school-based tobacco use prevention and cessation

programs Thousand Oaks CA Sage Publications IncSussman S Dent C W Simon T R Stacy A W Galaif E R

Moss M A Craig S Johnson C A (1995b) Effectiveness of

social influence substance abuse prevention curricula in compre-

hensive and continuation high schools Drugs and Society 865ndash81Sussman S Dent C W Galaif E R (1997) The correlates of

substance abuse and dependence among adolescents at high risk

for drug abuse Journal of Substance Abuse 9241ndash255Sussman S Dent C W Stacy A W (1996) The relation of pro-drug

use myths with self-reported drug use among youth at continuation

high schools Journal of Applied Social Psychology 26214ndash267Sussman S Dent C W Stacy A Craig S (1998) One-year outcomes

of project towards no drug abuse Preventive Medicine 27632ndash642

(erratum 766)Sussman S Dent C W Stacy S (2002) Project towards no drug

abuse a review of the findings and future directions American

Journal of Health Behavior 26354ndash365Sussman S McCuller W J Dent C W (2003) The associations of

social self-control personality disorders and demographics with

drug use among high risk youth Addictive Behaviors 281159ndash1166Sussman S Rohrbach L Patel R Holiday K (2003) A look at an

interactive classroom-based drug abuse prevention program

Interactive contents and suggestions for research Journal of Drug

Education 33355ndash368Sussman S Sun P McCuller W J Dent C W (2003) Project

towards no drug abuse two year outcomes of a trial that compares

health educator delivery to self-instruction Preventive Medicine

37155ndash162Tarter R E Vanyukov M (1994) Alcoholism a developmental disorder

Journal of Consulting and Clinical Psychology 621096ndash1107Thornton T N Craft C A Dahlberg L L Lynch B S Baer K

(2000) Best Practices of Youth Violence Prevention A Sourcebook

for Community Action Atlanta GA Division of Violence

Prevention Centers for Disease Control and PreventionTobler N S (1986) Meta-analysis of 143 adolescent drug prevention

programs quantitative outcome of program participants compared to

a control or comparison group Journal of Drug Issues 16537ndash567Tobler N S Roona M R Ochshorn P Marshall D G Streke

A V Stackpole K M (2000) School-based adolescent drug

Motivation Skills and Decision Making 2013

ORDER REPRINTS

prevention programs 1998 Meta-analysis The Journal of Primary

Prevention 20275ndash336US Department of Health and Human Services (USDHHS) (2003)

Substance Abuse andMental Health Services Administration Center

for Substance Abuse Prevention Science-based prevention programs and

principles 2002 Rockville MD US DHHS (SMA)03-3764 Also

see httpmodelprogramssamhsagovUnger J Baezconde-Garbanati L Shakib S Palmer P H Nezami

E Mora J (2004) What are the implications of structuralcultural

theory for drug abuse prevention Substance Use amp MisuseUpshaw H S Ostrom T M (1984) Psychological perspective in

attitude research In Eiser J R ed Attitudinal Judgment New

York Springer-Verlag 23ndash42Valente T W Gallaher P Mouttapa M (2004) Using social network

theory to understand and prevent substance use a transdisciplinary

perspective Substance Use amp MisuseVorrath H Brendtro L (1985) Positive peer culture 2nd edn Aldine

ChicagoWaldron H B Slesnick N Brody J L Turner C W Peterson T R

(2001) Treatment outcomes for adolescent substance abuse at 4-

and 7-month assessments Journal of Consulting amp Clinical

Psychology 69(5)802ndash813Watson D L Tharp R G (2002) Self-directed behavior Self-

modification for personal adjustment 8th edn Belmont CA

WadsworthWeissberg R P Caplan M Z Sivo P J (1989) A new conceptual

framework for establishing school-based social competence promo-

tion programs In Bond L A Compas B E eds Primary

Prevention amp Promotion in the Schools Newbury Park CA Sage

255ndash296Wills T A (1986) Stress and coping in early adolescence relationships

to substance use in urban school samples Health Psychology

5503ndash529Wills T A Cleary S D (1995) Stress-coping model for alcohol-

tobacco interactions in adolescence In Fertig J B Allen J P

eds Alcohol and Tobacco From Basic Science to Clinical Practice

Bethesda MD National Institute on Alcohol Abuse and

Alcoholism 107ndash128Wills T A Cleary S D (1999) Peer and adolescent substance use

among 6thndash9th graders Latent growth analyses of influence versus

selection mechanisms Health Psychology 18453ndash463

2014 Sussman et al

ORDER REPRINTS

Wills T A Hirky A E (1996) Coping and substance abuse InZeidner M Endler N S eds Handbook of Coping TheoryResearch and Applications New York Wiley 279ndash302

Wills T A Stoolmiller M (2002) The role of self-control in earlyescalation of substance use a time-varying analysis Journal ofConsulting and Clinical Psychology 70986ndash997

Wills T A Baker E Botvin G J (1989) Dimensions of assertivenessdifferential relationships to substance use in early adolescenceJournal of Consulting and Clinical Psychology 57(4)473ndash478

Wills T A Vaccaro D McNamara G (1994) Novelty seeking risktaking and related constructs as predictors of adolescent substanceuse an application of Cloningerrsquos theory Journal of SubstanceAbuse 61ndash20

Wills T A McNamara G Vaccaro D Hirky A E (1996a)Escalated substance use a longitudinal grouping analysis fromearly to middle adolescence Journal of Abnormal Psychology105166ndash180

Wills T A Pierce J P Evans R I (1996b) Large-scale environmentalrisk factors for substance use American Behavioral Scientist39808ndash822

Wills T A Windle M Cleary S D (1998) Role of temperamentnovelty-seeking and self-control in adolescent substance useJournal of Personality and Social Psychology 74387ndash406

Wills T A Sandy J M Shinar O (1999) Substance use level andproblems in late adolescence a mediational model based on self-control and coping motives Experimental and ClinicalPsychopharmacology 7122ndash134

Wills T A Cleary S D Filer M Shinar O Mariani J Spera K(2001) Temperament and self-control related to early-onsetsubstance use test of a developmental model Prevention Science2145ndash163

Wills T A Sandy J M Yaeger A (2002) Moderators of therelationship between substance use level and problems test of aself-regulation model in adolescence Journal of AbnormalPsychology 1113ndash21

Wills T A Gibbons F X Gerrard M Murry V Brody G (in press-a) Family communication and religiosity related to substance useand sexual behavior in early adolescence Psychology of AddictiveBehaviors

Wills T A Resko J Ainette M Mendoza D (in press-b) The role ofparent and peer support in adolescent substance use a test ofmediated effects Psychology of Addictive Behaviors

Motivation Skills and Decision Making 2015

ORDER REPRINTS

Young P T (1936) Motivation of Behavior New York John Wiley andSons

Zimmerman B J (2000) Attaining self-regulation a social cognitivemodel In Boekaerts M Pintrich P R eds Handbook of Self-Regulation San Diego Academic Press 13ndash39

2016 Sussman et al

Request PermissionOrder Reprints

Reprints of this article can also be ordered at

httpwwwdekkercomservletproductDOI101081JA200034769

Request Permission or Order Reprints Instantly

Interested in copying and sharing this article In most cases US Copyright Law requires that you get permission from the articlersquos rightsholder before using copyrighted content

All information and materials found in this article including but not limited to text trademarks patents logos graphics and images (the Materials) are the copyrighted works and other forms of intellectual property of Marcel Dekker Inc or its licensors All rights not expressly granted are reserved

Get permission to lawfully reproduce and distribute the Materials or order reprints quickly and painlessly Simply click on the Request Permission Order Reprints link below and follow the instructions Visit the US Copyright Office for information on Fair Use limitations of US copyright law Please refer to The Association of American Publishersrsquo (AAP) website for guidelines on Fair Use in the Classroom

The Materials are for your personal use only and cannot be reformatted reposted resold or distributed by electronic means or otherwise without permission from Marcel Dekker Inc Marcel Dekker Inc grants you the limited right to display the Materials only on your personal computer or personal wireless device and to copy and download single copies of such Materials provided that any copyright trademark or other notice appearing on such Materials is also retained by displayed copied or downloaded as part of the Materials and is not removed or obscured and provided you do not edit modify alter or enhance the Materials Please refer to our Website User Agreement for more details

ORDER REPRINTS

studies had histories of serious antisocial or delinquent behavior Thusachieving positive outcomes even if only short-term should encouragefurther research into the efficacy of FFT

Multisystemic Therapy (MST)As its name suggestsMST targets individual family peer school and

community influences of those youth offenders with serious problems thatmay include violence substance use and severe emotional problems (alsosee Table 1) Numerous researchers have published the results ofrandomized trials of MST (Henggeler et al 1996 1997 1998 Thorntonet al 2000) The most consistent findings across studies are decreased (1)drug use (2) re-arrest (3) self-reported criminal offense and (4) days inout-of-home placements Other consistent findings are improved familyrelations school attendance and psychiatric functioning One cautionarynote the programrsquos effectiveness lowers considerably if not implementedwith fidelity (Hengler et al 1997 1999) In other words all or key lessonsneed to be delivered as written by educators who are well-trained in usingthe strategies employed and youth need to be able to receive all material inan atmosphere conducive to learning the material The programdevelopers have instituted training strategies that address these fidelityissues thus shaping MST to be a very promising program for at-riskyouth

Multidimensional Treatment Foster Care (MTFC)MTFC targets family and peer factors influencing adolescents with a

pattern of repeat criminal offending (see Table 1) (Chamberlain 1994)This intervention includes placement of the youth into a foster homewith a foster parent trained in behavior management who receivessupport from intervention staff After the adolescent has begun torespond to the intervention in the foster home and after the parents havereceived the same training and support as the foster parents did theadolescent returns home Chamberlain and Reid (1998) tested theintervention with 85 boys with felony and other criminal histories andfound substantial benefits of the program Following treatment the boysassigned to MTFC (compared to those receiving community-based groupcare) showed fewer days in detention or lock-up twice as much timeliving with parents fewer misdemeanor and felony arrests and fewer self-reported index crimes felony arrests and general delinquency TheMTFC is a cost-effective alternative to incarceration however staffrequirements are extensive which may influence the ability of some

Motivation Skills and Decision Making 2001

ORDER REPRINTS

groups to apply the program with fidelity However as with each of theprograms described here the results of the randomized trials areencouraging

Future Research Needs in Targeted Prevention

Future research can help discern when and where targeted preventionprogramming will tend to work rather than produce potentiallydeleterious negative group effects or results that are irrelevant for pro-social healthy adaptation as well as what the critical necessary conditionsare for their effective operation within given de facto realities Comparedto the breadth of evaluated universal drug use prevention programs(Tobler et al 2000) relatively few targeted prevention programs havereceived empirical support Yet previous research suggests that universalschool-based drug use prevention programs implemented in junior highschool have relatively less chance of long-term success especially for thoseyouth that began using drugs before the prevention program wasimplemented Of course there are notable exceptions (eg effects lastedfor one and a half years effects lasted for six years) (Chou et al 1998Griffin et al 2003 Skara and Sussman 2003) Almost no research existsregarding maximization of booster programming with high-risk youthMore research on booster programs would help the field

While continuing to engage in this work there will be numerousissues to manage that go well beyond the scope of this article There willbe a need to avoid producing negative labeling effects while providingprogramming for those who are at risk for drug use It is possible thatcessation information needs to be included in the mix with preventionmaterial to provide better targeted-prevention effects There may be aneed to develop a teacher selection instrument to help select out teacherswho can deliver drug abuse prevention programming adequatelyCertainly definition of outcome variables needs continued explorationincluding analysis to ascertain the effects of programming on drug abusevs drug use and identification of the variables that are most closelylinked to change by targeted prevention components

A transdisciplinary approach helps to better understand the lifesituation of high-risk youth as based to some extent on both constitutionaland environmental factors (Fuqua et al 2004 Rutter et al 1997 Wills etal 1996b) From the transactional perspective their situation is in partconstitutional they may have temperamental characteristics that arepartly heritable and that have set the stage at earlier ages for decrements inself-control ability and academic performance that then increase risk for

2002 Sussman et al

ORDER REPRINTS

drug use However their situation is also part environmental based in parton family socialization and in part on the types of peers they have as well asthe type and quality of the physical and cultural environment-at-largeThere are many points at which a potential chain of failures can beinterrupted and the individualrsquos trajectory turned in a better directionProblems are not inevitable from starting level (Tarter and Vanyukov1994) and environmental modifications to support good self-controlability can help to avert an adverse impact from earlier experiences orcurrent difficulties (Brody et al 2002 Novak and Clayton 2001 Patock-Peckham et al 2001 Rutter et al 1997 Wills et al 2002)

The problems and needs of high-risk youth in our nationrsquos highschools demand our attention for designing and rigorously testingtargeted prevention approaches Substantial evidence shows that theseyouth are at greater risk for drug involvement and co-occurring problemssuch as aggression depression and suicidal behaviors as we previouslydiscussed It is hoped that the information presented in this article willstimulate others to join in extending this work including testing othermodels of targeted prevention

GLOSSARY

Universal programs Programs that aim to influence all subjects in acontext

Selective drug-abuse prevention programs Programs that servegroups at greater risk of ATOD usemdashfor example children of alcoholicparents They are at psychosocial risk for drug use and abuse

Indicated drug-abuse prevention programs Programs that attemptto benefit individuals who already show signs of drug involvement orrelated risk factors In indicated prevention programs the primary goal isto stem the progression of ATOD use or reduce drug involvementamong the high-risk youth

Targeted programming Programming that subsumes selective andindicated programming sometimes the other two types of programs thattarget specific groups lsquolsquoat riskrsquorsquo are considered together

ACKNOWLEDGMENTS

This research was supported by grants from the National Institute onDrug Abuse (DA01070 DA07601 DA13814 and DA16094) and by aResearch Scientist Development Award K02 DA00252 from theNational Institute on Drug Abuse

Motivation Skills and Decision Making 2003

ORDER REPRINTS

REFERENCES

Alexander J F Barton C Schiaro R S Parsons B V (1976)

Systems-behavioral intervention with families of delinquents

therapist characteristics family behavior and outcome Journal of

Consulting and Clinical Psychology 44(4)656ndash664Alexander J F Parsons B V (1973) Short-term behavioral interven-

tion with delinquent families impact on family process and

recidivism Journal of Abnormal Psychology 3219ndash225American psychiatric association (APA) (1994) Diagnostic and

Statistical Manual of Mental Disorders 4th edn (DSM-IV)

Washington DC American Psychiatric AssociationAmes S L Sussman S Dent C W (1999) Pro-drug-use myths and

competing constructs in the prediction of substance use among

youth at continuation high schools a one-year prospective study

Personality and Individual Differences 26987ndash1003Bachman S G Wadsworth K N OrsquoMalley P M Johnston L D

Schulenberg J E (1997) Smoking drinking and drug use in young

adulthood Mahwah NJ Lawrence Erlbaum Associates 8ndash25

153ndash190Bandura A (1986) Social Foundations of Thought and Action A Social

Cognitive Theory Englewood Cliffs NJ Prentice HallBarton C Alexander J F Waldron H Turner C W Warburton J

(1985) Generalizing treatment effects of functional family therapy

Three replications The American Journal of Family Therapy

13(3)16ndash26Battin-Pearson S R Newcomb M D Abbott R D Hill K G

Catalano R F Hawkins J D (2000) Predicting early high school

dropout Journal of Educational Psychology 92568ndash582Biglan A Brennan P A Foster S L Holder H D Miller T L

Cunningham P B et al (in press) Helping Adolescents at Risk

Prevention of Multiple Problem Behaviors New York NY Guilford

PressBindra D Stewart J (1996) Motivation Baltimore MD Penguin

BooksBlanton H Gibbons F X Gerrard M Conger K J Smith G E

(1998) The role of family and peers in the development of

prototypes associated with substance use Journal of Family

Psychology 11271ndash288

2004 Sussman et al

ORDER REPRINTS

Botvin G J (1993) School-based drug abuse prevention Long-termfollow-up results In First Annual Meeting of the Society forPrevention Research Kentuck Lexington Society for PreventionResearch

Botvin G J Baker E Dusenbury L Botvin E M Diaz T (1995)Long-term follow-up results of a randomized drug abuse preven-tion trial in a white middle-class population Journal of theAmerican Medical Association 2731106ndash1012

Brody G H Dorsey S Forehand R Armistead L (2002) Uniquecontributions of parenting and classroom processes to the self-control of AfricanndashAmerican children Child Development73274ndash286

Carroll M E (1996) Reducing drug abuse by enriching the environmentwith alternative nondrug reinforcers In Green L Kagel J Heds Advances in Behavioral Economics Norwood NJ NorwoodPublishing Corp 37ndash68

Carver C S Scheier M F (1998) On the Self-Regulation of BehaviorNew York Cambridge University Press

Catalano R F Hawkins J D (1996) The social developmental modela theory of antisocial behavior In Hawkins J D ed Delinquencyand Crime Current Theories New York Cambridge UniversityPress

Centers for Disease Control (CDC) (October 1999) Youth risk BehaviorSurveillancemdashNational Alternative High School Youth RiskBehavior Survey 1998 Morbidity and Mortality Weekly Report48 No SS-7

Chamberlain P (1994) Family connections A treatment foster caremodel for adolescents with delinquency Eugene OR CastaliaPublishing Company

Chamberlain P Reid J B (1998) Comparison of two communityalternatives to incarceration for chronic juvenile offenders Journalof Consulting and Clinical Psychology 66(4)624ndash633

Chassin L A Presson C C Sherman S J (1985) Stepping backwardin order to step forward an acquisition-oriented approach toprimary prevention Journal of Consulting and Clinical Psychology53612ndash622

Chou C-P Montgomery S Pentz M A Rohrbach L A JohnsonC A Flay B R MacKinnon D P (1998) Effects of acommunity-based prevention program on decreasing drug use inhigh-risk adolescentsAmerican Journal of Public Health 88944ndash948

Conducts Problems Prevention Research Group (CPPRG) (1999) Initialimpact of the fast track prevention trial for conduct problems I

Motivation Skills and Decision Making 2005

ORDER REPRINTS

The high-risk sample Journal of Consulting and Clinical Psychology

67631ndash647Conducts Problems Prevention Research Group (CPPRG) (2000)

Merging universal and indicated prevention programs the fast

track model Addictive Behaviors 25913ndash927Council of Philosophical Studies (1981) Psychology and the Philosophy

of Mind in the Philosophy Curriculum San Francisco San Francisco

State UniversityCummings K M Hellmann R Emont S L (1988) Correlates of

participation in a worksite stop smoking program Journal of

Behavioral Medicine 11267ndash277Curry S Wagner E H Gothaus L C (1990) Intrinsic and extrinsic

motivation for smoking cessation Journal of Consulting and

Clinical Psychology 58310ndash316Dent C W Sussman S McCuller W J Stacy A W (2001) Drug

abuse prevention among youth at comprehensive high schools

Preventive Medicine 32514ndash520Dewey J (1886) Psychology New York HarperDishion T J French D C Patterson G R (1995) The development

and ecology of antisocial behavior In Cicchetti D Cohen D

eds Manual of developmental psychopathology New York John

Wiley 421ndash471Eggert L L Herting J R (1991) Preventing teenage drug abuse

exploratory effects of network social support Youth and Society

22482ndash534 [Reprinted National Prevention Evaluation Research

CollectionRockville MD Aspen 1993]Eggert L L Herting J R Thompson E A Nicholas L J Dicker

B G (1994) Preventing adolescent drug abuse and high school

dropout through an intensive school-based social network devel-

opment program American Journal of Health Promotion

8202ndash214Eggert L L Thompson E A Herting J R Nicholas L J (1995)

Reducing suicide potential among high-risk youth tests of a school-

based prevention program Suicide amp Life-Threatening Behavior

25276ndash296Ellickson P L Bell R M (1990) Drug prevention in junior high a

multi-site longitudinal test Science 2471299ndash1305Elliott D S (Series ed) (2003) Blueprints for violence prevention

Boulder CO Institute of Behavioral Science Regents of the

University of Colorado wwwcoloradoeducspvblueprints

2006 Sussman et al

ORDER REPRINTS

Farrell A D Danish S J (1993) Peer drug associations and emotionalrestraint Causes or consequences of adolescent drug use Journal ofConsulting and Clinical Psychology 61327ndash334

Festinger L A (1957) A Theory of Cognitive Dissonance New YorkHarper amp Row

Fuqua J Stokols D Gress J Phillips K Harvey R (2004)Transdisciplinary collaboration as a basis for enhancing the scienceand prevention of substance use and abuse Substance Use ampMisuse

Giuliano J D (1994) A peer education program to promote the use ofconflict resolution skills among at-risk school-age males PublicHealth Reports 109158ndash169

Glynn K Levanthal H Hirschman R (1985) A cognitivedevelopmental approach to smoking prevention In Bell C SBattjes R eds Prevention research Deterring Drug Abuse AmongChildren and Adolescents Rockville MD NIDA ResearchMonograph 63

Glynn T J (1989) Essential elements of school-based smokingprevention programs Journal of School Health 59181ndash188

Goodman R M Burdine J N Meehan E McLeroy K R eds(1993) Community coalitions for health promotion Special issue ofHealth Education Research Theory and Practice 8309ndash453

Goodyear R D Newcomb M D Locke T F (2002) PregnantLatina teenagers psychosocial and developmental determinants ofhow they select and perceive the men who father their childrenJournal of Counseling Psychology 49187ndash201

Gordon R (1987) An operational classification of disease preventionIn Steinberg J A Silverman M M eds Preventing MentalDisorders Rockville MD DHHS 20ndash26

Graham J W Johnson C A Hansen W B Flay B R Gee M(1990) Drug use prevention programs gender and ethnicityevaluation of three seventh-grade project SMART cohortsPreventive Medicine 19305ndash313

Griffin K W Botvin G J Nichols T R Doyal M M (2003)Effectiveness of a universal drug abuse prevention approach foryouth at high risk for substance use initiation Preventive Medicine36(1)1ndash7

Hamilton S (August 20 2000) Views slowly changing on alternativeschools The Sacramento Bee 1ndash3

Hansen W B (1992) School-based substance abuse prevention a reviewof the state of the art in curriculum 1980ndash1990 Health EducationResearch 7403ndash430

Motivation Skills and Decision Making 2007

ORDER REPRINTS

Hansen W B Johnson C A Flay B R Graham J W Sobel J(1988) Affective and social influences approaches to the preventionof multiple substance abuse among seventh grade students resultsfrom project SMART Preventive Medicine 17135ndash154

Hansen W B Graham J W (1991) Preventing alcohol marijuanaand cigarette use among adolescents peer pressure and resistancetraining versus establishing conservative norms PreventiveMedicine 20414ndash430

Hawkins D H Catalano R F Miller J Y (1992) Risk andprotective factors for alcohol and other drug problems inadolescence and early adulthood Implications for substanceabuse prevention Psychological Bulletin 11254ndash105

Hawkins J D Catalano R F Kosterman R Abbott R Hill K G(1999) Preventing adolescent health-risk behaviors by strengthen-ing protection during childhood Archives of Pediatric amp AdolescentMedicine 153226ndash234

Heider F (1958) The Psychology of Interpersonal Relations New YorkWiley

Henggeler S W Pickrel S G Brondino M J Crouch J L (1996)Eliminating (almost) treatment dropout of substance abusing ordependent delinquents through home-based multisystemic therapyAmerican Journal of Psychiatry 153(3)427ndash428

Henggeler S W Melton G B Brondino M J Scherer D GHanley J H (1997) Multisystemic therapy with violent andchronic juvenile offenders and their families the role of treatmentfidelity in successful dissemination Journal of Consulting andClinical Psychology 65(5)821ndash833

Henggeler S W Schoenwald S K Borduin C M Rowland M DCunningham P B (1998) Multisystemic treatment of antisocialbehavior in children and adolescents New York The Guilford Press

Henggeler S W Pickrel S G Brondino M J (1999) Multisystemictreatment of substance-abusing and dependent delinquents out-comes treatment fidelity and transportability Mental HealthServices Residual 1(3)171ndash84

Johnson C A Pentz M A Weber M D Dwyer J H Baer NMacKinnon D P Hansen W B Flay B R (1990) Relativeeffectiveness of comprehensive community programming for drugabuse prevention with high-risk and low-risk adolescents Journalof Consulting and Clinical Psychology 58447ndash456

Kaftarian S J Hansen W B eds (1994) CSAP special issuecommunity partnership program Journal of Community Psychologypages 205

2008 Sussman et al

ORDER REPRINTS

Karoly P (1993) Mechanisms in self-regulation A systems view AnnualReview of Psychology 4423ndash51

Karoly P (1980) Person variables in therapeutic change and develop-ment In Karoly P Steffen J J eds Improving the Long-TermEffects of Psychotherapy New York Gardner Press 195ndash261

Kendall P C Braswell L (1982) Cognitive-behavioral self-controltherapy for children a components analysis Journal of Consultingand Clinical Psychology 50672ndash689

Kerr M Tremblay R E Pagani L Vitaro F (1997) Boysrsquobehavioral inhibition and the risk of later delinquency Archivesof General Psychiatry 54809ndash816

Klein N C Alexander J F Parsons B V (1977) Impact of familysystems intervention on recidivism and sibling delinquency a modelof primary prevention and program evaluation Journal ofConsulting and Clinical Psychology 45(3)469ndash474

Kumpfer K L (1999) Outcomes measures of interventions in the studyof children of substance-abusing parents Pediatrics 1031128ndash1144

Lau R R Hartman K A Ware J E (1986) Health as a valuemethodological and theoretical considerations Health Psychology525ndash43

Lichtenstein E L Glasgow R E (1997) A pragmatic framework forsmoking cessation implications for clinical and public healthprograms Psychology of Addictive Behaviors 11142ndash151

Locke T F Newcomb M D (in press) Childhood maltreatmentparent drug problems polydrug problems and parenting practicesa test of gender differences and four theoretical perspectivesJournal of Family Psychology

McCreary D R Newcomb M D Sadava S W (1999) The male rolealcohol use and alcohol problems a structural modeling examina-tion in adult women and men Journal of Counseling Psychology46109ndash124

McGee L Newcomb M D (1992) General deviance syndromeexpanded hierarchical evaluations at four ages from earlyadolescence to adulthood Journal of Consulting amp ClinicalPsychology 60766ndash776

Miller W R Brown J M (1991) Self-regulation as a conceptual basisfor the prevention of addictive behaviours In Heather N MillerW R Greeley J eds Self-control and the Addictive BehavioursSydney Australia Maxwell Macmillan 3ndash79

Miller W R Leckman A L Delaney H D Tinkcom M (1993)Long-term follow-up of behavioral self-control training forproblem drinkers Journal of Studies on Alcohol 53249ndash261

Motivation Skills and Decision Making 2009

ORDER REPRINTS

Miller W R Rollnick S (1991) Motivational InterviewingPreparing People to Change Addictive Behavior New YorkGuilford Press

Moffitt T E Caspi A Harrington H Milne B J (2002) Males onthe life-course-persistent and adolescence-limited antisocial path-ways follow-up at age 26 years Development and Psychopathology14(1)179ndash207

National Institute on Drug Abuse (NIDA) (1997) Drug abuseprevention What works NIH Publication 97-4110 DHHSNational Institutes of Health National Institute on Drug AbuseOffice of Science Policy and Communications Rockville MD

Newcomb M D (1992a) Substance abuse and control in the UnitedStates ethical and legal issues Social Science and Medicine35471ndash479

Newcomb M D (1992b) Understanding the multidimensional nature ofdrug use and abuse The role of consumption risk factors andprotective factors In Glantz M D Pickens R eds Vulnerabilityto Drug Abuse Washington DC American PsychologicalAssociation 255ndash298

Newcomb M D (1996a) Pseudomaturity among adolescents constructvalidation sex differences and associations in adulthood Journalof Drug Issues 26477ndash504

Newcomb M D (1996b) Adolescence Pathologizing a normal processThe Counseling Psychologist 24482ndash490

Newcomb M D (1997) Psychosocial predictors and consequences ofdrug use a developmental perspective within a prospective studyJournal of Addictive Diseases 1651ndash89

Newcomb M D Bentler P M (1988) Consequences of Adolescent DrugUse Impact on the Lives of Young Adults Beverly Hills CA Sage

Newcomb M D Bentler P M (1989) Substance use and abuse amongchildren and teenagers American Psychologist 44242ndash248

Newcomb M D Harlow L L (1986) Life events and substance useamong adolescents Mediating effects of perceived loss of controland meaninglessness in life Journal of Personality and SocialPsychology 51564ndash577

Newcomb M D Chou C-P Bentler P M Huba G J (1988)Cognitive motivations for drug use among adolescents longitudinaltests of gender differences and predictors of change in drug useJournal of Counseling Psychology 35426ndash438

Newcomb M D Abbott R D Catalano R F Hawkins J DBattin-Pearson S R Hill K (2002) Mediational and deviancetheories of late high school failure Process roles of structural

2010 Sussman et al

ORDER REPRINTS

strains academic competence and general versus specific problem

behaviors Journal of Counseling Psychology 49172ndash186Nezami E Sussman S Pentz M A (2003) Motivation in tobacco use

cessation research Substance Use amp Misuse 3825ndash5Novak S P Clayton R R (2001) The influence of school environment

and self-regulation on transitions between stages of cigarette

smoking Health Psychology 20196ndash207Offord D R (2000) Selection of levels of prevention Addictive

Behaviors 25833ndash842Palinkas L A Atkins C J Miller C Ferreira D (1996) Social skills

training for drug prevention in high-risk female adolescents

Preventive Medicine 25692ndash701Patock-Peckham J A Cheong J-W Balhorn M E Nagoshi C T

(2001) A model of parenting styles self-regulation perceived

drinking control and alcohol use and problems Alcoholism

Experimental and Clinical Research 251284ndash1292Pentz M A (1994) Directions for future research in drug abuse

prevention Preventive Medicine 23646ndash652Pentz M A Dwyer J H MacKinnon D Flay B R Hansen W B

Wang E Y I Johnson C A (1989) A multi-community trial for

primary prevention of adolescent drug abuse effects on drug use

prevalence JAMA 2623259ndash3266Pentz M A Mares D Schinke S Rohrbach L (in press) Political

science public policy and drug abuse prevention Substance Use amp

MisuseProchaska J O DiClemente C C (1982) Transtheoretical therapy

toward a more integrative model of change Psychotherapy Theory

Research and Practice 19275ndash288Pulkkinen L Pitkanen T (1994) A prospective study of the precursors

to problem drinking in young adulthood Journal of Studies on

Alcohol 55578ndash587Rathus S A Nevid J S (1977) Behavior Therapy Strategies for

Solving Problems in Living New York Doubleday and Company

IncResnicow K Botvin G (1993) School-based substance use prevention

programs why do effects decay Preventive Medicine 22484ndash490Rutter M Dunn J Plomin R Simonoff E Pickles A Maughan

B Ormel J Meyer J Eaves L (1997) Integrating nature and

nurture implications of person-environment interactions for

developmental psychopathology Development and Psychopathology

9335ndash364

Motivation Skills and Decision Making 2011

ORDER REPRINTS

Salomon G Stein Y Eisenberg S Klein L (1984) Adolescent

smokers and nonsmokers profiles and their changing structure

Preventive Medicine 13446ndash461Sambrano S (1999) National cross-site evaluation of high risk youth

programs In Interim findings Bulletin Washington DC CSAP

SAMSHA US DHHS May 1ndash16Schinke S P Gilchrist L D (1985) Preventing substance abuse with

children and adolescents Journal of Consulting and Clinical

Psychology 53596ndash602Skara S N Sussman S (2003) A review of 25 long-term adolescent

tobacco and other drug use prevention program evaluations

Preventive MedicineSmith C Lizotte A J Thornberry T P Krohn M D (1995)

Resilient youth identifying factors that prevent high-risk youth

from engaging in delinquency and drug use Delinquency and

Disrepute in the Life Course Greenwich CT John Hagan JAI

press 217ndash247Sommers P V (1972) The Biology of Behavior Australia Pty ltd

Sydney John Wiley amp SonsSt Pierre T L Kaltreider D L Mark M M Aikin K J (1992)

Drug prevention in a community setting a longitudinal study of the

relative effectiveness of a three-year primary prevention program in

boys and girls clubs across the nation American Journal of

Community Psychology 20673ndash706Stein J A Newcomb M D Bentler P M (1987) An eight year study

of multiple influences on drug use and drug use consequences

Journal of Personality and Social Psychology 531094ndash1105Sully J (1884) Outlines of Psychology New York D Appleton amp CoSussman S (1989) Two social influence perspectives of tobacco use

development and prevention Health Education Research Theory

and Practice 4213ndash223Sussman S (1991) Curriculum development in school-based prevention

research Health Education Research Theory and Practice

6339ndash351Sussman S (1996) Development of a school-based drug abuse

prevention curriculum for high risk youth Journal of

Psychoactive Drugs 28169ndash182Sussman S Ames S L (2001) The social psychology of drug abuse

Buckingham GB Open University PressSussman S Unger J (2004) A drug abuse theoretical integration a

transdisciplinary speculation Substance Use amp Misuse

2012 Sussman et al

ORDER REPRINTS

Sussman S Dent C W Burton D Stacy A W Flay B R (1995a)

Developing school-based tobacco use prevention and cessation

programs Thousand Oaks CA Sage Publications IncSussman S Dent C W Simon T R Stacy A W Galaif E R

Moss M A Craig S Johnson C A (1995b) Effectiveness of

social influence substance abuse prevention curricula in compre-

hensive and continuation high schools Drugs and Society 865ndash81Sussman S Dent C W Galaif E R (1997) The correlates of

substance abuse and dependence among adolescents at high risk

for drug abuse Journal of Substance Abuse 9241ndash255Sussman S Dent C W Stacy A W (1996) The relation of pro-drug

use myths with self-reported drug use among youth at continuation

high schools Journal of Applied Social Psychology 26214ndash267Sussman S Dent C W Stacy A Craig S (1998) One-year outcomes

of project towards no drug abuse Preventive Medicine 27632ndash642

(erratum 766)Sussman S Dent C W Stacy S (2002) Project towards no drug

abuse a review of the findings and future directions American

Journal of Health Behavior 26354ndash365Sussman S McCuller W J Dent C W (2003) The associations of

social self-control personality disorders and demographics with

drug use among high risk youth Addictive Behaviors 281159ndash1166Sussman S Rohrbach L Patel R Holiday K (2003) A look at an

interactive classroom-based drug abuse prevention program

Interactive contents and suggestions for research Journal of Drug

Education 33355ndash368Sussman S Sun P McCuller W J Dent C W (2003) Project

towards no drug abuse two year outcomes of a trial that compares

health educator delivery to self-instruction Preventive Medicine

37155ndash162Tarter R E Vanyukov M (1994) Alcoholism a developmental disorder

Journal of Consulting and Clinical Psychology 621096ndash1107Thornton T N Craft C A Dahlberg L L Lynch B S Baer K

(2000) Best Practices of Youth Violence Prevention A Sourcebook

for Community Action Atlanta GA Division of Violence

Prevention Centers for Disease Control and PreventionTobler N S (1986) Meta-analysis of 143 adolescent drug prevention

programs quantitative outcome of program participants compared to

a control or comparison group Journal of Drug Issues 16537ndash567Tobler N S Roona M R Ochshorn P Marshall D G Streke

A V Stackpole K M (2000) School-based adolescent drug

Motivation Skills and Decision Making 2013

ORDER REPRINTS

prevention programs 1998 Meta-analysis The Journal of Primary

Prevention 20275ndash336US Department of Health and Human Services (USDHHS) (2003)

Substance Abuse andMental Health Services Administration Center

for Substance Abuse Prevention Science-based prevention programs and

principles 2002 Rockville MD US DHHS (SMA)03-3764 Also

see httpmodelprogramssamhsagovUnger J Baezconde-Garbanati L Shakib S Palmer P H Nezami

E Mora J (2004) What are the implications of structuralcultural

theory for drug abuse prevention Substance Use amp MisuseUpshaw H S Ostrom T M (1984) Psychological perspective in

attitude research In Eiser J R ed Attitudinal Judgment New

York Springer-Verlag 23ndash42Valente T W Gallaher P Mouttapa M (2004) Using social network

theory to understand and prevent substance use a transdisciplinary

perspective Substance Use amp MisuseVorrath H Brendtro L (1985) Positive peer culture 2nd edn Aldine

ChicagoWaldron H B Slesnick N Brody J L Turner C W Peterson T R

(2001) Treatment outcomes for adolescent substance abuse at 4-

and 7-month assessments Journal of Consulting amp Clinical

Psychology 69(5)802ndash813Watson D L Tharp R G (2002) Self-directed behavior Self-

modification for personal adjustment 8th edn Belmont CA

WadsworthWeissberg R P Caplan M Z Sivo P J (1989) A new conceptual

framework for establishing school-based social competence promo-

tion programs In Bond L A Compas B E eds Primary

Prevention amp Promotion in the Schools Newbury Park CA Sage

255ndash296Wills T A (1986) Stress and coping in early adolescence relationships

to substance use in urban school samples Health Psychology

5503ndash529Wills T A Cleary S D (1995) Stress-coping model for alcohol-

tobacco interactions in adolescence In Fertig J B Allen J P

eds Alcohol and Tobacco From Basic Science to Clinical Practice

Bethesda MD National Institute on Alcohol Abuse and

Alcoholism 107ndash128Wills T A Cleary S D (1999) Peer and adolescent substance use

among 6thndash9th graders Latent growth analyses of influence versus

selection mechanisms Health Psychology 18453ndash463

2014 Sussman et al

ORDER REPRINTS

Wills T A Hirky A E (1996) Coping and substance abuse InZeidner M Endler N S eds Handbook of Coping TheoryResearch and Applications New York Wiley 279ndash302

Wills T A Stoolmiller M (2002) The role of self-control in earlyescalation of substance use a time-varying analysis Journal ofConsulting and Clinical Psychology 70986ndash997

Wills T A Baker E Botvin G J (1989) Dimensions of assertivenessdifferential relationships to substance use in early adolescenceJournal of Consulting and Clinical Psychology 57(4)473ndash478

Wills T A Vaccaro D McNamara G (1994) Novelty seeking risktaking and related constructs as predictors of adolescent substanceuse an application of Cloningerrsquos theory Journal of SubstanceAbuse 61ndash20

Wills T A McNamara G Vaccaro D Hirky A E (1996a)Escalated substance use a longitudinal grouping analysis fromearly to middle adolescence Journal of Abnormal Psychology105166ndash180

Wills T A Pierce J P Evans R I (1996b) Large-scale environmentalrisk factors for substance use American Behavioral Scientist39808ndash822

Wills T A Windle M Cleary S D (1998) Role of temperamentnovelty-seeking and self-control in adolescent substance useJournal of Personality and Social Psychology 74387ndash406

Wills T A Sandy J M Shinar O (1999) Substance use level andproblems in late adolescence a mediational model based on self-control and coping motives Experimental and ClinicalPsychopharmacology 7122ndash134

Wills T A Cleary S D Filer M Shinar O Mariani J Spera K(2001) Temperament and self-control related to early-onsetsubstance use test of a developmental model Prevention Science2145ndash163

Wills T A Sandy J M Yaeger A (2002) Moderators of therelationship between substance use level and problems test of aself-regulation model in adolescence Journal of AbnormalPsychology 1113ndash21

Wills T A Gibbons F X Gerrard M Murry V Brody G (in press-a) Family communication and religiosity related to substance useand sexual behavior in early adolescence Psychology of AddictiveBehaviors

Wills T A Resko J Ainette M Mendoza D (in press-b) The role ofparent and peer support in adolescent substance use a test ofmediated effects Psychology of Addictive Behaviors

Motivation Skills and Decision Making 2015

ORDER REPRINTS

Young P T (1936) Motivation of Behavior New York John Wiley andSons

Zimmerman B J (2000) Attaining self-regulation a social cognitivemodel In Boekaerts M Pintrich P R eds Handbook of Self-Regulation San Diego Academic Press 13ndash39

2016 Sussman et al

Request PermissionOrder Reprints

Reprints of this article can also be ordered at

httpwwwdekkercomservletproductDOI101081JA200034769

Request Permission or Order Reprints Instantly

Interested in copying and sharing this article In most cases US Copyright Law requires that you get permission from the articlersquos rightsholder before using copyrighted content

All information and materials found in this article including but not limited to text trademarks patents logos graphics and images (the Materials) are the copyrighted works and other forms of intellectual property of Marcel Dekker Inc or its licensors All rights not expressly granted are reserved

Get permission to lawfully reproduce and distribute the Materials or order reprints quickly and painlessly Simply click on the Request Permission Order Reprints link below and follow the instructions Visit the US Copyright Office for information on Fair Use limitations of US copyright law Please refer to The Association of American Publishersrsquo (AAP) website for guidelines on Fair Use in the Classroom

The Materials are for your personal use only and cannot be reformatted reposted resold or distributed by electronic means or otherwise without permission from Marcel Dekker Inc Marcel Dekker Inc grants you the limited right to display the Materials only on your personal computer or personal wireless device and to copy and download single copies of such Materials provided that any copyright trademark or other notice appearing on such Materials is also retained by displayed copied or downloaded as part of the Materials and is not removed or obscured and provided you do not edit modify alter or enhance the Materials Please refer to our Website User Agreement for more details

ORDER REPRINTS

groups to apply the program with fidelity However as with each of theprograms described here the results of the randomized trials areencouraging

Future Research Needs in Targeted Prevention

Future research can help discern when and where targeted preventionprogramming will tend to work rather than produce potentiallydeleterious negative group effects or results that are irrelevant for pro-social healthy adaptation as well as what the critical necessary conditionsare for their effective operation within given de facto realities Comparedto the breadth of evaluated universal drug use prevention programs(Tobler et al 2000) relatively few targeted prevention programs havereceived empirical support Yet previous research suggests that universalschool-based drug use prevention programs implemented in junior highschool have relatively less chance of long-term success especially for thoseyouth that began using drugs before the prevention program wasimplemented Of course there are notable exceptions (eg effects lastedfor one and a half years effects lasted for six years) (Chou et al 1998Griffin et al 2003 Skara and Sussman 2003) Almost no research existsregarding maximization of booster programming with high-risk youthMore research on booster programs would help the field

While continuing to engage in this work there will be numerousissues to manage that go well beyond the scope of this article There willbe a need to avoid producing negative labeling effects while providingprogramming for those who are at risk for drug use It is possible thatcessation information needs to be included in the mix with preventionmaterial to provide better targeted-prevention effects There may be aneed to develop a teacher selection instrument to help select out teacherswho can deliver drug abuse prevention programming adequatelyCertainly definition of outcome variables needs continued explorationincluding analysis to ascertain the effects of programming on drug abusevs drug use and identification of the variables that are most closelylinked to change by targeted prevention components

A transdisciplinary approach helps to better understand the lifesituation of high-risk youth as based to some extent on both constitutionaland environmental factors (Fuqua et al 2004 Rutter et al 1997 Wills etal 1996b) From the transactional perspective their situation is in partconstitutional they may have temperamental characteristics that arepartly heritable and that have set the stage at earlier ages for decrements inself-control ability and academic performance that then increase risk for

2002 Sussman et al

ORDER REPRINTS

drug use However their situation is also part environmental based in parton family socialization and in part on the types of peers they have as well asthe type and quality of the physical and cultural environment-at-largeThere are many points at which a potential chain of failures can beinterrupted and the individualrsquos trajectory turned in a better directionProblems are not inevitable from starting level (Tarter and Vanyukov1994) and environmental modifications to support good self-controlability can help to avert an adverse impact from earlier experiences orcurrent difficulties (Brody et al 2002 Novak and Clayton 2001 Patock-Peckham et al 2001 Rutter et al 1997 Wills et al 2002)

The problems and needs of high-risk youth in our nationrsquos highschools demand our attention for designing and rigorously testingtargeted prevention approaches Substantial evidence shows that theseyouth are at greater risk for drug involvement and co-occurring problemssuch as aggression depression and suicidal behaviors as we previouslydiscussed It is hoped that the information presented in this article willstimulate others to join in extending this work including testing othermodels of targeted prevention

GLOSSARY

Universal programs Programs that aim to influence all subjects in acontext

Selective drug-abuse prevention programs Programs that servegroups at greater risk of ATOD usemdashfor example children of alcoholicparents They are at psychosocial risk for drug use and abuse

Indicated drug-abuse prevention programs Programs that attemptto benefit individuals who already show signs of drug involvement orrelated risk factors In indicated prevention programs the primary goal isto stem the progression of ATOD use or reduce drug involvementamong the high-risk youth

Targeted programming Programming that subsumes selective andindicated programming sometimes the other two types of programs thattarget specific groups lsquolsquoat riskrsquorsquo are considered together

ACKNOWLEDGMENTS

This research was supported by grants from the National Institute onDrug Abuse (DA01070 DA07601 DA13814 and DA16094) and by aResearch Scientist Development Award K02 DA00252 from theNational Institute on Drug Abuse

Motivation Skills and Decision Making 2003

ORDER REPRINTS

REFERENCES

Alexander J F Barton C Schiaro R S Parsons B V (1976)

Systems-behavioral intervention with families of delinquents

therapist characteristics family behavior and outcome Journal of

Consulting and Clinical Psychology 44(4)656ndash664Alexander J F Parsons B V (1973) Short-term behavioral interven-

tion with delinquent families impact on family process and

recidivism Journal of Abnormal Psychology 3219ndash225American psychiatric association (APA) (1994) Diagnostic and

Statistical Manual of Mental Disorders 4th edn (DSM-IV)

Washington DC American Psychiatric AssociationAmes S L Sussman S Dent C W (1999) Pro-drug-use myths and

competing constructs in the prediction of substance use among

youth at continuation high schools a one-year prospective study

Personality and Individual Differences 26987ndash1003Bachman S G Wadsworth K N OrsquoMalley P M Johnston L D

Schulenberg J E (1997) Smoking drinking and drug use in young

adulthood Mahwah NJ Lawrence Erlbaum Associates 8ndash25

153ndash190Bandura A (1986) Social Foundations of Thought and Action A Social

Cognitive Theory Englewood Cliffs NJ Prentice HallBarton C Alexander J F Waldron H Turner C W Warburton J

(1985) Generalizing treatment effects of functional family therapy

Three replications The American Journal of Family Therapy

13(3)16ndash26Battin-Pearson S R Newcomb M D Abbott R D Hill K G

Catalano R F Hawkins J D (2000) Predicting early high school

dropout Journal of Educational Psychology 92568ndash582Biglan A Brennan P A Foster S L Holder H D Miller T L

Cunningham P B et al (in press) Helping Adolescents at Risk

Prevention of Multiple Problem Behaviors New York NY Guilford

PressBindra D Stewart J (1996) Motivation Baltimore MD Penguin

BooksBlanton H Gibbons F X Gerrard M Conger K J Smith G E

(1998) The role of family and peers in the development of

prototypes associated with substance use Journal of Family

Psychology 11271ndash288

2004 Sussman et al

ORDER REPRINTS

Botvin G J (1993) School-based drug abuse prevention Long-termfollow-up results In First Annual Meeting of the Society forPrevention Research Kentuck Lexington Society for PreventionResearch

Botvin G J Baker E Dusenbury L Botvin E M Diaz T (1995)Long-term follow-up results of a randomized drug abuse preven-tion trial in a white middle-class population Journal of theAmerican Medical Association 2731106ndash1012

Brody G H Dorsey S Forehand R Armistead L (2002) Uniquecontributions of parenting and classroom processes to the self-control of AfricanndashAmerican children Child Development73274ndash286

Carroll M E (1996) Reducing drug abuse by enriching the environmentwith alternative nondrug reinforcers In Green L Kagel J Heds Advances in Behavioral Economics Norwood NJ NorwoodPublishing Corp 37ndash68

Carver C S Scheier M F (1998) On the Self-Regulation of BehaviorNew York Cambridge University Press

Catalano R F Hawkins J D (1996) The social developmental modela theory of antisocial behavior In Hawkins J D ed Delinquencyand Crime Current Theories New York Cambridge UniversityPress

Centers for Disease Control (CDC) (October 1999) Youth risk BehaviorSurveillancemdashNational Alternative High School Youth RiskBehavior Survey 1998 Morbidity and Mortality Weekly Report48 No SS-7

Chamberlain P (1994) Family connections A treatment foster caremodel for adolescents with delinquency Eugene OR CastaliaPublishing Company

Chamberlain P Reid J B (1998) Comparison of two communityalternatives to incarceration for chronic juvenile offenders Journalof Consulting and Clinical Psychology 66(4)624ndash633

Chassin L A Presson C C Sherman S J (1985) Stepping backwardin order to step forward an acquisition-oriented approach toprimary prevention Journal of Consulting and Clinical Psychology53612ndash622

Chou C-P Montgomery S Pentz M A Rohrbach L A JohnsonC A Flay B R MacKinnon D P (1998) Effects of acommunity-based prevention program on decreasing drug use inhigh-risk adolescentsAmerican Journal of Public Health 88944ndash948

Conducts Problems Prevention Research Group (CPPRG) (1999) Initialimpact of the fast track prevention trial for conduct problems I

Motivation Skills and Decision Making 2005

ORDER REPRINTS

The high-risk sample Journal of Consulting and Clinical Psychology

67631ndash647Conducts Problems Prevention Research Group (CPPRG) (2000)

Merging universal and indicated prevention programs the fast

track model Addictive Behaviors 25913ndash927Council of Philosophical Studies (1981) Psychology and the Philosophy

of Mind in the Philosophy Curriculum San Francisco San Francisco

State UniversityCummings K M Hellmann R Emont S L (1988) Correlates of

participation in a worksite stop smoking program Journal of

Behavioral Medicine 11267ndash277Curry S Wagner E H Gothaus L C (1990) Intrinsic and extrinsic

motivation for smoking cessation Journal of Consulting and

Clinical Psychology 58310ndash316Dent C W Sussman S McCuller W J Stacy A W (2001) Drug

abuse prevention among youth at comprehensive high schools

Preventive Medicine 32514ndash520Dewey J (1886) Psychology New York HarperDishion T J French D C Patterson G R (1995) The development

and ecology of antisocial behavior In Cicchetti D Cohen D

eds Manual of developmental psychopathology New York John

Wiley 421ndash471Eggert L L Herting J R (1991) Preventing teenage drug abuse

exploratory effects of network social support Youth and Society

22482ndash534 [Reprinted National Prevention Evaluation Research

CollectionRockville MD Aspen 1993]Eggert L L Herting J R Thompson E A Nicholas L J Dicker

B G (1994) Preventing adolescent drug abuse and high school

dropout through an intensive school-based social network devel-

opment program American Journal of Health Promotion

8202ndash214Eggert L L Thompson E A Herting J R Nicholas L J (1995)

Reducing suicide potential among high-risk youth tests of a school-

based prevention program Suicide amp Life-Threatening Behavior

25276ndash296Ellickson P L Bell R M (1990) Drug prevention in junior high a

multi-site longitudinal test Science 2471299ndash1305Elliott D S (Series ed) (2003) Blueprints for violence prevention

Boulder CO Institute of Behavioral Science Regents of the

University of Colorado wwwcoloradoeducspvblueprints

2006 Sussman et al

ORDER REPRINTS

Farrell A D Danish S J (1993) Peer drug associations and emotionalrestraint Causes or consequences of adolescent drug use Journal ofConsulting and Clinical Psychology 61327ndash334

Festinger L A (1957) A Theory of Cognitive Dissonance New YorkHarper amp Row

Fuqua J Stokols D Gress J Phillips K Harvey R (2004)Transdisciplinary collaboration as a basis for enhancing the scienceand prevention of substance use and abuse Substance Use ampMisuse

Giuliano J D (1994) A peer education program to promote the use ofconflict resolution skills among at-risk school-age males PublicHealth Reports 109158ndash169

Glynn K Levanthal H Hirschman R (1985) A cognitivedevelopmental approach to smoking prevention In Bell C SBattjes R eds Prevention research Deterring Drug Abuse AmongChildren and Adolescents Rockville MD NIDA ResearchMonograph 63

Glynn T J (1989) Essential elements of school-based smokingprevention programs Journal of School Health 59181ndash188

Goodman R M Burdine J N Meehan E McLeroy K R eds(1993) Community coalitions for health promotion Special issue ofHealth Education Research Theory and Practice 8309ndash453

Goodyear R D Newcomb M D Locke T F (2002) PregnantLatina teenagers psychosocial and developmental determinants ofhow they select and perceive the men who father their childrenJournal of Counseling Psychology 49187ndash201

Gordon R (1987) An operational classification of disease preventionIn Steinberg J A Silverman M M eds Preventing MentalDisorders Rockville MD DHHS 20ndash26

Graham J W Johnson C A Hansen W B Flay B R Gee M(1990) Drug use prevention programs gender and ethnicityevaluation of three seventh-grade project SMART cohortsPreventive Medicine 19305ndash313

Griffin K W Botvin G J Nichols T R Doyal M M (2003)Effectiveness of a universal drug abuse prevention approach foryouth at high risk for substance use initiation Preventive Medicine36(1)1ndash7

Hamilton S (August 20 2000) Views slowly changing on alternativeschools The Sacramento Bee 1ndash3

Hansen W B (1992) School-based substance abuse prevention a reviewof the state of the art in curriculum 1980ndash1990 Health EducationResearch 7403ndash430

Motivation Skills and Decision Making 2007

ORDER REPRINTS

Hansen W B Johnson C A Flay B R Graham J W Sobel J(1988) Affective and social influences approaches to the preventionof multiple substance abuse among seventh grade students resultsfrom project SMART Preventive Medicine 17135ndash154

Hansen W B Graham J W (1991) Preventing alcohol marijuanaand cigarette use among adolescents peer pressure and resistancetraining versus establishing conservative norms PreventiveMedicine 20414ndash430

Hawkins D H Catalano R F Miller J Y (1992) Risk andprotective factors for alcohol and other drug problems inadolescence and early adulthood Implications for substanceabuse prevention Psychological Bulletin 11254ndash105

Hawkins J D Catalano R F Kosterman R Abbott R Hill K G(1999) Preventing adolescent health-risk behaviors by strengthen-ing protection during childhood Archives of Pediatric amp AdolescentMedicine 153226ndash234

Heider F (1958) The Psychology of Interpersonal Relations New YorkWiley

Henggeler S W Pickrel S G Brondino M J Crouch J L (1996)Eliminating (almost) treatment dropout of substance abusing ordependent delinquents through home-based multisystemic therapyAmerican Journal of Psychiatry 153(3)427ndash428

Henggeler S W Melton G B Brondino M J Scherer D GHanley J H (1997) Multisystemic therapy with violent andchronic juvenile offenders and their families the role of treatmentfidelity in successful dissemination Journal of Consulting andClinical Psychology 65(5)821ndash833

Henggeler S W Schoenwald S K Borduin C M Rowland M DCunningham P B (1998) Multisystemic treatment of antisocialbehavior in children and adolescents New York The Guilford Press

Henggeler S W Pickrel S G Brondino M J (1999) Multisystemictreatment of substance-abusing and dependent delinquents out-comes treatment fidelity and transportability Mental HealthServices Residual 1(3)171ndash84

Johnson C A Pentz M A Weber M D Dwyer J H Baer NMacKinnon D P Hansen W B Flay B R (1990) Relativeeffectiveness of comprehensive community programming for drugabuse prevention with high-risk and low-risk adolescents Journalof Consulting and Clinical Psychology 58447ndash456

Kaftarian S J Hansen W B eds (1994) CSAP special issuecommunity partnership program Journal of Community Psychologypages 205

2008 Sussman et al

ORDER REPRINTS

Karoly P (1993) Mechanisms in self-regulation A systems view AnnualReview of Psychology 4423ndash51

Karoly P (1980) Person variables in therapeutic change and develop-ment In Karoly P Steffen J J eds Improving the Long-TermEffects of Psychotherapy New York Gardner Press 195ndash261

Kendall P C Braswell L (1982) Cognitive-behavioral self-controltherapy for children a components analysis Journal of Consultingand Clinical Psychology 50672ndash689

Kerr M Tremblay R E Pagani L Vitaro F (1997) Boysrsquobehavioral inhibition and the risk of later delinquency Archivesof General Psychiatry 54809ndash816

Klein N C Alexander J F Parsons B V (1977) Impact of familysystems intervention on recidivism and sibling delinquency a modelof primary prevention and program evaluation Journal ofConsulting and Clinical Psychology 45(3)469ndash474

Kumpfer K L (1999) Outcomes measures of interventions in the studyof children of substance-abusing parents Pediatrics 1031128ndash1144

Lau R R Hartman K A Ware J E (1986) Health as a valuemethodological and theoretical considerations Health Psychology525ndash43

Lichtenstein E L Glasgow R E (1997) A pragmatic framework forsmoking cessation implications for clinical and public healthprograms Psychology of Addictive Behaviors 11142ndash151

Locke T F Newcomb M D (in press) Childhood maltreatmentparent drug problems polydrug problems and parenting practicesa test of gender differences and four theoretical perspectivesJournal of Family Psychology

McCreary D R Newcomb M D Sadava S W (1999) The male rolealcohol use and alcohol problems a structural modeling examina-tion in adult women and men Journal of Counseling Psychology46109ndash124

McGee L Newcomb M D (1992) General deviance syndromeexpanded hierarchical evaluations at four ages from earlyadolescence to adulthood Journal of Consulting amp ClinicalPsychology 60766ndash776

Miller W R Brown J M (1991) Self-regulation as a conceptual basisfor the prevention of addictive behaviours In Heather N MillerW R Greeley J eds Self-control and the Addictive BehavioursSydney Australia Maxwell Macmillan 3ndash79

Miller W R Leckman A L Delaney H D Tinkcom M (1993)Long-term follow-up of behavioral self-control training forproblem drinkers Journal of Studies on Alcohol 53249ndash261

Motivation Skills and Decision Making 2009

ORDER REPRINTS

Miller W R Rollnick S (1991) Motivational InterviewingPreparing People to Change Addictive Behavior New YorkGuilford Press

Moffitt T E Caspi A Harrington H Milne B J (2002) Males onthe life-course-persistent and adolescence-limited antisocial path-ways follow-up at age 26 years Development and Psychopathology14(1)179ndash207

National Institute on Drug Abuse (NIDA) (1997) Drug abuseprevention What works NIH Publication 97-4110 DHHSNational Institutes of Health National Institute on Drug AbuseOffice of Science Policy and Communications Rockville MD

Newcomb M D (1992a) Substance abuse and control in the UnitedStates ethical and legal issues Social Science and Medicine35471ndash479

Newcomb M D (1992b) Understanding the multidimensional nature ofdrug use and abuse The role of consumption risk factors andprotective factors In Glantz M D Pickens R eds Vulnerabilityto Drug Abuse Washington DC American PsychologicalAssociation 255ndash298

Newcomb M D (1996a) Pseudomaturity among adolescents constructvalidation sex differences and associations in adulthood Journalof Drug Issues 26477ndash504

Newcomb M D (1996b) Adolescence Pathologizing a normal processThe Counseling Psychologist 24482ndash490

Newcomb M D (1997) Psychosocial predictors and consequences ofdrug use a developmental perspective within a prospective studyJournal of Addictive Diseases 1651ndash89

Newcomb M D Bentler P M (1988) Consequences of Adolescent DrugUse Impact on the Lives of Young Adults Beverly Hills CA Sage

Newcomb M D Bentler P M (1989) Substance use and abuse amongchildren and teenagers American Psychologist 44242ndash248

Newcomb M D Harlow L L (1986) Life events and substance useamong adolescents Mediating effects of perceived loss of controland meaninglessness in life Journal of Personality and SocialPsychology 51564ndash577

Newcomb M D Chou C-P Bentler P M Huba G J (1988)Cognitive motivations for drug use among adolescents longitudinaltests of gender differences and predictors of change in drug useJournal of Counseling Psychology 35426ndash438

Newcomb M D Abbott R D Catalano R F Hawkins J DBattin-Pearson S R Hill K (2002) Mediational and deviancetheories of late high school failure Process roles of structural

2010 Sussman et al

ORDER REPRINTS

strains academic competence and general versus specific problem

behaviors Journal of Counseling Psychology 49172ndash186Nezami E Sussman S Pentz M A (2003) Motivation in tobacco use

cessation research Substance Use amp Misuse 3825ndash5Novak S P Clayton R R (2001) The influence of school environment

and self-regulation on transitions between stages of cigarette

smoking Health Psychology 20196ndash207Offord D R (2000) Selection of levels of prevention Addictive

Behaviors 25833ndash842Palinkas L A Atkins C J Miller C Ferreira D (1996) Social skills

training for drug prevention in high-risk female adolescents

Preventive Medicine 25692ndash701Patock-Peckham J A Cheong J-W Balhorn M E Nagoshi C T

(2001) A model of parenting styles self-regulation perceived

drinking control and alcohol use and problems Alcoholism

Experimental and Clinical Research 251284ndash1292Pentz M A (1994) Directions for future research in drug abuse

prevention Preventive Medicine 23646ndash652Pentz M A Dwyer J H MacKinnon D Flay B R Hansen W B

Wang E Y I Johnson C A (1989) A multi-community trial for

primary prevention of adolescent drug abuse effects on drug use

prevalence JAMA 2623259ndash3266Pentz M A Mares D Schinke S Rohrbach L (in press) Political

science public policy and drug abuse prevention Substance Use amp

MisuseProchaska J O DiClemente C C (1982) Transtheoretical therapy

toward a more integrative model of change Psychotherapy Theory

Research and Practice 19275ndash288Pulkkinen L Pitkanen T (1994) A prospective study of the precursors

to problem drinking in young adulthood Journal of Studies on

Alcohol 55578ndash587Rathus S A Nevid J S (1977) Behavior Therapy Strategies for

Solving Problems in Living New York Doubleday and Company

IncResnicow K Botvin G (1993) School-based substance use prevention

programs why do effects decay Preventive Medicine 22484ndash490Rutter M Dunn J Plomin R Simonoff E Pickles A Maughan

B Ormel J Meyer J Eaves L (1997) Integrating nature and

nurture implications of person-environment interactions for

developmental psychopathology Development and Psychopathology

9335ndash364

Motivation Skills and Decision Making 2011

ORDER REPRINTS

Salomon G Stein Y Eisenberg S Klein L (1984) Adolescent

smokers and nonsmokers profiles and their changing structure

Preventive Medicine 13446ndash461Sambrano S (1999) National cross-site evaluation of high risk youth

programs In Interim findings Bulletin Washington DC CSAP

SAMSHA US DHHS May 1ndash16Schinke S P Gilchrist L D (1985) Preventing substance abuse with

children and adolescents Journal of Consulting and Clinical

Psychology 53596ndash602Skara S N Sussman S (2003) A review of 25 long-term adolescent

tobacco and other drug use prevention program evaluations

Preventive MedicineSmith C Lizotte A J Thornberry T P Krohn M D (1995)

Resilient youth identifying factors that prevent high-risk youth

from engaging in delinquency and drug use Delinquency and

Disrepute in the Life Course Greenwich CT John Hagan JAI

press 217ndash247Sommers P V (1972) The Biology of Behavior Australia Pty ltd

Sydney John Wiley amp SonsSt Pierre T L Kaltreider D L Mark M M Aikin K J (1992)

Drug prevention in a community setting a longitudinal study of the

relative effectiveness of a three-year primary prevention program in

boys and girls clubs across the nation American Journal of

Community Psychology 20673ndash706Stein J A Newcomb M D Bentler P M (1987) An eight year study

of multiple influences on drug use and drug use consequences

Journal of Personality and Social Psychology 531094ndash1105Sully J (1884) Outlines of Psychology New York D Appleton amp CoSussman S (1989) Two social influence perspectives of tobacco use

development and prevention Health Education Research Theory

and Practice 4213ndash223Sussman S (1991) Curriculum development in school-based prevention

research Health Education Research Theory and Practice

6339ndash351Sussman S (1996) Development of a school-based drug abuse

prevention curriculum for high risk youth Journal of

Psychoactive Drugs 28169ndash182Sussman S Ames S L (2001) The social psychology of drug abuse

Buckingham GB Open University PressSussman S Unger J (2004) A drug abuse theoretical integration a

transdisciplinary speculation Substance Use amp Misuse

2012 Sussman et al

ORDER REPRINTS

Sussman S Dent C W Burton D Stacy A W Flay B R (1995a)

Developing school-based tobacco use prevention and cessation

programs Thousand Oaks CA Sage Publications IncSussman S Dent C W Simon T R Stacy A W Galaif E R

Moss M A Craig S Johnson C A (1995b) Effectiveness of

social influence substance abuse prevention curricula in compre-

hensive and continuation high schools Drugs and Society 865ndash81Sussman S Dent C W Galaif E R (1997) The correlates of

substance abuse and dependence among adolescents at high risk

for drug abuse Journal of Substance Abuse 9241ndash255Sussman S Dent C W Stacy A W (1996) The relation of pro-drug

use myths with self-reported drug use among youth at continuation

high schools Journal of Applied Social Psychology 26214ndash267Sussman S Dent C W Stacy A Craig S (1998) One-year outcomes

of project towards no drug abuse Preventive Medicine 27632ndash642

(erratum 766)Sussman S Dent C W Stacy S (2002) Project towards no drug

abuse a review of the findings and future directions American

Journal of Health Behavior 26354ndash365Sussman S McCuller W J Dent C W (2003) The associations of

social self-control personality disorders and demographics with

drug use among high risk youth Addictive Behaviors 281159ndash1166Sussman S Rohrbach L Patel R Holiday K (2003) A look at an

interactive classroom-based drug abuse prevention program

Interactive contents and suggestions for research Journal of Drug

Education 33355ndash368Sussman S Sun P McCuller W J Dent C W (2003) Project

towards no drug abuse two year outcomes of a trial that compares

health educator delivery to self-instruction Preventive Medicine

37155ndash162Tarter R E Vanyukov M (1994) Alcoholism a developmental disorder

Journal of Consulting and Clinical Psychology 621096ndash1107Thornton T N Craft C A Dahlberg L L Lynch B S Baer K

(2000) Best Practices of Youth Violence Prevention A Sourcebook

for Community Action Atlanta GA Division of Violence

Prevention Centers for Disease Control and PreventionTobler N S (1986) Meta-analysis of 143 adolescent drug prevention

programs quantitative outcome of program participants compared to

a control or comparison group Journal of Drug Issues 16537ndash567Tobler N S Roona M R Ochshorn P Marshall D G Streke

A V Stackpole K M (2000) School-based adolescent drug

Motivation Skills and Decision Making 2013

ORDER REPRINTS

prevention programs 1998 Meta-analysis The Journal of Primary

Prevention 20275ndash336US Department of Health and Human Services (USDHHS) (2003)

Substance Abuse andMental Health Services Administration Center

for Substance Abuse Prevention Science-based prevention programs and

principles 2002 Rockville MD US DHHS (SMA)03-3764 Also

see httpmodelprogramssamhsagovUnger J Baezconde-Garbanati L Shakib S Palmer P H Nezami

E Mora J (2004) What are the implications of structuralcultural

theory for drug abuse prevention Substance Use amp MisuseUpshaw H S Ostrom T M (1984) Psychological perspective in

attitude research In Eiser J R ed Attitudinal Judgment New

York Springer-Verlag 23ndash42Valente T W Gallaher P Mouttapa M (2004) Using social network

theory to understand and prevent substance use a transdisciplinary

perspective Substance Use amp MisuseVorrath H Brendtro L (1985) Positive peer culture 2nd edn Aldine

ChicagoWaldron H B Slesnick N Brody J L Turner C W Peterson T R

(2001) Treatment outcomes for adolescent substance abuse at 4-

and 7-month assessments Journal of Consulting amp Clinical

Psychology 69(5)802ndash813Watson D L Tharp R G (2002) Self-directed behavior Self-

modification for personal adjustment 8th edn Belmont CA

WadsworthWeissberg R P Caplan M Z Sivo P J (1989) A new conceptual

framework for establishing school-based social competence promo-

tion programs In Bond L A Compas B E eds Primary

Prevention amp Promotion in the Schools Newbury Park CA Sage

255ndash296Wills T A (1986) Stress and coping in early adolescence relationships

to substance use in urban school samples Health Psychology

5503ndash529Wills T A Cleary S D (1995) Stress-coping model for alcohol-

tobacco interactions in adolescence In Fertig J B Allen J P

eds Alcohol and Tobacco From Basic Science to Clinical Practice

Bethesda MD National Institute on Alcohol Abuse and

Alcoholism 107ndash128Wills T A Cleary S D (1999) Peer and adolescent substance use

among 6thndash9th graders Latent growth analyses of influence versus

selection mechanisms Health Psychology 18453ndash463

2014 Sussman et al

ORDER REPRINTS

Wills T A Hirky A E (1996) Coping and substance abuse InZeidner M Endler N S eds Handbook of Coping TheoryResearch and Applications New York Wiley 279ndash302

Wills T A Stoolmiller M (2002) The role of self-control in earlyescalation of substance use a time-varying analysis Journal ofConsulting and Clinical Psychology 70986ndash997

Wills T A Baker E Botvin G J (1989) Dimensions of assertivenessdifferential relationships to substance use in early adolescenceJournal of Consulting and Clinical Psychology 57(4)473ndash478

Wills T A Vaccaro D McNamara G (1994) Novelty seeking risktaking and related constructs as predictors of adolescent substanceuse an application of Cloningerrsquos theory Journal of SubstanceAbuse 61ndash20

Wills T A McNamara G Vaccaro D Hirky A E (1996a)Escalated substance use a longitudinal grouping analysis fromearly to middle adolescence Journal of Abnormal Psychology105166ndash180

Wills T A Pierce J P Evans R I (1996b) Large-scale environmentalrisk factors for substance use American Behavioral Scientist39808ndash822

Wills T A Windle M Cleary S D (1998) Role of temperamentnovelty-seeking and self-control in adolescent substance useJournal of Personality and Social Psychology 74387ndash406

Wills T A Sandy J M Shinar O (1999) Substance use level andproblems in late adolescence a mediational model based on self-control and coping motives Experimental and ClinicalPsychopharmacology 7122ndash134

Wills T A Cleary S D Filer M Shinar O Mariani J Spera K(2001) Temperament and self-control related to early-onsetsubstance use test of a developmental model Prevention Science2145ndash163

Wills T A Sandy J M Yaeger A (2002) Moderators of therelationship between substance use level and problems test of aself-regulation model in adolescence Journal of AbnormalPsychology 1113ndash21

Wills T A Gibbons F X Gerrard M Murry V Brody G (in press-a) Family communication and religiosity related to substance useand sexual behavior in early adolescence Psychology of AddictiveBehaviors

Wills T A Resko J Ainette M Mendoza D (in press-b) The role ofparent and peer support in adolescent substance use a test ofmediated effects Psychology of Addictive Behaviors

Motivation Skills and Decision Making 2015

ORDER REPRINTS

Young P T (1936) Motivation of Behavior New York John Wiley andSons

Zimmerman B J (2000) Attaining self-regulation a social cognitivemodel In Boekaerts M Pintrich P R eds Handbook of Self-Regulation San Diego Academic Press 13ndash39

2016 Sussman et al

Request PermissionOrder Reprints

Reprints of this article can also be ordered at

httpwwwdekkercomservletproductDOI101081JA200034769

Request Permission or Order Reprints Instantly

Interested in copying and sharing this article In most cases US Copyright Law requires that you get permission from the articlersquos rightsholder before using copyrighted content

All information and materials found in this article including but not limited to text trademarks patents logos graphics and images (the Materials) are the copyrighted works and other forms of intellectual property of Marcel Dekker Inc or its licensors All rights not expressly granted are reserved

Get permission to lawfully reproduce and distribute the Materials or order reprints quickly and painlessly Simply click on the Request Permission Order Reprints link below and follow the instructions Visit the US Copyright Office for information on Fair Use limitations of US copyright law Please refer to The Association of American Publishersrsquo (AAP) website for guidelines on Fair Use in the Classroom

The Materials are for your personal use only and cannot be reformatted reposted resold or distributed by electronic means or otherwise without permission from Marcel Dekker Inc Marcel Dekker Inc grants you the limited right to display the Materials only on your personal computer or personal wireless device and to copy and download single copies of such Materials provided that any copyright trademark or other notice appearing on such Materials is also retained by displayed copied or downloaded as part of the Materials and is not removed or obscured and provided you do not edit modify alter or enhance the Materials Please refer to our Website User Agreement for more details

ORDER REPRINTS

drug use However their situation is also part environmental based in parton family socialization and in part on the types of peers they have as well asthe type and quality of the physical and cultural environment-at-largeThere are many points at which a potential chain of failures can beinterrupted and the individualrsquos trajectory turned in a better directionProblems are not inevitable from starting level (Tarter and Vanyukov1994) and environmental modifications to support good self-controlability can help to avert an adverse impact from earlier experiences orcurrent difficulties (Brody et al 2002 Novak and Clayton 2001 Patock-Peckham et al 2001 Rutter et al 1997 Wills et al 2002)

The problems and needs of high-risk youth in our nationrsquos highschools demand our attention for designing and rigorously testingtargeted prevention approaches Substantial evidence shows that theseyouth are at greater risk for drug involvement and co-occurring problemssuch as aggression depression and suicidal behaviors as we previouslydiscussed It is hoped that the information presented in this article willstimulate others to join in extending this work including testing othermodels of targeted prevention

GLOSSARY

Universal programs Programs that aim to influence all subjects in acontext

Selective drug-abuse prevention programs Programs that servegroups at greater risk of ATOD usemdashfor example children of alcoholicparents They are at psychosocial risk for drug use and abuse

Indicated drug-abuse prevention programs Programs that attemptto benefit individuals who already show signs of drug involvement orrelated risk factors In indicated prevention programs the primary goal isto stem the progression of ATOD use or reduce drug involvementamong the high-risk youth

Targeted programming Programming that subsumes selective andindicated programming sometimes the other two types of programs thattarget specific groups lsquolsquoat riskrsquorsquo are considered together

ACKNOWLEDGMENTS

This research was supported by grants from the National Institute onDrug Abuse (DA01070 DA07601 DA13814 and DA16094) and by aResearch Scientist Development Award K02 DA00252 from theNational Institute on Drug Abuse

Motivation Skills and Decision Making 2003

ORDER REPRINTS

REFERENCES

Alexander J F Barton C Schiaro R S Parsons B V (1976)

Systems-behavioral intervention with families of delinquents

therapist characteristics family behavior and outcome Journal of

Consulting and Clinical Psychology 44(4)656ndash664Alexander J F Parsons B V (1973) Short-term behavioral interven-

tion with delinquent families impact on family process and

recidivism Journal of Abnormal Psychology 3219ndash225American psychiatric association (APA) (1994) Diagnostic and

Statistical Manual of Mental Disorders 4th edn (DSM-IV)

Washington DC American Psychiatric AssociationAmes S L Sussman S Dent C W (1999) Pro-drug-use myths and

competing constructs in the prediction of substance use among

youth at continuation high schools a one-year prospective study

Personality and Individual Differences 26987ndash1003Bachman S G Wadsworth K N OrsquoMalley P M Johnston L D

Schulenberg J E (1997) Smoking drinking and drug use in young

adulthood Mahwah NJ Lawrence Erlbaum Associates 8ndash25

153ndash190Bandura A (1986) Social Foundations of Thought and Action A Social

Cognitive Theory Englewood Cliffs NJ Prentice HallBarton C Alexander J F Waldron H Turner C W Warburton J

(1985) Generalizing treatment effects of functional family therapy

Three replications The American Journal of Family Therapy

13(3)16ndash26Battin-Pearson S R Newcomb M D Abbott R D Hill K G

Catalano R F Hawkins J D (2000) Predicting early high school

dropout Journal of Educational Psychology 92568ndash582Biglan A Brennan P A Foster S L Holder H D Miller T L

Cunningham P B et al (in press) Helping Adolescents at Risk

Prevention of Multiple Problem Behaviors New York NY Guilford

PressBindra D Stewart J (1996) Motivation Baltimore MD Penguin

BooksBlanton H Gibbons F X Gerrard M Conger K J Smith G E

(1998) The role of family and peers in the development of

prototypes associated with substance use Journal of Family

Psychology 11271ndash288

2004 Sussman et al

ORDER REPRINTS

Botvin G J (1993) School-based drug abuse prevention Long-termfollow-up results In First Annual Meeting of the Society forPrevention Research Kentuck Lexington Society for PreventionResearch

Botvin G J Baker E Dusenbury L Botvin E M Diaz T (1995)Long-term follow-up results of a randomized drug abuse preven-tion trial in a white middle-class population Journal of theAmerican Medical Association 2731106ndash1012

Brody G H Dorsey S Forehand R Armistead L (2002) Uniquecontributions of parenting and classroom processes to the self-control of AfricanndashAmerican children Child Development73274ndash286

Carroll M E (1996) Reducing drug abuse by enriching the environmentwith alternative nondrug reinforcers In Green L Kagel J Heds Advances in Behavioral Economics Norwood NJ NorwoodPublishing Corp 37ndash68

Carver C S Scheier M F (1998) On the Self-Regulation of BehaviorNew York Cambridge University Press

Catalano R F Hawkins J D (1996) The social developmental modela theory of antisocial behavior In Hawkins J D ed Delinquencyand Crime Current Theories New York Cambridge UniversityPress

Centers for Disease Control (CDC) (October 1999) Youth risk BehaviorSurveillancemdashNational Alternative High School Youth RiskBehavior Survey 1998 Morbidity and Mortality Weekly Report48 No SS-7

Chamberlain P (1994) Family connections A treatment foster caremodel for adolescents with delinquency Eugene OR CastaliaPublishing Company

Chamberlain P Reid J B (1998) Comparison of two communityalternatives to incarceration for chronic juvenile offenders Journalof Consulting and Clinical Psychology 66(4)624ndash633

Chassin L A Presson C C Sherman S J (1985) Stepping backwardin order to step forward an acquisition-oriented approach toprimary prevention Journal of Consulting and Clinical Psychology53612ndash622

Chou C-P Montgomery S Pentz M A Rohrbach L A JohnsonC A Flay B R MacKinnon D P (1998) Effects of acommunity-based prevention program on decreasing drug use inhigh-risk adolescentsAmerican Journal of Public Health 88944ndash948

Conducts Problems Prevention Research Group (CPPRG) (1999) Initialimpact of the fast track prevention trial for conduct problems I

Motivation Skills and Decision Making 2005

ORDER REPRINTS

The high-risk sample Journal of Consulting and Clinical Psychology

67631ndash647Conducts Problems Prevention Research Group (CPPRG) (2000)

Merging universal and indicated prevention programs the fast

track model Addictive Behaviors 25913ndash927Council of Philosophical Studies (1981) Psychology and the Philosophy

of Mind in the Philosophy Curriculum San Francisco San Francisco

State UniversityCummings K M Hellmann R Emont S L (1988) Correlates of

participation in a worksite stop smoking program Journal of

Behavioral Medicine 11267ndash277Curry S Wagner E H Gothaus L C (1990) Intrinsic and extrinsic

motivation for smoking cessation Journal of Consulting and

Clinical Psychology 58310ndash316Dent C W Sussman S McCuller W J Stacy A W (2001) Drug

abuse prevention among youth at comprehensive high schools

Preventive Medicine 32514ndash520Dewey J (1886) Psychology New York HarperDishion T J French D C Patterson G R (1995) The development

and ecology of antisocial behavior In Cicchetti D Cohen D

eds Manual of developmental psychopathology New York John

Wiley 421ndash471Eggert L L Herting J R (1991) Preventing teenage drug abuse

exploratory effects of network social support Youth and Society

22482ndash534 [Reprinted National Prevention Evaluation Research

CollectionRockville MD Aspen 1993]Eggert L L Herting J R Thompson E A Nicholas L J Dicker

B G (1994) Preventing adolescent drug abuse and high school

dropout through an intensive school-based social network devel-

opment program American Journal of Health Promotion

8202ndash214Eggert L L Thompson E A Herting J R Nicholas L J (1995)

Reducing suicide potential among high-risk youth tests of a school-

based prevention program Suicide amp Life-Threatening Behavior

25276ndash296Ellickson P L Bell R M (1990) Drug prevention in junior high a

multi-site longitudinal test Science 2471299ndash1305Elliott D S (Series ed) (2003) Blueprints for violence prevention

Boulder CO Institute of Behavioral Science Regents of the

University of Colorado wwwcoloradoeducspvblueprints

2006 Sussman et al

ORDER REPRINTS

Farrell A D Danish S J (1993) Peer drug associations and emotionalrestraint Causes or consequences of adolescent drug use Journal ofConsulting and Clinical Psychology 61327ndash334

Festinger L A (1957) A Theory of Cognitive Dissonance New YorkHarper amp Row

Fuqua J Stokols D Gress J Phillips K Harvey R (2004)Transdisciplinary collaboration as a basis for enhancing the scienceand prevention of substance use and abuse Substance Use ampMisuse

Giuliano J D (1994) A peer education program to promote the use ofconflict resolution skills among at-risk school-age males PublicHealth Reports 109158ndash169

Glynn K Levanthal H Hirschman R (1985) A cognitivedevelopmental approach to smoking prevention In Bell C SBattjes R eds Prevention research Deterring Drug Abuse AmongChildren and Adolescents Rockville MD NIDA ResearchMonograph 63

Glynn T J (1989) Essential elements of school-based smokingprevention programs Journal of School Health 59181ndash188

Goodman R M Burdine J N Meehan E McLeroy K R eds(1993) Community coalitions for health promotion Special issue ofHealth Education Research Theory and Practice 8309ndash453

Goodyear R D Newcomb M D Locke T F (2002) PregnantLatina teenagers psychosocial and developmental determinants ofhow they select and perceive the men who father their childrenJournal of Counseling Psychology 49187ndash201

Gordon R (1987) An operational classification of disease preventionIn Steinberg J A Silverman M M eds Preventing MentalDisorders Rockville MD DHHS 20ndash26

Graham J W Johnson C A Hansen W B Flay B R Gee M(1990) Drug use prevention programs gender and ethnicityevaluation of three seventh-grade project SMART cohortsPreventive Medicine 19305ndash313

Griffin K W Botvin G J Nichols T R Doyal M M (2003)Effectiveness of a universal drug abuse prevention approach foryouth at high risk for substance use initiation Preventive Medicine36(1)1ndash7

Hamilton S (August 20 2000) Views slowly changing on alternativeschools The Sacramento Bee 1ndash3

Hansen W B (1992) School-based substance abuse prevention a reviewof the state of the art in curriculum 1980ndash1990 Health EducationResearch 7403ndash430

Motivation Skills and Decision Making 2007

ORDER REPRINTS

Hansen W B Johnson C A Flay B R Graham J W Sobel J(1988) Affective and social influences approaches to the preventionof multiple substance abuse among seventh grade students resultsfrom project SMART Preventive Medicine 17135ndash154

Hansen W B Graham J W (1991) Preventing alcohol marijuanaand cigarette use among adolescents peer pressure and resistancetraining versus establishing conservative norms PreventiveMedicine 20414ndash430

Hawkins D H Catalano R F Miller J Y (1992) Risk andprotective factors for alcohol and other drug problems inadolescence and early adulthood Implications for substanceabuse prevention Psychological Bulletin 11254ndash105

Hawkins J D Catalano R F Kosterman R Abbott R Hill K G(1999) Preventing adolescent health-risk behaviors by strengthen-ing protection during childhood Archives of Pediatric amp AdolescentMedicine 153226ndash234

Heider F (1958) The Psychology of Interpersonal Relations New YorkWiley

Henggeler S W Pickrel S G Brondino M J Crouch J L (1996)Eliminating (almost) treatment dropout of substance abusing ordependent delinquents through home-based multisystemic therapyAmerican Journal of Psychiatry 153(3)427ndash428

Henggeler S W Melton G B Brondino M J Scherer D GHanley J H (1997) Multisystemic therapy with violent andchronic juvenile offenders and their families the role of treatmentfidelity in successful dissemination Journal of Consulting andClinical Psychology 65(5)821ndash833

Henggeler S W Schoenwald S K Borduin C M Rowland M DCunningham P B (1998) Multisystemic treatment of antisocialbehavior in children and adolescents New York The Guilford Press

Henggeler S W Pickrel S G Brondino M J (1999) Multisystemictreatment of substance-abusing and dependent delinquents out-comes treatment fidelity and transportability Mental HealthServices Residual 1(3)171ndash84

Johnson C A Pentz M A Weber M D Dwyer J H Baer NMacKinnon D P Hansen W B Flay B R (1990) Relativeeffectiveness of comprehensive community programming for drugabuse prevention with high-risk and low-risk adolescents Journalof Consulting and Clinical Psychology 58447ndash456

Kaftarian S J Hansen W B eds (1994) CSAP special issuecommunity partnership program Journal of Community Psychologypages 205

2008 Sussman et al

ORDER REPRINTS

Karoly P (1993) Mechanisms in self-regulation A systems view AnnualReview of Psychology 4423ndash51

Karoly P (1980) Person variables in therapeutic change and develop-ment In Karoly P Steffen J J eds Improving the Long-TermEffects of Psychotherapy New York Gardner Press 195ndash261

Kendall P C Braswell L (1982) Cognitive-behavioral self-controltherapy for children a components analysis Journal of Consultingand Clinical Psychology 50672ndash689

Kerr M Tremblay R E Pagani L Vitaro F (1997) Boysrsquobehavioral inhibition and the risk of later delinquency Archivesof General Psychiatry 54809ndash816

Klein N C Alexander J F Parsons B V (1977) Impact of familysystems intervention on recidivism and sibling delinquency a modelof primary prevention and program evaluation Journal ofConsulting and Clinical Psychology 45(3)469ndash474

Kumpfer K L (1999) Outcomes measures of interventions in the studyof children of substance-abusing parents Pediatrics 1031128ndash1144

Lau R R Hartman K A Ware J E (1986) Health as a valuemethodological and theoretical considerations Health Psychology525ndash43

Lichtenstein E L Glasgow R E (1997) A pragmatic framework forsmoking cessation implications for clinical and public healthprograms Psychology of Addictive Behaviors 11142ndash151

Locke T F Newcomb M D (in press) Childhood maltreatmentparent drug problems polydrug problems and parenting practicesa test of gender differences and four theoretical perspectivesJournal of Family Psychology

McCreary D R Newcomb M D Sadava S W (1999) The male rolealcohol use and alcohol problems a structural modeling examina-tion in adult women and men Journal of Counseling Psychology46109ndash124

McGee L Newcomb M D (1992) General deviance syndromeexpanded hierarchical evaluations at four ages from earlyadolescence to adulthood Journal of Consulting amp ClinicalPsychology 60766ndash776

Miller W R Brown J M (1991) Self-regulation as a conceptual basisfor the prevention of addictive behaviours In Heather N MillerW R Greeley J eds Self-control and the Addictive BehavioursSydney Australia Maxwell Macmillan 3ndash79

Miller W R Leckman A L Delaney H D Tinkcom M (1993)Long-term follow-up of behavioral self-control training forproblem drinkers Journal of Studies on Alcohol 53249ndash261

Motivation Skills and Decision Making 2009

ORDER REPRINTS

Miller W R Rollnick S (1991) Motivational InterviewingPreparing People to Change Addictive Behavior New YorkGuilford Press

Moffitt T E Caspi A Harrington H Milne B J (2002) Males onthe life-course-persistent and adolescence-limited antisocial path-ways follow-up at age 26 years Development and Psychopathology14(1)179ndash207

National Institute on Drug Abuse (NIDA) (1997) Drug abuseprevention What works NIH Publication 97-4110 DHHSNational Institutes of Health National Institute on Drug AbuseOffice of Science Policy and Communications Rockville MD

Newcomb M D (1992a) Substance abuse and control in the UnitedStates ethical and legal issues Social Science and Medicine35471ndash479

Newcomb M D (1992b) Understanding the multidimensional nature ofdrug use and abuse The role of consumption risk factors andprotective factors In Glantz M D Pickens R eds Vulnerabilityto Drug Abuse Washington DC American PsychologicalAssociation 255ndash298

Newcomb M D (1996a) Pseudomaturity among adolescents constructvalidation sex differences and associations in adulthood Journalof Drug Issues 26477ndash504

Newcomb M D (1996b) Adolescence Pathologizing a normal processThe Counseling Psychologist 24482ndash490

Newcomb M D (1997) Psychosocial predictors and consequences ofdrug use a developmental perspective within a prospective studyJournal of Addictive Diseases 1651ndash89

Newcomb M D Bentler P M (1988) Consequences of Adolescent DrugUse Impact on the Lives of Young Adults Beverly Hills CA Sage

Newcomb M D Bentler P M (1989) Substance use and abuse amongchildren and teenagers American Psychologist 44242ndash248

Newcomb M D Harlow L L (1986) Life events and substance useamong adolescents Mediating effects of perceived loss of controland meaninglessness in life Journal of Personality and SocialPsychology 51564ndash577

Newcomb M D Chou C-P Bentler P M Huba G J (1988)Cognitive motivations for drug use among adolescents longitudinaltests of gender differences and predictors of change in drug useJournal of Counseling Psychology 35426ndash438

Newcomb M D Abbott R D Catalano R F Hawkins J DBattin-Pearson S R Hill K (2002) Mediational and deviancetheories of late high school failure Process roles of structural

2010 Sussman et al

ORDER REPRINTS

strains academic competence and general versus specific problem

behaviors Journal of Counseling Psychology 49172ndash186Nezami E Sussman S Pentz M A (2003) Motivation in tobacco use

cessation research Substance Use amp Misuse 3825ndash5Novak S P Clayton R R (2001) The influence of school environment

and self-regulation on transitions between stages of cigarette

smoking Health Psychology 20196ndash207Offord D R (2000) Selection of levels of prevention Addictive

Behaviors 25833ndash842Palinkas L A Atkins C J Miller C Ferreira D (1996) Social skills

training for drug prevention in high-risk female adolescents

Preventive Medicine 25692ndash701Patock-Peckham J A Cheong J-W Balhorn M E Nagoshi C T

(2001) A model of parenting styles self-regulation perceived

drinking control and alcohol use and problems Alcoholism

Experimental and Clinical Research 251284ndash1292Pentz M A (1994) Directions for future research in drug abuse

prevention Preventive Medicine 23646ndash652Pentz M A Dwyer J H MacKinnon D Flay B R Hansen W B

Wang E Y I Johnson C A (1989) A multi-community trial for

primary prevention of adolescent drug abuse effects on drug use

prevalence JAMA 2623259ndash3266Pentz M A Mares D Schinke S Rohrbach L (in press) Political

science public policy and drug abuse prevention Substance Use amp

MisuseProchaska J O DiClemente C C (1982) Transtheoretical therapy

toward a more integrative model of change Psychotherapy Theory

Research and Practice 19275ndash288Pulkkinen L Pitkanen T (1994) A prospective study of the precursors

to problem drinking in young adulthood Journal of Studies on

Alcohol 55578ndash587Rathus S A Nevid J S (1977) Behavior Therapy Strategies for

Solving Problems in Living New York Doubleday and Company

IncResnicow K Botvin G (1993) School-based substance use prevention

programs why do effects decay Preventive Medicine 22484ndash490Rutter M Dunn J Plomin R Simonoff E Pickles A Maughan

B Ormel J Meyer J Eaves L (1997) Integrating nature and

nurture implications of person-environment interactions for

developmental psychopathology Development and Psychopathology

9335ndash364

Motivation Skills and Decision Making 2011

ORDER REPRINTS

Salomon G Stein Y Eisenberg S Klein L (1984) Adolescent

smokers and nonsmokers profiles and their changing structure

Preventive Medicine 13446ndash461Sambrano S (1999) National cross-site evaluation of high risk youth

programs In Interim findings Bulletin Washington DC CSAP

SAMSHA US DHHS May 1ndash16Schinke S P Gilchrist L D (1985) Preventing substance abuse with

children and adolescents Journal of Consulting and Clinical

Psychology 53596ndash602Skara S N Sussman S (2003) A review of 25 long-term adolescent

tobacco and other drug use prevention program evaluations

Preventive MedicineSmith C Lizotte A J Thornberry T P Krohn M D (1995)

Resilient youth identifying factors that prevent high-risk youth

from engaging in delinquency and drug use Delinquency and

Disrepute in the Life Course Greenwich CT John Hagan JAI

press 217ndash247Sommers P V (1972) The Biology of Behavior Australia Pty ltd

Sydney John Wiley amp SonsSt Pierre T L Kaltreider D L Mark M M Aikin K J (1992)

Drug prevention in a community setting a longitudinal study of the

relative effectiveness of a three-year primary prevention program in

boys and girls clubs across the nation American Journal of

Community Psychology 20673ndash706Stein J A Newcomb M D Bentler P M (1987) An eight year study

of multiple influences on drug use and drug use consequences

Journal of Personality and Social Psychology 531094ndash1105Sully J (1884) Outlines of Psychology New York D Appleton amp CoSussman S (1989) Two social influence perspectives of tobacco use

development and prevention Health Education Research Theory

and Practice 4213ndash223Sussman S (1991) Curriculum development in school-based prevention

research Health Education Research Theory and Practice

6339ndash351Sussman S (1996) Development of a school-based drug abuse

prevention curriculum for high risk youth Journal of

Psychoactive Drugs 28169ndash182Sussman S Ames S L (2001) The social psychology of drug abuse

Buckingham GB Open University PressSussman S Unger J (2004) A drug abuse theoretical integration a

transdisciplinary speculation Substance Use amp Misuse

2012 Sussman et al

ORDER REPRINTS

Sussman S Dent C W Burton D Stacy A W Flay B R (1995a)

Developing school-based tobacco use prevention and cessation

programs Thousand Oaks CA Sage Publications IncSussman S Dent C W Simon T R Stacy A W Galaif E R

Moss M A Craig S Johnson C A (1995b) Effectiveness of

social influence substance abuse prevention curricula in compre-

hensive and continuation high schools Drugs and Society 865ndash81Sussman S Dent C W Galaif E R (1997) The correlates of

substance abuse and dependence among adolescents at high risk

for drug abuse Journal of Substance Abuse 9241ndash255Sussman S Dent C W Stacy A W (1996) The relation of pro-drug

use myths with self-reported drug use among youth at continuation

high schools Journal of Applied Social Psychology 26214ndash267Sussman S Dent C W Stacy A Craig S (1998) One-year outcomes

of project towards no drug abuse Preventive Medicine 27632ndash642

(erratum 766)Sussman S Dent C W Stacy S (2002) Project towards no drug

abuse a review of the findings and future directions American

Journal of Health Behavior 26354ndash365Sussman S McCuller W J Dent C W (2003) The associations of

social self-control personality disorders and demographics with

drug use among high risk youth Addictive Behaviors 281159ndash1166Sussman S Rohrbach L Patel R Holiday K (2003) A look at an

interactive classroom-based drug abuse prevention program

Interactive contents and suggestions for research Journal of Drug

Education 33355ndash368Sussman S Sun P McCuller W J Dent C W (2003) Project

towards no drug abuse two year outcomes of a trial that compares

health educator delivery to self-instruction Preventive Medicine

37155ndash162Tarter R E Vanyukov M (1994) Alcoholism a developmental disorder

Journal of Consulting and Clinical Psychology 621096ndash1107Thornton T N Craft C A Dahlberg L L Lynch B S Baer K

(2000) Best Practices of Youth Violence Prevention A Sourcebook

for Community Action Atlanta GA Division of Violence

Prevention Centers for Disease Control and PreventionTobler N S (1986) Meta-analysis of 143 adolescent drug prevention

programs quantitative outcome of program participants compared to

a control or comparison group Journal of Drug Issues 16537ndash567Tobler N S Roona M R Ochshorn P Marshall D G Streke

A V Stackpole K M (2000) School-based adolescent drug

Motivation Skills and Decision Making 2013

ORDER REPRINTS

prevention programs 1998 Meta-analysis The Journal of Primary

Prevention 20275ndash336US Department of Health and Human Services (USDHHS) (2003)

Substance Abuse andMental Health Services Administration Center

for Substance Abuse Prevention Science-based prevention programs and

principles 2002 Rockville MD US DHHS (SMA)03-3764 Also

see httpmodelprogramssamhsagovUnger J Baezconde-Garbanati L Shakib S Palmer P H Nezami

E Mora J (2004) What are the implications of structuralcultural

theory for drug abuse prevention Substance Use amp MisuseUpshaw H S Ostrom T M (1984) Psychological perspective in

attitude research In Eiser J R ed Attitudinal Judgment New

York Springer-Verlag 23ndash42Valente T W Gallaher P Mouttapa M (2004) Using social network

theory to understand and prevent substance use a transdisciplinary

perspective Substance Use amp MisuseVorrath H Brendtro L (1985) Positive peer culture 2nd edn Aldine

ChicagoWaldron H B Slesnick N Brody J L Turner C W Peterson T R

(2001) Treatment outcomes for adolescent substance abuse at 4-

and 7-month assessments Journal of Consulting amp Clinical

Psychology 69(5)802ndash813Watson D L Tharp R G (2002) Self-directed behavior Self-

modification for personal adjustment 8th edn Belmont CA

WadsworthWeissberg R P Caplan M Z Sivo P J (1989) A new conceptual

framework for establishing school-based social competence promo-

tion programs In Bond L A Compas B E eds Primary

Prevention amp Promotion in the Schools Newbury Park CA Sage

255ndash296Wills T A (1986) Stress and coping in early adolescence relationships

to substance use in urban school samples Health Psychology

5503ndash529Wills T A Cleary S D (1995) Stress-coping model for alcohol-

tobacco interactions in adolescence In Fertig J B Allen J P

eds Alcohol and Tobacco From Basic Science to Clinical Practice

Bethesda MD National Institute on Alcohol Abuse and

Alcoholism 107ndash128Wills T A Cleary S D (1999) Peer and adolescent substance use

among 6thndash9th graders Latent growth analyses of influence versus

selection mechanisms Health Psychology 18453ndash463

2014 Sussman et al

ORDER REPRINTS

Wills T A Hirky A E (1996) Coping and substance abuse InZeidner M Endler N S eds Handbook of Coping TheoryResearch and Applications New York Wiley 279ndash302

Wills T A Stoolmiller M (2002) The role of self-control in earlyescalation of substance use a time-varying analysis Journal ofConsulting and Clinical Psychology 70986ndash997

Wills T A Baker E Botvin G J (1989) Dimensions of assertivenessdifferential relationships to substance use in early adolescenceJournal of Consulting and Clinical Psychology 57(4)473ndash478

Wills T A Vaccaro D McNamara G (1994) Novelty seeking risktaking and related constructs as predictors of adolescent substanceuse an application of Cloningerrsquos theory Journal of SubstanceAbuse 61ndash20

Wills T A McNamara G Vaccaro D Hirky A E (1996a)Escalated substance use a longitudinal grouping analysis fromearly to middle adolescence Journal of Abnormal Psychology105166ndash180

Wills T A Pierce J P Evans R I (1996b) Large-scale environmentalrisk factors for substance use American Behavioral Scientist39808ndash822

Wills T A Windle M Cleary S D (1998) Role of temperamentnovelty-seeking and self-control in adolescent substance useJournal of Personality and Social Psychology 74387ndash406

Wills T A Sandy J M Shinar O (1999) Substance use level andproblems in late adolescence a mediational model based on self-control and coping motives Experimental and ClinicalPsychopharmacology 7122ndash134

Wills T A Cleary S D Filer M Shinar O Mariani J Spera K(2001) Temperament and self-control related to early-onsetsubstance use test of a developmental model Prevention Science2145ndash163

Wills T A Sandy J M Yaeger A (2002) Moderators of therelationship between substance use level and problems test of aself-regulation model in adolescence Journal of AbnormalPsychology 1113ndash21

Wills T A Gibbons F X Gerrard M Murry V Brody G (in press-a) Family communication and religiosity related to substance useand sexual behavior in early adolescence Psychology of AddictiveBehaviors

Wills T A Resko J Ainette M Mendoza D (in press-b) The role ofparent and peer support in adolescent substance use a test ofmediated effects Psychology of Addictive Behaviors

Motivation Skills and Decision Making 2015

ORDER REPRINTS

Young P T (1936) Motivation of Behavior New York John Wiley andSons

Zimmerman B J (2000) Attaining self-regulation a social cognitivemodel In Boekaerts M Pintrich P R eds Handbook of Self-Regulation San Diego Academic Press 13ndash39

2016 Sussman et al

Request PermissionOrder Reprints

Reprints of this article can also be ordered at

httpwwwdekkercomservletproductDOI101081JA200034769

Request Permission or Order Reprints Instantly

Interested in copying and sharing this article In most cases US Copyright Law requires that you get permission from the articlersquos rightsholder before using copyrighted content

All information and materials found in this article including but not limited to text trademarks patents logos graphics and images (the Materials) are the copyrighted works and other forms of intellectual property of Marcel Dekker Inc or its licensors All rights not expressly granted are reserved

Get permission to lawfully reproduce and distribute the Materials or order reprints quickly and painlessly Simply click on the Request Permission Order Reprints link below and follow the instructions Visit the US Copyright Office for information on Fair Use limitations of US copyright law Please refer to The Association of American Publishersrsquo (AAP) website for guidelines on Fair Use in the Classroom

The Materials are for your personal use only and cannot be reformatted reposted resold or distributed by electronic means or otherwise without permission from Marcel Dekker Inc Marcel Dekker Inc grants you the limited right to display the Materials only on your personal computer or personal wireless device and to copy and download single copies of such Materials provided that any copyright trademark or other notice appearing on such Materials is also retained by displayed copied or downloaded as part of the Materials and is not removed or obscured and provided you do not edit modify alter or enhance the Materials Please refer to our Website User Agreement for more details

ORDER REPRINTS

REFERENCES

Alexander J F Barton C Schiaro R S Parsons B V (1976)

Systems-behavioral intervention with families of delinquents

therapist characteristics family behavior and outcome Journal of

Consulting and Clinical Psychology 44(4)656ndash664Alexander J F Parsons B V (1973) Short-term behavioral interven-

tion with delinquent families impact on family process and

recidivism Journal of Abnormal Psychology 3219ndash225American psychiatric association (APA) (1994) Diagnostic and

Statistical Manual of Mental Disorders 4th edn (DSM-IV)

Washington DC American Psychiatric AssociationAmes S L Sussman S Dent C W (1999) Pro-drug-use myths and

competing constructs in the prediction of substance use among

youth at continuation high schools a one-year prospective study

Personality and Individual Differences 26987ndash1003Bachman S G Wadsworth K N OrsquoMalley P M Johnston L D

Schulenberg J E (1997) Smoking drinking and drug use in young

adulthood Mahwah NJ Lawrence Erlbaum Associates 8ndash25

153ndash190Bandura A (1986) Social Foundations of Thought and Action A Social

Cognitive Theory Englewood Cliffs NJ Prentice HallBarton C Alexander J F Waldron H Turner C W Warburton J

(1985) Generalizing treatment effects of functional family therapy

Three replications The American Journal of Family Therapy

13(3)16ndash26Battin-Pearson S R Newcomb M D Abbott R D Hill K G

Catalano R F Hawkins J D (2000) Predicting early high school

dropout Journal of Educational Psychology 92568ndash582Biglan A Brennan P A Foster S L Holder H D Miller T L

Cunningham P B et al (in press) Helping Adolescents at Risk

Prevention of Multiple Problem Behaviors New York NY Guilford

PressBindra D Stewart J (1996) Motivation Baltimore MD Penguin

BooksBlanton H Gibbons F X Gerrard M Conger K J Smith G E

(1998) The role of family and peers in the development of

prototypes associated with substance use Journal of Family

Psychology 11271ndash288

2004 Sussman et al

ORDER REPRINTS

Botvin G J (1993) School-based drug abuse prevention Long-termfollow-up results In First Annual Meeting of the Society forPrevention Research Kentuck Lexington Society for PreventionResearch

Botvin G J Baker E Dusenbury L Botvin E M Diaz T (1995)Long-term follow-up results of a randomized drug abuse preven-tion trial in a white middle-class population Journal of theAmerican Medical Association 2731106ndash1012

Brody G H Dorsey S Forehand R Armistead L (2002) Uniquecontributions of parenting and classroom processes to the self-control of AfricanndashAmerican children Child Development73274ndash286

Carroll M E (1996) Reducing drug abuse by enriching the environmentwith alternative nondrug reinforcers In Green L Kagel J Heds Advances in Behavioral Economics Norwood NJ NorwoodPublishing Corp 37ndash68

Carver C S Scheier M F (1998) On the Self-Regulation of BehaviorNew York Cambridge University Press

Catalano R F Hawkins J D (1996) The social developmental modela theory of antisocial behavior In Hawkins J D ed Delinquencyand Crime Current Theories New York Cambridge UniversityPress

Centers for Disease Control (CDC) (October 1999) Youth risk BehaviorSurveillancemdashNational Alternative High School Youth RiskBehavior Survey 1998 Morbidity and Mortality Weekly Report48 No SS-7

Chamberlain P (1994) Family connections A treatment foster caremodel for adolescents with delinquency Eugene OR CastaliaPublishing Company

Chamberlain P Reid J B (1998) Comparison of two communityalternatives to incarceration for chronic juvenile offenders Journalof Consulting and Clinical Psychology 66(4)624ndash633

Chassin L A Presson C C Sherman S J (1985) Stepping backwardin order to step forward an acquisition-oriented approach toprimary prevention Journal of Consulting and Clinical Psychology53612ndash622

Chou C-P Montgomery S Pentz M A Rohrbach L A JohnsonC A Flay B R MacKinnon D P (1998) Effects of acommunity-based prevention program on decreasing drug use inhigh-risk adolescentsAmerican Journal of Public Health 88944ndash948

Conducts Problems Prevention Research Group (CPPRG) (1999) Initialimpact of the fast track prevention trial for conduct problems I

Motivation Skills and Decision Making 2005

ORDER REPRINTS

The high-risk sample Journal of Consulting and Clinical Psychology

67631ndash647Conducts Problems Prevention Research Group (CPPRG) (2000)

Merging universal and indicated prevention programs the fast

track model Addictive Behaviors 25913ndash927Council of Philosophical Studies (1981) Psychology and the Philosophy

of Mind in the Philosophy Curriculum San Francisco San Francisco

State UniversityCummings K M Hellmann R Emont S L (1988) Correlates of

participation in a worksite stop smoking program Journal of

Behavioral Medicine 11267ndash277Curry S Wagner E H Gothaus L C (1990) Intrinsic and extrinsic

motivation for smoking cessation Journal of Consulting and

Clinical Psychology 58310ndash316Dent C W Sussman S McCuller W J Stacy A W (2001) Drug

abuse prevention among youth at comprehensive high schools

Preventive Medicine 32514ndash520Dewey J (1886) Psychology New York HarperDishion T J French D C Patterson G R (1995) The development

and ecology of antisocial behavior In Cicchetti D Cohen D

eds Manual of developmental psychopathology New York John

Wiley 421ndash471Eggert L L Herting J R (1991) Preventing teenage drug abuse

exploratory effects of network social support Youth and Society

22482ndash534 [Reprinted National Prevention Evaluation Research

CollectionRockville MD Aspen 1993]Eggert L L Herting J R Thompson E A Nicholas L J Dicker

B G (1994) Preventing adolescent drug abuse and high school

dropout through an intensive school-based social network devel-

opment program American Journal of Health Promotion

8202ndash214Eggert L L Thompson E A Herting J R Nicholas L J (1995)

Reducing suicide potential among high-risk youth tests of a school-

based prevention program Suicide amp Life-Threatening Behavior

25276ndash296Ellickson P L Bell R M (1990) Drug prevention in junior high a

multi-site longitudinal test Science 2471299ndash1305Elliott D S (Series ed) (2003) Blueprints for violence prevention

Boulder CO Institute of Behavioral Science Regents of the

University of Colorado wwwcoloradoeducspvblueprints

2006 Sussman et al

ORDER REPRINTS

Farrell A D Danish S J (1993) Peer drug associations and emotionalrestraint Causes or consequences of adolescent drug use Journal ofConsulting and Clinical Psychology 61327ndash334

Festinger L A (1957) A Theory of Cognitive Dissonance New YorkHarper amp Row

Fuqua J Stokols D Gress J Phillips K Harvey R (2004)Transdisciplinary collaboration as a basis for enhancing the scienceand prevention of substance use and abuse Substance Use ampMisuse

Giuliano J D (1994) A peer education program to promote the use ofconflict resolution skills among at-risk school-age males PublicHealth Reports 109158ndash169

Glynn K Levanthal H Hirschman R (1985) A cognitivedevelopmental approach to smoking prevention In Bell C SBattjes R eds Prevention research Deterring Drug Abuse AmongChildren and Adolescents Rockville MD NIDA ResearchMonograph 63

Glynn T J (1989) Essential elements of school-based smokingprevention programs Journal of School Health 59181ndash188

Goodman R M Burdine J N Meehan E McLeroy K R eds(1993) Community coalitions for health promotion Special issue ofHealth Education Research Theory and Practice 8309ndash453

Goodyear R D Newcomb M D Locke T F (2002) PregnantLatina teenagers psychosocial and developmental determinants ofhow they select and perceive the men who father their childrenJournal of Counseling Psychology 49187ndash201

Gordon R (1987) An operational classification of disease preventionIn Steinberg J A Silverman M M eds Preventing MentalDisorders Rockville MD DHHS 20ndash26

Graham J W Johnson C A Hansen W B Flay B R Gee M(1990) Drug use prevention programs gender and ethnicityevaluation of three seventh-grade project SMART cohortsPreventive Medicine 19305ndash313

Griffin K W Botvin G J Nichols T R Doyal M M (2003)Effectiveness of a universal drug abuse prevention approach foryouth at high risk for substance use initiation Preventive Medicine36(1)1ndash7

Hamilton S (August 20 2000) Views slowly changing on alternativeschools The Sacramento Bee 1ndash3

Hansen W B (1992) School-based substance abuse prevention a reviewof the state of the art in curriculum 1980ndash1990 Health EducationResearch 7403ndash430

Motivation Skills and Decision Making 2007

ORDER REPRINTS

Hansen W B Johnson C A Flay B R Graham J W Sobel J(1988) Affective and social influences approaches to the preventionof multiple substance abuse among seventh grade students resultsfrom project SMART Preventive Medicine 17135ndash154

Hansen W B Graham J W (1991) Preventing alcohol marijuanaand cigarette use among adolescents peer pressure and resistancetraining versus establishing conservative norms PreventiveMedicine 20414ndash430

Hawkins D H Catalano R F Miller J Y (1992) Risk andprotective factors for alcohol and other drug problems inadolescence and early adulthood Implications for substanceabuse prevention Psychological Bulletin 11254ndash105

Hawkins J D Catalano R F Kosterman R Abbott R Hill K G(1999) Preventing adolescent health-risk behaviors by strengthen-ing protection during childhood Archives of Pediatric amp AdolescentMedicine 153226ndash234

Heider F (1958) The Psychology of Interpersonal Relations New YorkWiley

Henggeler S W Pickrel S G Brondino M J Crouch J L (1996)Eliminating (almost) treatment dropout of substance abusing ordependent delinquents through home-based multisystemic therapyAmerican Journal of Psychiatry 153(3)427ndash428

Henggeler S W Melton G B Brondino M J Scherer D GHanley J H (1997) Multisystemic therapy with violent andchronic juvenile offenders and their families the role of treatmentfidelity in successful dissemination Journal of Consulting andClinical Psychology 65(5)821ndash833

Henggeler S W Schoenwald S K Borduin C M Rowland M DCunningham P B (1998) Multisystemic treatment of antisocialbehavior in children and adolescents New York The Guilford Press

Henggeler S W Pickrel S G Brondino M J (1999) Multisystemictreatment of substance-abusing and dependent delinquents out-comes treatment fidelity and transportability Mental HealthServices Residual 1(3)171ndash84

Johnson C A Pentz M A Weber M D Dwyer J H Baer NMacKinnon D P Hansen W B Flay B R (1990) Relativeeffectiveness of comprehensive community programming for drugabuse prevention with high-risk and low-risk adolescents Journalof Consulting and Clinical Psychology 58447ndash456

Kaftarian S J Hansen W B eds (1994) CSAP special issuecommunity partnership program Journal of Community Psychologypages 205

2008 Sussman et al

ORDER REPRINTS

Karoly P (1993) Mechanisms in self-regulation A systems view AnnualReview of Psychology 4423ndash51

Karoly P (1980) Person variables in therapeutic change and develop-ment In Karoly P Steffen J J eds Improving the Long-TermEffects of Psychotherapy New York Gardner Press 195ndash261

Kendall P C Braswell L (1982) Cognitive-behavioral self-controltherapy for children a components analysis Journal of Consultingand Clinical Psychology 50672ndash689

Kerr M Tremblay R E Pagani L Vitaro F (1997) Boysrsquobehavioral inhibition and the risk of later delinquency Archivesof General Psychiatry 54809ndash816

Klein N C Alexander J F Parsons B V (1977) Impact of familysystems intervention on recidivism and sibling delinquency a modelof primary prevention and program evaluation Journal ofConsulting and Clinical Psychology 45(3)469ndash474

Kumpfer K L (1999) Outcomes measures of interventions in the studyof children of substance-abusing parents Pediatrics 1031128ndash1144

Lau R R Hartman K A Ware J E (1986) Health as a valuemethodological and theoretical considerations Health Psychology525ndash43

Lichtenstein E L Glasgow R E (1997) A pragmatic framework forsmoking cessation implications for clinical and public healthprograms Psychology of Addictive Behaviors 11142ndash151

Locke T F Newcomb M D (in press) Childhood maltreatmentparent drug problems polydrug problems and parenting practicesa test of gender differences and four theoretical perspectivesJournal of Family Psychology

McCreary D R Newcomb M D Sadava S W (1999) The male rolealcohol use and alcohol problems a structural modeling examina-tion in adult women and men Journal of Counseling Psychology46109ndash124

McGee L Newcomb M D (1992) General deviance syndromeexpanded hierarchical evaluations at four ages from earlyadolescence to adulthood Journal of Consulting amp ClinicalPsychology 60766ndash776

Miller W R Brown J M (1991) Self-regulation as a conceptual basisfor the prevention of addictive behaviours In Heather N MillerW R Greeley J eds Self-control and the Addictive BehavioursSydney Australia Maxwell Macmillan 3ndash79

Miller W R Leckman A L Delaney H D Tinkcom M (1993)Long-term follow-up of behavioral self-control training forproblem drinkers Journal of Studies on Alcohol 53249ndash261

Motivation Skills and Decision Making 2009

ORDER REPRINTS

Miller W R Rollnick S (1991) Motivational InterviewingPreparing People to Change Addictive Behavior New YorkGuilford Press

Moffitt T E Caspi A Harrington H Milne B J (2002) Males onthe life-course-persistent and adolescence-limited antisocial path-ways follow-up at age 26 years Development and Psychopathology14(1)179ndash207

National Institute on Drug Abuse (NIDA) (1997) Drug abuseprevention What works NIH Publication 97-4110 DHHSNational Institutes of Health National Institute on Drug AbuseOffice of Science Policy and Communications Rockville MD

Newcomb M D (1992a) Substance abuse and control in the UnitedStates ethical and legal issues Social Science and Medicine35471ndash479

Newcomb M D (1992b) Understanding the multidimensional nature ofdrug use and abuse The role of consumption risk factors andprotective factors In Glantz M D Pickens R eds Vulnerabilityto Drug Abuse Washington DC American PsychologicalAssociation 255ndash298

Newcomb M D (1996a) Pseudomaturity among adolescents constructvalidation sex differences and associations in adulthood Journalof Drug Issues 26477ndash504

Newcomb M D (1996b) Adolescence Pathologizing a normal processThe Counseling Psychologist 24482ndash490

Newcomb M D (1997) Psychosocial predictors and consequences ofdrug use a developmental perspective within a prospective studyJournal of Addictive Diseases 1651ndash89

Newcomb M D Bentler P M (1988) Consequences of Adolescent DrugUse Impact on the Lives of Young Adults Beverly Hills CA Sage

Newcomb M D Bentler P M (1989) Substance use and abuse amongchildren and teenagers American Psychologist 44242ndash248

Newcomb M D Harlow L L (1986) Life events and substance useamong adolescents Mediating effects of perceived loss of controland meaninglessness in life Journal of Personality and SocialPsychology 51564ndash577

Newcomb M D Chou C-P Bentler P M Huba G J (1988)Cognitive motivations for drug use among adolescents longitudinaltests of gender differences and predictors of change in drug useJournal of Counseling Psychology 35426ndash438

Newcomb M D Abbott R D Catalano R F Hawkins J DBattin-Pearson S R Hill K (2002) Mediational and deviancetheories of late high school failure Process roles of structural

2010 Sussman et al

ORDER REPRINTS

strains academic competence and general versus specific problem

behaviors Journal of Counseling Psychology 49172ndash186Nezami E Sussman S Pentz M A (2003) Motivation in tobacco use

cessation research Substance Use amp Misuse 3825ndash5Novak S P Clayton R R (2001) The influence of school environment

and self-regulation on transitions between stages of cigarette

smoking Health Psychology 20196ndash207Offord D R (2000) Selection of levels of prevention Addictive

Behaviors 25833ndash842Palinkas L A Atkins C J Miller C Ferreira D (1996) Social skills

training for drug prevention in high-risk female adolescents

Preventive Medicine 25692ndash701Patock-Peckham J A Cheong J-W Balhorn M E Nagoshi C T

(2001) A model of parenting styles self-regulation perceived

drinking control and alcohol use and problems Alcoholism

Experimental and Clinical Research 251284ndash1292Pentz M A (1994) Directions for future research in drug abuse

prevention Preventive Medicine 23646ndash652Pentz M A Dwyer J H MacKinnon D Flay B R Hansen W B

Wang E Y I Johnson C A (1989) A multi-community trial for

primary prevention of adolescent drug abuse effects on drug use

prevalence JAMA 2623259ndash3266Pentz M A Mares D Schinke S Rohrbach L (in press) Political

science public policy and drug abuse prevention Substance Use amp

MisuseProchaska J O DiClemente C C (1982) Transtheoretical therapy

toward a more integrative model of change Psychotherapy Theory

Research and Practice 19275ndash288Pulkkinen L Pitkanen T (1994) A prospective study of the precursors

to problem drinking in young adulthood Journal of Studies on

Alcohol 55578ndash587Rathus S A Nevid J S (1977) Behavior Therapy Strategies for

Solving Problems in Living New York Doubleday and Company

IncResnicow K Botvin G (1993) School-based substance use prevention

programs why do effects decay Preventive Medicine 22484ndash490Rutter M Dunn J Plomin R Simonoff E Pickles A Maughan

B Ormel J Meyer J Eaves L (1997) Integrating nature and

nurture implications of person-environment interactions for

developmental psychopathology Development and Psychopathology

9335ndash364

Motivation Skills and Decision Making 2011

ORDER REPRINTS

Salomon G Stein Y Eisenberg S Klein L (1984) Adolescent

smokers and nonsmokers profiles and their changing structure

Preventive Medicine 13446ndash461Sambrano S (1999) National cross-site evaluation of high risk youth

programs In Interim findings Bulletin Washington DC CSAP

SAMSHA US DHHS May 1ndash16Schinke S P Gilchrist L D (1985) Preventing substance abuse with

children and adolescents Journal of Consulting and Clinical

Psychology 53596ndash602Skara S N Sussman S (2003) A review of 25 long-term adolescent

tobacco and other drug use prevention program evaluations

Preventive MedicineSmith C Lizotte A J Thornberry T P Krohn M D (1995)

Resilient youth identifying factors that prevent high-risk youth

from engaging in delinquency and drug use Delinquency and

Disrepute in the Life Course Greenwich CT John Hagan JAI

press 217ndash247Sommers P V (1972) The Biology of Behavior Australia Pty ltd

Sydney John Wiley amp SonsSt Pierre T L Kaltreider D L Mark M M Aikin K J (1992)

Drug prevention in a community setting a longitudinal study of the

relative effectiveness of a three-year primary prevention program in

boys and girls clubs across the nation American Journal of

Community Psychology 20673ndash706Stein J A Newcomb M D Bentler P M (1987) An eight year study

of multiple influences on drug use and drug use consequences

Journal of Personality and Social Psychology 531094ndash1105Sully J (1884) Outlines of Psychology New York D Appleton amp CoSussman S (1989) Two social influence perspectives of tobacco use

development and prevention Health Education Research Theory

and Practice 4213ndash223Sussman S (1991) Curriculum development in school-based prevention

research Health Education Research Theory and Practice

6339ndash351Sussman S (1996) Development of a school-based drug abuse

prevention curriculum for high risk youth Journal of

Psychoactive Drugs 28169ndash182Sussman S Ames S L (2001) The social psychology of drug abuse

Buckingham GB Open University PressSussman S Unger J (2004) A drug abuse theoretical integration a

transdisciplinary speculation Substance Use amp Misuse

2012 Sussman et al

ORDER REPRINTS

Sussman S Dent C W Burton D Stacy A W Flay B R (1995a)

Developing school-based tobacco use prevention and cessation

programs Thousand Oaks CA Sage Publications IncSussman S Dent C W Simon T R Stacy A W Galaif E R

Moss M A Craig S Johnson C A (1995b) Effectiveness of

social influence substance abuse prevention curricula in compre-

hensive and continuation high schools Drugs and Society 865ndash81Sussman S Dent C W Galaif E R (1997) The correlates of

substance abuse and dependence among adolescents at high risk

for drug abuse Journal of Substance Abuse 9241ndash255Sussman S Dent C W Stacy A W (1996) The relation of pro-drug

use myths with self-reported drug use among youth at continuation

high schools Journal of Applied Social Psychology 26214ndash267Sussman S Dent C W Stacy A Craig S (1998) One-year outcomes

of project towards no drug abuse Preventive Medicine 27632ndash642

(erratum 766)Sussman S Dent C W Stacy S (2002) Project towards no drug

abuse a review of the findings and future directions American

Journal of Health Behavior 26354ndash365Sussman S McCuller W J Dent C W (2003) The associations of

social self-control personality disorders and demographics with

drug use among high risk youth Addictive Behaviors 281159ndash1166Sussman S Rohrbach L Patel R Holiday K (2003) A look at an

interactive classroom-based drug abuse prevention program

Interactive contents and suggestions for research Journal of Drug

Education 33355ndash368Sussman S Sun P McCuller W J Dent C W (2003) Project

towards no drug abuse two year outcomes of a trial that compares

health educator delivery to self-instruction Preventive Medicine

37155ndash162Tarter R E Vanyukov M (1994) Alcoholism a developmental disorder

Journal of Consulting and Clinical Psychology 621096ndash1107Thornton T N Craft C A Dahlberg L L Lynch B S Baer K

(2000) Best Practices of Youth Violence Prevention A Sourcebook

for Community Action Atlanta GA Division of Violence

Prevention Centers for Disease Control and PreventionTobler N S (1986) Meta-analysis of 143 adolescent drug prevention

programs quantitative outcome of program participants compared to

a control or comparison group Journal of Drug Issues 16537ndash567Tobler N S Roona M R Ochshorn P Marshall D G Streke

A V Stackpole K M (2000) School-based adolescent drug

Motivation Skills and Decision Making 2013

ORDER REPRINTS

prevention programs 1998 Meta-analysis The Journal of Primary

Prevention 20275ndash336US Department of Health and Human Services (USDHHS) (2003)

Substance Abuse andMental Health Services Administration Center

for Substance Abuse Prevention Science-based prevention programs and

principles 2002 Rockville MD US DHHS (SMA)03-3764 Also

see httpmodelprogramssamhsagovUnger J Baezconde-Garbanati L Shakib S Palmer P H Nezami

E Mora J (2004) What are the implications of structuralcultural

theory for drug abuse prevention Substance Use amp MisuseUpshaw H S Ostrom T M (1984) Psychological perspective in

attitude research In Eiser J R ed Attitudinal Judgment New

York Springer-Verlag 23ndash42Valente T W Gallaher P Mouttapa M (2004) Using social network

theory to understand and prevent substance use a transdisciplinary

perspective Substance Use amp MisuseVorrath H Brendtro L (1985) Positive peer culture 2nd edn Aldine

ChicagoWaldron H B Slesnick N Brody J L Turner C W Peterson T R

(2001) Treatment outcomes for adolescent substance abuse at 4-

and 7-month assessments Journal of Consulting amp Clinical

Psychology 69(5)802ndash813Watson D L Tharp R G (2002) Self-directed behavior Self-

modification for personal adjustment 8th edn Belmont CA

WadsworthWeissberg R P Caplan M Z Sivo P J (1989) A new conceptual

framework for establishing school-based social competence promo-

tion programs In Bond L A Compas B E eds Primary

Prevention amp Promotion in the Schools Newbury Park CA Sage

255ndash296Wills T A (1986) Stress and coping in early adolescence relationships

to substance use in urban school samples Health Psychology

5503ndash529Wills T A Cleary S D (1995) Stress-coping model for alcohol-

tobacco interactions in adolescence In Fertig J B Allen J P

eds Alcohol and Tobacco From Basic Science to Clinical Practice

Bethesda MD National Institute on Alcohol Abuse and

Alcoholism 107ndash128Wills T A Cleary S D (1999) Peer and adolescent substance use

among 6thndash9th graders Latent growth analyses of influence versus

selection mechanisms Health Psychology 18453ndash463

2014 Sussman et al

ORDER REPRINTS

Wills T A Hirky A E (1996) Coping and substance abuse InZeidner M Endler N S eds Handbook of Coping TheoryResearch and Applications New York Wiley 279ndash302

Wills T A Stoolmiller M (2002) The role of self-control in earlyescalation of substance use a time-varying analysis Journal ofConsulting and Clinical Psychology 70986ndash997

Wills T A Baker E Botvin G J (1989) Dimensions of assertivenessdifferential relationships to substance use in early adolescenceJournal of Consulting and Clinical Psychology 57(4)473ndash478

Wills T A Vaccaro D McNamara G (1994) Novelty seeking risktaking and related constructs as predictors of adolescent substanceuse an application of Cloningerrsquos theory Journal of SubstanceAbuse 61ndash20

Wills T A McNamara G Vaccaro D Hirky A E (1996a)Escalated substance use a longitudinal grouping analysis fromearly to middle adolescence Journal of Abnormal Psychology105166ndash180

Wills T A Pierce J P Evans R I (1996b) Large-scale environmentalrisk factors for substance use American Behavioral Scientist39808ndash822

Wills T A Windle M Cleary S D (1998) Role of temperamentnovelty-seeking and self-control in adolescent substance useJournal of Personality and Social Psychology 74387ndash406

Wills T A Sandy J M Shinar O (1999) Substance use level andproblems in late adolescence a mediational model based on self-control and coping motives Experimental and ClinicalPsychopharmacology 7122ndash134

Wills T A Cleary S D Filer M Shinar O Mariani J Spera K(2001) Temperament and self-control related to early-onsetsubstance use test of a developmental model Prevention Science2145ndash163

Wills T A Sandy J M Yaeger A (2002) Moderators of therelationship between substance use level and problems test of aself-regulation model in adolescence Journal of AbnormalPsychology 1113ndash21

Wills T A Gibbons F X Gerrard M Murry V Brody G (in press-a) Family communication and religiosity related to substance useand sexual behavior in early adolescence Psychology of AddictiveBehaviors

Wills T A Resko J Ainette M Mendoza D (in press-b) The role ofparent and peer support in adolescent substance use a test ofmediated effects Psychology of Addictive Behaviors

Motivation Skills and Decision Making 2015

ORDER REPRINTS

Young P T (1936) Motivation of Behavior New York John Wiley andSons

Zimmerman B J (2000) Attaining self-regulation a social cognitivemodel In Boekaerts M Pintrich P R eds Handbook of Self-Regulation San Diego Academic Press 13ndash39

2016 Sussman et al

Request PermissionOrder Reprints

Reprints of this article can also be ordered at

httpwwwdekkercomservletproductDOI101081JA200034769

Request Permission or Order Reprints Instantly

Interested in copying and sharing this article In most cases US Copyright Law requires that you get permission from the articlersquos rightsholder before using copyrighted content

All information and materials found in this article including but not limited to text trademarks patents logos graphics and images (the Materials) are the copyrighted works and other forms of intellectual property of Marcel Dekker Inc or its licensors All rights not expressly granted are reserved

Get permission to lawfully reproduce and distribute the Materials or order reprints quickly and painlessly Simply click on the Request Permission Order Reprints link below and follow the instructions Visit the US Copyright Office for information on Fair Use limitations of US copyright law Please refer to The Association of American Publishersrsquo (AAP) website for guidelines on Fair Use in the Classroom

The Materials are for your personal use only and cannot be reformatted reposted resold or distributed by electronic means or otherwise without permission from Marcel Dekker Inc Marcel Dekker Inc grants you the limited right to display the Materials only on your personal computer or personal wireless device and to copy and download single copies of such Materials provided that any copyright trademark or other notice appearing on such Materials is also retained by displayed copied or downloaded as part of the Materials and is not removed or obscured and provided you do not edit modify alter or enhance the Materials Please refer to our Website User Agreement for more details

ORDER REPRINTS

Botvin G J (1993) School-based drug abuse prevention Long-termfollow-up results In First Annual Meeting of the Society forPrevention Research Kentuck Lexington Society for PreventionResearch

Botvin G J Baker E Dusenbury L Botvin E M Diaz T (1995)Long-term follow-up results of a randomized drug abuse preven-tion trial in a white middle-class population Journal of theAmerican Medical Association 2731106ndash1012

Brody G H Dorsey S Forehand R Armistead L (2002) Uniquecontributions of parenting and classroom processes to the self-control of AfricanndashAmerican children Child Development73274ndash286

Carroll M E (1996) Reducing drug abuse by enriching the environmentwith alternative nondrug reinforcers In Green L Kagel J Heds Advances in Behavioral Economics Norwood NJ NorwoodPublishing Corp 37ndash68

Carver C S Scheier M F (1998) On the Self-Regulation of BehaviorNew York Cambridge University Press

Catalano R F Hawkins J D (1996) The social developmental modela theory of antisocial behavior In Hawkins J D ed Delinquencyand Crime Current Theories New York Cambridge UniversityPress

Centers for Disease Control (CDC) (October 1999) Youth risk BehaviorSurveillancemdashNational Alternative High School Youth RiskBehavior Survey 1998 Morbidity and Mortality Weekly Report48 No SS-7

Chamberlain P (1994) Family connections A treatment foster caremodel for adolescents with delinquency Eugene OR CastaliaPublishing Company

Chamberlain P Reid J B (1998) Comparison of two communityalternatives to incarceration for chronic juvenile offenders Journalof Consulting and Clinical Psychology 66(4)624ndash633

Chassin L A Presson C C Sherman S J (1985) Stepping backwardin order to step forward an acquisition-oriented approach toprimary prevention Journal of Consulting and Clinical Psychology53612ndash622

Chou C-P Montgomery S Pentz M A Rohrbach L A JohnsonC A Flay B R MacKinnon D P (1998) Effects of acommunity-based prevention program on decreasing drug use inhigh-risk adolescentsAmerican Journal of Public Health 88944ndash948

Conducts Problems Prevention Research Group (CPPRG) (1999) Initialimpact of the fast track prevention trial for conduct problems I

Motivation Skills and Decision Making 2005

ORDER REPRINTS

The high-risk sample Journal of Consulting and Clinical Psychology

67631ndash647Conducts Problems Prevention Research Group (CPPRG) (2000)

Merging universal and indicated prevention programs the fast

track model Addictive Behaviors 25913ndash927Council of Philosophical Studies (1981) Psychology and the Philosophy

of Mind in the Philosophy Curriculum San Francisco San Francisco

State UniversityCummings K M Hellmann R Emont S L (1988) Correlates of

participation in a worksite stop smoking program Journal of

Behavioral Medicine 11267ndash277Curry S Wagner E H Gothaus L C (1990) Intrinsic and extrinsic

motivation for smoking cessation Journal of Consulting and

Clinical Psychology 58310ndash316Dent C W Sussman S McCuller W J Stacy A W (2001) Drug

abuse prevention among youth at comprehensive high schools

Preventive Medicine 32514ndash520Dewey J (1886) Psychology New York HarperDishion T J French D C Patterson G R (1995) The development

and ecology of antisocial behavior In Cicchetti D Cohen D

eds Manual of developmental psychopathology New York John

Wiley 421ndash471Eggert L L Herting J R (1991) Preventing teenage drug abuse

exploratory effects of network social support Youth and Society

22482ndash534 [Reprinted National Prevention Evaluation Research

CollectionRockville MD Aspen 1993]Eggert L L Herting J R Thompson E A Nicholas L J Dicker

B G (1994) Preventing adolescent drug abuse and high school

dropout through an intensive school-based social network devel-

opment program American Journal of Health Promotion

8202ndash214Eggert L L Thompson E A Herting J R Nicholas L J (1995)

Reducing suicide potential among high-risk youth tests of a school-

based prevention program Suicide amp Life-Threatening Behavior

25276ndash296Ellickson P L Bell R M (1990) Drug prevention in junior high a

multi-site longitudinal test Science 2471299ndash1305Elliott D S (Series ed) (2003) Blueprints for violence prevention

Boulder CO Institute of Behavioral Science Regents of the

University of Colorado wwwcoloradoeducspvblueprints

2006 Sussman et al

ORDER REPRINTS

Farrell A D Danish S J (1993) Peer drug associations and emotionalrestraint Causes or consequences of adolescent drug use Journal ofConsulting and Clinical Psychology 61327ndash334

Festinger L A (1957) A Theory of Cognitive Dissonance New YorkHarper amp Row

Fuqua J Stokols D Gress J Phillips K Harvey R (2004)Transdisciplinary collaboration as a basis for enhancing the scienceand prevention of substance use and abuse Substance Use ampMisuse

Giuliano J D (1994) A peer education program to promote the use ofconflict resolution skills among at-risk school-age males PublicHealth Reports 109158ndash169

Glynn K Levanthal H Hirschman R (1985) A cognitivedevelopmental approach to smoking prevention In Bell C SBattjes R eds Prevention research Deterring Drug Abuse AmongChildren and Adolescents Rockville MD NIDA ResearchMonograph 63

Glynn T J (1989) Essential elements of school-based smokingprevention programs Journal of School Health 59181ndash188

Goodman R M Burdine J N Meehan E McLeroy K R eds(1993) Community coalitions for health promotion Special issue ofHealth Education Research Theory and Practice 8309ndash453

Goodyear R D Newcomb M D Locke T F (2002) PregnantLatina teenagers psychosocial and developmental determinants ofhow they select and perceive the men who father their childrenJournal of Counseling Psychology 49187ndash201

Gordon R (1987) An operational classification of disease preventionIn Steinberg J A Silverman M M eds Preventing MentalDisorders Rockville MD DHHS 20ndash26

Graham J W Johnson C A Hansen W B Flay B R Gee M(1990) Drug use prevention programs gender and ethnicityevaluation of three seventh-grade project SMART cohortsPreventive Medicine 19305ndash313

Griffin K W Botvin G J Nichols T R Doyal M M (2003)Effectiveness of a universal drug abuse prevention approach foryouth at high risk for substance use initiation Preventive Medicine36(1)1ndash7

Hamilton S (August 20 2000) Views slowly changing on alternativeschools The Sacramento Bee 1ndash3

Hansen W B (1992) School-based substance abuse prevention a reviewof the state of the art in curriculum 1980ndash1990 Health EducationResearch 7403ndash430

Motivation Skills and Decision Making 2007

ORDER REPRINTS

Hansen W B Johnson C A Flay B R Graham J W Sobel J(1988) Affective and social influences approaches to the preventionof multiple substance abuse among seventh grade students resultsfrom project SMART Preventive Medicine 17135ndash154

Hansen W B Graham J W (1991) Preventing alcohol marijuanaand cigarette use among adolescents peer pressure and resistancetraining versus establishing conservative norms PreventiveMedicine 20414ndash430

Hawkins D H Catalano R F Miller J Y (1992) Risk andprotective factors for alcohol and other drug problems inadolescence and early adulthood Implications for substanceabuse prevention Psychological Bulletin 11254ndash105

Hawkins J D Catalano R F Kosterman R Abbott R Hill K G(1999) Preventing adolescent health-risk behaviors by strengthen-ing protection during childhood Archives of Pediatric amp AdolescentMedicine 153226ndash234

Heider F (1958) The Psychology of Interpersonal Relations New YorkWiley

Henggeler S W Pickrel S G Brondino M J Crouch J L (1996)Eliminating (almost) treatment dropout of substance abusing ordependent delinquents through home-based multisystemic therapyAmerican Journal of Psychiatry 153(3)427ndash428

Henggeler S W Melton G B Brondino M J Scherer D GHanley J H (1997) Multisystemic therapy with violent andchronic juvenile offenders and their families the role of treatmentfidelity in successful dissemination Journal of Consulting andClinical Psychology 65(5)821ndash833

Henggeler S W Schoenwald S K Borduin C M Rowland M DCunningham P B (1998) Multisystemic treatment of antisocialbehavior in children and adolescents New York The Guilford Press

Henggeler S W Pickrel S G Brondino M J (1999) Multisystemictreatment of substance-abusing and dependent delinquents out-comes treatment fidelity and transportability Mental HealthServices Residual 1(3)171ndash84

Johnson C A Pentz M A Weber M D Dwyer J H Baer NMacKinnon D P Hansen W B Flay B R (1990) Relativeeffectiveness of comprehensive community programming for drugabuse prevention with high-risk and low-risk adolescents Journalof Consulting and Clinical Psychology 58447ndash456

Kaftarian S J Hansen W B eds (1994) CSAP special issuecommunity partnership program Journal of Community Psychologypages 205

2008 Sussman et al

ORDER REPRINTS

Karoly P (1993) Mechanisms in self-regulation A systems view AnnualReview of Psychology 4423ndash51

Karoly P (1980) Person variables in therapeutic change and develop-ment In Karoly P Steffen J J eds Improving the Long-TermEffects of Psychotherapy New York Gardner Press 195ndash261

Kendall P C Braswell L (1982) Cognitive-behavioral self-controltherapy for children a components analysis Journal of Consultingand Clinical Psychology 50672ndash689

Kerr M Tremblay R E Pagani L Vitaro F (1997) Boysrsquobehavioral inhibition and the risk of later delinquency Archivesof General Psychiatry 54809ndash816

Klein N C Alexander J F Parsons B V (1977) Impact of familysystems intervention on recidivism and sibling delinquency a modelof primary prevention and program evaluation Journal ofConsulting and Clinical Psychology 45(3)469ndash474

Kumpfer K L (1999) Outcomes measures of interventions in the studyof children of substance-abusing parents Pediatrics 1031128ndash1144

Lau R R Hartman K A Ware J E (1986) Health as a valuemethodological and theoretical considerations Health Psychology525ndash43

Lichtenstein E L Glasgow R E (1997) A pragmatic framework forsmoking cessation implications for clinical and public healthprograms Psychology of Addictive Behaviors 11142ndash151

Locke T F Newcomb M D (in press) Childhood maltreatmentparent drug problems polydrug problems and parenting practicesa test of gender differences and four theoretical perspectivesJournal of Family Psychology

McCreary D R Newcomb M D Sadava S W (1999) The male rolealcohol use and alcohol problems a structural modeling examina-tion in adult women and men Journal of Counseling Psychology46109ndash124

McGee L Newcomb M D (1992) General deviance syndromeexpanded hierarchical evaluations at four ages from earlyadolescence to adulthood Journal of Consulting amp ClinicalPsychology 60766ndash776

Miller W R Brown J M (1991) Self-regulation as a conceptual basisfor the prevention of addictive behaviours In Heather N MillerW R Greeley J eds Self-control and the Addictive BehavioursSydney Australia Maxwell Macmillan 3ndash79

Miller W R Leckman A L Delaney H D Tinkcom M (1993)Long-term follow-up of behavioral self-control training forproblem drinkers Journal of Studies on Alcohol 53249ndash261

Motivation Skills and Decision Making 2009

ORDER REPRINTS

Miller W R Rollnick S (1991) Motivational InterviewingPreparing People to Change Addictive Behavior New YorkGuilford Press

Moffitt T E Caspi A Harrington H Milne B J (2002) Males onthe life-course-persistent and adolescence-limited antisocial path-ways follow-up at age 26 years Development and Psychopathology14(1)179ndash207

National Institute on Drug Abuse (NIDA) (1997) Drug abuseprevention What works NIH Publication 97-4110 DHHSNational Institutes of Health National Institute on Drug AbuseOffice of Science Policy and Communications Rockville MD

Newcomb M D (1992a) Substance abuse and control in the UnitedStates ethical and legal issues Social Science and Medicine35471ndash479

Newcomb M D (1992b) Understanding the multidimensional nature ofdrug use and abuse The role of consumption risk factors andprotective factors In Glantz M D Pickens R eds Vulnerabilityto Drug Abuse Washington DC American PsychologicalAssociation 255ndash298

Newcomb M D (1996a) Pseudomaturity among adolescents constructvalidation sex differences and associations in adulthood Journalof Drug Issues 26477ndash504

Newcomb M D (1996b) Adolescence Pathologizing a normal processThe Counseling Psychologist 24482ndash490

Newcomb M D (1997) Psychosocial predictors and consequences ofdrug use a developmental perspective within a prospective studyJournal of Addictive Diseases 1651ndash89

Newcomb M D Bentler P M (1988) Consequences of Adolescent DrugUse Impact on the Lives of Young Adults Beverly Hills CA Sage

Newcomb M D Bentler P M (1989) Substance use and abuse amongchildren and teenagers American Psychologist 44242ndash248

Newcomb M D Harlow L L (1986) Life events and substance useamong adolescents Mediating effects of perceived loss of controland meaninglessness in life Journal of Personality and SocialPsychology 51564ndash577

Newcomb M D Chou C-P Bentler P M Huba G J (1988)Cognitive motivations for drug use among adolescents longitudinaltests of gender differences and predictors of change in drug useJournal of Counseling Psychology 35426ndash438

Newcomb M D Abbott R D Catalano R F Hawkins J DBattin-Pearson S R Hill K (2002) Mediational and deviancetheories of late high school failure Process roles of structural

2010 Sussman et al

ORDER REPRINTS

strains academic competence and general versus specific problem

behaviors Journal of Counseling Psychology 49172ndash186Nezami E Sussman S Pentz M A (2003) Motivation in tobacco use

cessation research Substance Use amp Misuse 3825ndash5Novak S P Clayton R R (2001) The influence of school environment

and self-regulation on transitions between stages of cigarette

smoking Health Psychology 20196ndash207Offord D R (2000) Selection of levels of prevention Addictive

Behaviors 25833ndash842Palinkas L A Atkins C J Miller C Ferreira D (1996) Social skills

training for drug prevention in high-risk female adolescents

Preventive Medicine 25692ndash701Patock-Peckham J A Cheong J-W Balhorn M E Nagoshi C T

(2001) A model of parenting styles self-regulation perceived

drinking control and alcohol use and problems Alcoholism

Experimental and Clinical Research 251284ndash1292Pentz M A (1994) Directions for future research in drug abuse

prevention Preventive Medicine 23646ndash652Pentz M A Dwyer J H MacKinnon D Flay B R Hansen W B

Wang E Y I Johnson C A (1989) A multi-community trial for

primary prevention of adolescent drug abuse effects on drug use

prevalence JAMA 2623259ndash3266Pentz M A Mares D Schinke S Rohrbach L (in press) Political

science public policy and drug abuse prevention Substance Use amp

MisuseProchaska J O DiClemente C C (1982) Transtheoretical therapy

toward a more integrative model of change Psychotherapy Theory

Research and Practice 19275ndash288Pulkkinen L Pitkanen T (1994) A prospective study of the precursors

to problem drinking in young adulthood Journal of Studies on

Alcohol 55578ndash587Rathus S A Nevid J S (1977) Behavior Therapy Strategies for

Solving Problems in Living New York Doubleday and Company

IncResnicow K Botvin G (1993) School-based substance use prevention

programs why do effects decay Preventive Medicine 22484ndash490Rutter M Dunn J Plomin R Simonoff E Pickles A Maughan

B Ormel J Meyer J Eaves L (1997) Integrating nature and

nurture implications of person-environment interactions for

developmental psychopathology Development and Psychopathology

9335ndash364

Motivation Skills and Decision Making 2011

ORDER REPRINTS

Salomon G Stein Y Eisenberg S Klein L (1984) Adolescent

smokers and nonsmokers profiles and their changing structure

Preventive Medicine 13446ndash461Sambrano S (1999) National cross-site evaluation of high risk youth

programs In Interim findings Bulletin Washington DC CSAP

SAMSHA US DHHS May 1ndash16Schinke S P Gilchrist L D (1985) Preventing substance abuse with

children and adolescents Journal of Consulting and Clinical

Psychology 53596ndash602Skara S N Sussman S (2003) A review of 25 long-term adolescent

tobacco and other drug use prevention program evaluations

Preventive MedicineSmith C Lizotte A J Thornberry T P Krohn M D (1995)

Resilient youth identifying factors that prevent high-risk youth

from engaging in delinquency and drug use Delinquency and

Disrepute in the Life Course Greenwich CT John Hagan JAI

press 217ndash247Sommers P V (1972) The Biology of Behavior Australia Pty ltd

Sydney John Wiley amp SonsSt Pierre T L Kaltreider D L Mark M M Aikin K J (1992)

Drug prevention in a community setting a longitudinal study of the

relative effectiveness of a three-year primary prevention program in

boys and girls clubs across the nation American Journal of

Community Psychology 20673ndash706Stein J A Newcomb M D Bentler P M (1987) An eight year study

of multiple influences on drug use and drug use consequences

Journal of Personality and Social Psychology 531094ndash1105Sully J (1884) Outlines of Psychology New York D Appleton amp CoSussman S (1989) Two social influence perspectives of tobacco use

development and prevention Health Education Research Theory

and Practice 4213ndash223Sussman S (1991) Curriculum development in school-based prevention

research Health Education Research Theory and Practice

6339ndash351Sussman S (1996) Development of a school-based drug abuse

prevention curriculum for high risk youth Journal of

Psychoactive Drugs 28169ndash182Sussman S Ames S L (2001) The social psychology of drug abuse

Buckingham GB Open University PressSussman S Unger J (2004) A drug abuse theoretical integration a

transdisciplinary speculation Substance Use amp Misuse

2012 Sussman et al

ORDER REPRINTS

Sussman S Dent C W Burton D Stacy A W Flay B R (1995a)

Developing school-based tobacco use prevention and cessation

programs Thousand Oaks CA Sage Publications IncSussman S Dent C W Simon T R Stacy A W Galaif E R

Moss M A Craig S Johnson C A (1995b) Effectiveness of

social influence substance abuse prevention curricula in compre-

hensive and continuation high schools Drugs and Society 865ndash81Sussman S Dent C W Galaif E R (1997) The correlates of

substance abuse and dependence among adolescents at high risk

for drug abuse Journal of Substance Abuse 9241ndash255Sussman S Dent C W Stacy A W (1996) The relation of pro-drug

use myths with self-reported drug use among youth at continuation

high schools Journal of Applied Social Psychology 26214ndash267Sussman S Dent C W Stacy A Craig S (1998) One-year outcomes

of project towards no drug abuse Preventive Medicine 27632ndash642

(erratum 766)Sussman S Dent C W Stacy S (2002) Project towards no drug

abuse a review of the findings and future directions American

Journal of Health Behavior 26354ndash365Sussman S McCuller W J Dent C W (2003) The associations of

social self-control personality disorders and demographics with

drug use among high risk youth Addictive Behaviors 281159ndash1166Sussman S Rohrbach L Patel R Holiday K (2003) A look at an

interactive classroom-based drug abuse prevention program

Interactive contents and suggestions for research Journal of Drug

Education 33355ndash368Sussman S Sun P McCuller W J Dent C W (2003) Project

towards no drug abuse two year outcomes of a trial that compares

health educator delivery to self-instruction Preventive Medicine

37155ndash162Tarter R E Vanyukov M (1994) Alcoholism a developmental disorder

Journal of Consulting and Clinical Psychology 621096ndash1107Thornton T N Craft C A Dahlberg L L Lynch B S Baer K

(2000) Best Practices of Youth Violence Prevention A Sourcebook

for Community Action Atlanta GA Division of Violence

Prevention Centers for Disease Control and PreventionTobler N S (1986) Meta-analysis of 143 adolescent drug prevention

programs quantitative outcome of program participants compared to

a control or comparison group Journal of Drug Issues 16537ndash567Tobler N S Roona M R Ochshorn P Marshall D G Streke

A V Stackpole K M (2000) School-based adolescent drug

Motivation Skills and Decision Making 2013

ORDER REPRINTS

prevention programs 1998 Meta-analysis The Journal of Primary

Prevention 20275ndash336US Department of Health and Human Services (USDHHS) (2003)

Substance Abuse andMental Health Services Administration Center

for Substance Abuse Prevention Science-based prevention programs and

principles 2002 Rockville MD US DHHS (SMA)03-3764 Also

see httpmodelprogramssamhsagovUnger J Baezconde-Garbanati L Shakib S Palmer P H Nezami

E Mora J (2004) What are the implications of structuralcultural

theory for drug abuse prevention Substance Use amp MisuseUpshaw H S Ostrom T M (1984) Psychological perspective in

attitude research In Eiser J R ed Attitudinal Judgment New

York Springer-Verlag 23ndash42Valente T W Gallaher P Mouttapa M (2004) Using social network

theory to understand and prevent substance use a transdisciplinary

perspective Substance Use amp MisuseVorrath H Brendtro L (1985) Positive peer culture 2nd edn Aldine

ChicagoWaldron H B Slesnick N Brody J L Turner C W Peterson T R

(2001) Treatment outcomes for adolescent substance abuse at 4-

and 7-month assessments Journal of Consulting amp Clinical

Psychology 69(5)802ndash813Watson D L Tharp R G (2002) Self-directed behavior Self-

modification for personal adjustment 8th edn Belmont CA

WadsworthWeissberg R P Caplan M Z Sivo P J (1989) A new conceptual

framework for establishing school-based social competence promo-

tion programs In Bond L A Compas B E eds Primary

Prevention amp Promotion in the Schools Newbury Park CA Sage

255ndash296Wills T A (1986) Stress and coping in early adolescence relationships

to substance use in urban school samples Health Psychology

5503ndash529Wills T A Cleary S D (1995) Stress-coping model for alcohol-

tobacco interactions in adolescence In Fertig J B Allen J P

eds Alcohol and Tobacco From Basic Science to Clinical Practice

Bethesda MD National Institute on Alcohol Abuse and

Alcoholism 107ndash128Wills T A Cleary S D (1999) Peer and adolescent substance use

among 6thndash9th graders Latent growth analyses of influence versus

selection mechanisms Health Psychology 18453ndash463

2014 Sussman et al

ORDER REPRINTS

Wills T A Hirky A E (1996) Coping and substance abuse InZeidner M Endler N S eds Handbook of Coping TheoryResearch and Applications New York Wiley 279ndash302

Wills T A Stoolmiller M (2002) The role of self-control in earlyescalation of substance use a time-varying analysis Journal ofConsulting and Clinical Psychology 70986ndash997

Wills T A Baker E Botvin G J (1989) Dimensions of assertivenessdifferential relationships to substance use in early adolescenceJournal of Consulting and Clinical Psychology 57(4)473ndash478

Wills T A Vaccaro D McNamara G (1994) Novelty seeking risktaking and related constructs as predictors of adolescent substanceuse an application of Cloningerrsquos theory Journal of SubstanceAbuse 61ndash20

Wills T A McNamara G Vaccaro D Hirky A E (1996a)Escalated substance use a longitudinal grouping analysis fromearly to middle adolescence Journal of Abnormal Psychology105166ndash180

Wills T A Pierce J P Evans R I (1996b) Large-scale environmentalrisk factors for substance use American Behavioral Scientist39808ndash822

Wills T A Windle M Cleary S D (1998) Role of temperamentnovelty-seeking and self-control in adolescent substance useJournal of Personality and Social Psychology 74387ndash406

Wills T A Sandy J M Shinar O (1999) Substance use level andproblems in late adolescence a mediational model based on self-control and coping motives Experimental and ClinicalPsychopharmacology 7122ndash134

Wills T A Cleary S D Filer M Shinar O Mariani J Spera K(2001) Temperament and self-control related to early-onsetsubstance use test of a developmental model Prevention Science2145ndash163

Wills T A Sandy J M Yaeger A (2002) Moderators of therelationship between substance use level and problems test of aself-regulation model in adolescence Journal of AbnormalPsychology 1113ndash21

Wills T A Gibbons F X Gerrard M Murry V Brody G (in press-a) Family communication and religiosity related to substance useand sexual behavior in early adolescence Psychology of AddictiveBehaviors

Wills T A Resko J Ainette M Mendoza D (in press-b) The role ofparent and peer support in adolescent substance use a test ofmediated effects Psychology of Addictive Behaviors

Motivation Skills and Decision Making 2015

ORDER REPRINTS

Young P T (1936) Motivation of Behavior New York John Wiley andSons

Zimmerman B J (2000) Attaining self-regulation a social cognitivemodel In Boekaerts M Pintrich P R eds Handbook of Self-Regulation San Diego Academic Press 13ndash39

2016 Sussman et al

Request PermissionOrder Reprints

Reprints of this article can also be ordered at

httpwwwdekkercomservletproductDOI101081JA200034769

Request Permission or Order Reprints Instantly

Interested in copying and sharing this article In most cases US Copyright Law requires that you get permission from the articlersquos rightsholder before using copyrighted content

All information and materials found in this article including but not limited to text trademarks patents logos graphics and images (the Materials) are the copyrighted works and other forms of intellectual property of Marcel Dekker Inc or its licensors All rights not expressly granted are reserved

Get permission to lawfully reproduce and distribute the Materials or order reprints quickly and painlessly Simply click on the Request Permission Order Reprints link below and follow the instructions Visit the US Copyright Office for information on Fair Use limitations of US copyright law Please refer to The Association of American Publishersrsquo (AAP) website for guidelines on Fair Use in the Classroom

The Materials are for your personal use only and cannot be reformatted reposted resold or distributed by electronic means or otherwise without permission from Marcel Dekker Inc Marcel Dekker Inc grants you the limited right to display the Materials only on your personal computer or personal wireless device and to copy and download single copies of such Materials provided that any copyright trademark or other notice appearing on such Materials is also retained by displayed copied or downloaded as part of the Materials and is not removed or obscured and provided you do not edit modify alter or enhance the Materials Please refer to our Website User Agreement for more details

ORDER REPRINTS

The high-risk sample Journal of Consulting and Clinical Psychology

67631ndash647Conducts Problems Prevention Research Group (CPPRG) (2000)

Merging universal and indicated prevention programs the fast

track model Addictive Behaviors 25913ndash927Council of Philosophical Studies (1981) Psychology and the Philosophy

of Mind in the Philosophy Curriculum San Francisco San Francisco

State UniversityCummings K M Hellmann R Emont S L (1988) Correlates of

participation in a worksite stop smoking program Journal of

Behavioral Medicine 11267ndash277Curry S Wagner E H Gothaus L C (1990) Intrinsic and extrinsic

motivation for smoking cessation Journal of Consulting and

Clinical Psychology 58310ndash316Dent C W Sussman S McCuller W J Stacy A W (2001) Drug

abuse prevention among youth at comprehensive high schools

Preventive Medicine 32514ndash520Dewey J (1886) Psychology New York HarperDishion T J French D C Patterson G R (1995) The development

and ecology of antisocial behavior In Cicchetti D Cohen D

eds Manual of developmental psychopathology New York John

Wiley 421ndash471Eggert L L Herting J R (1991) Preventing teenage drug abuse

exploratory effects of network social support Youth and Society

22482ndash534 [Reprinted National Prevention Evaluation Research

CollectionRockville MD Aspen 1993]Eggert L L Herting J R Thompson E A Nicholas L J Dicker

B G (1994) Preventing adolescent drug abuse and high school

dropout through an intensive school-based social network devel-

opment program American Journal of Health Promotion

8202ndash214Eggert L L Thompson E A Herting J R Nicholas L J (1995)

Reducing suicide potential among high-risk youth tests of a school-

based prevention program Suicide amp Life-Threatening Behavior

25276ndash296Ellickson P L Bell R M (1990) Drug prevention in junior high a

multi-site longitudinal test Science 2471299ndash1305Elliott D S (Series ed) (2003) Blueprints for violence prevention

Boulder CO Institute of Behavioral Science Regents of the

University of Colorado wwwcoloradoeducspvblueprints

2006 Sussman et al

ORDER REPRINTS

Farrell A D Danish S J (1993) Peer drug associations and emotionalrestraint Causes or consequences of adolescent drug use Journal ofConsulting and Clinical Psychology 61327ndash334

Festinger L A (1957) A Theory of Cognitive Dissonance New YorkHarper amp Row

Fuqua J Stokols D Gress J Phillips K Harvey R (2004)Transdisciplinary collaboration as a basis for enhancing the scienceand prevention of substance use and abuse Substance Use ampMisuse

Giuliano J D (1994) A peer education program to promote the use ofconflict resolution skills among at-risk school-age males PublicHealth Reports 109158ndash169

Glynn K Levanthal H Hirschman R (1985) A cognitivedevelopmental approach to smoking prevention In Bell C SBattjes R eds Prevention research Deterring Drug Abuse AmongChildren and Adolescents Rockville MD NIDA ResearchMonograph 63

Glynn T J (1989) Essential elements of school-based smokingprevention programs Journal of School Health 59181ndash188

Goodman R M Burdine J N Meehan E McLeroy K R eds(1993) Community coalitions for health promotion Special issue ofHealth Education Research Theory and Practice 8309ndash453

Goodyear R D Newcomb M D Locke T F (2002) PregnantLatina teenagers psychosocial and developmental determinants ofhow they select and perceive the men who father their childrenJournal of Counseling Psychology 49187ndash201

Gordon R (1987) An operational classification of disease preventionIn Steinberg J A Silverman M M eds Preventing MentalDisorders Rockville MD DHHS 20ndash26

Graham J W Johnson C A Hansen W B Flay B R Gee M(1990) Drug use prevention programs gender and ethnicityevaluation of three seventh-grade project SMART cohortsPreventive Medicine 19305ndash313

Griffin K W Botvin G J Nichols T R Doyal M M (2003)Effectiveness of a universal drug abuse prevention approach foryouth at high risk for substance use initiation Preventive Medicine36(1)1ndash7

Hamilton S (August 20 2000) Views slowly changing on alternativeschools The Sacramento Bee 1ndash3

Hansen W B (1992) School-based substance abuse prevention a reviewof the state of the art in curriculum 1980ndash1990 Health EducationResearch 7403ndash430

Motivation Skills and Decision Making 2007

ORDER REPRINTS

Hansen W B Johnson C A Flay B R Graham J W Sobel J(1988) Affective and social influences approaches to the preventionof multiple substance abuse among seventh grade students resultsfrom project SMART Preventive Medicine 17135ndash154

Hansen W B Graham J W (1991) Preventing alcohol marijuanaand cigarette use among adolescents peer pressure and resistancetraining versus establishing conservative norms PreventiveMedicine 20414ndash430

Hawkins D H Catalano R F Miller J Y (1992) Risk andprotective factors for alcohol and other drug problems inadolescence and early adulthood Implications for substanceabuse prevention Psychological Bulletin 11254ndash105

Hawkins J D Catalano R F Kosterman R Abbott R Hill K G(1999) Preventing adolescent health-risk behaviors by strengthen-ing protection during childhood Archives of Pediatric amp AdolescentMedicine 153226ndash234

Heider F (1958) The Psychology of Interpersonal Relations New YorkWiley

Henggeler S W Pickrel S G Brondino M J Crouch J L (1996)Eliminating (almost) treatment dropout of substance abusing ordependent delinquents through home-based multisystemic therapyAmerican Journal of Psychiatry 153(3)427ndash428

Henggeler S W Melton G B Brondino M J Scherer D GHanley J H (1997) Multisystemic therapy with violent andchronic juvenile offenders and their families the role of treatmentfidelity in successful dissemination Journal of Consulting andClinical Psychology 65(5)821ndash833

Henggeler S W Schoenwald S K Borduin C M Rowland M DCunningham P B (1998) Multisystemic treatment of antisocialbehavior in children and adolescents New York The Guilford Press

Henggeler S W Pickrel S G Brondino M J (1999) Multisystemictreatment of substance-abusing and dependent delinquents out-comes treatment fidelity and transportability Mental HealthServices Residual 1(3)171ndash84

Johnson C A Pentz M A Weber M D Dwyer J H Baer NMacKinnon D P Hansen W B Flay B R (1990) Relativeeffectiveness of comprehensive community programming for drugabuse prevention with high-risk and low-risk adolescents Journalof Consulting and Clinical Psychology 58447ndash456

Kaftarian S J Hansen W B eds (1994) CSAP special issuecommunity partnership program Journal of Community Psychologypages 205

2008 Sussman et al

ORDER REPRINTS

Karoly P (1993) Mechanisms in self-regulation A systems view AnnualReview of Psychology 4423ndash51

Karoly P (1980) Person variables in therapeutic change and develop-ment In Karoly P Steffen J J eds Improving the Long-TermEffects of Psychotherapy New York Gardner Press 195ndash261

Kendall P C Braswell L (1982) Cognitive-behavioral self-controltherapy for children a components analysis Journal of Consultingand Clinical Psychology 50672ndash689

Kerr M Tremblay R E Pagani L Vitaro F (1997) Boysrsquobehavioral inhibition and the risk of later delinquency Archivesof General Psychiatry 54809ndash816

Klein N C Alexander J F Parsons B V (1977) Impact of familysystems intervention on recidivism and sibling delinquency a modelof primary prevention and program evaluation Journal ofConsulting and Clinical Psychology 45(3)469ndash474

Kumpfer K L (1999) Outcomes measures of interventions in the studyof children of substance-abusing parents Pediatrics 1031128ndash1144

Lau R R Hartman K A Ware J E (1986) Health as a valuemethodological and theoretical considerations Health Psychology525ndash43

Lichtenstein E L Glasgow R E (1997) A pragmatic framework forsmoking cessation implications for clinical and public healthprograms Psychology of Addictive Behaviors 11142ndash151

Locke T F Newcomb M D (in press) Childhood maltreatmentparent drug problems polydrug problems and parenting practicesa test of gender differences and four theoretical perspectivesJournal of Family Psychology

McCreary D R Newcomb M D Sadava S W (1999) The male rolealcohol use and alcohol problems a structural modeling examina-tion in adult women and men Journal of Counseling Psychology46109ndash124

McGee L Newcomb M D (1992) General deviance syndromeexpanded hierarchical evaluations at four ages from earlyadolescence to adulthood Journal of Consulting amp ClinicalPsychology 60766ndash776

Miller W R Brown J M (1991) Self-regulation as a conceptual basisfor the prevention of addictive behaviours In Heather N MillerW R Greeley J eds Self-control and the Addictive BehavioursSydney Australia Maxwell Macmillan 3ndash79

Miller W R Leckman A L Delaney H D Tinkcom M (1993)Long-term follow-up of behavioral self-control training forproblem drinkers Journal of Studies on Alcohol 53249ndash261

Motivation Skills and Decision Making 2009

ORDER REPRINTS

Miller W R Rollnick S (1991) Motivational InterviewingPreparing People to Change Addictive Behavior New YorkGuilford Press

Moffitt T E Caspi A Harrington H Milne B J (2002) Males onthe life-course-persistent and adolescence-limited antisocial path-ways follow-up at age 26 years Development and Psychopathology14(1)179ndash207

National Institute on Drug Abuse (NIDA) (1997) Drug abuseprevention What works NIH Publication 97-4110 DHHSNational Institutes of Health National Institute on Drug AbuseOffice of Science Policy and Communications Rockville MD

Newcomb M D (1992a) Substance abuse and control in the UnitedStates ethical and legal issues Social Science and Medicine35471ndash479

Newcomb M D (1992b) Understanding the multidimensional nature ofdrug use and abuse The role of consumption risk factors andprotective factors In Glantz M D Pickens R eds Vulnerabilityto Drug Abuse Washington DC American PsychologicalAssociation 255ndash298

Newcomb M D (1996a) Pseudomaturity among adolescents constructvalidation sex differences and associations in adulthood Journalof Drug Issues 26477ndash504

Newcomb M D (1996b) Adolescence Pathologizing a normal processThe Counseling Psychologist 24482ndash490

Newcomb M D (1997) Psychosocial predictors and consequences ofdrug use a developmental perspective within a prospective studyJournal of Addictive Diseases 1651ndash89

Newcomb M D Bentler P M (1988) Consequences of Adolescent DrugUse Impact on the Lives of Young Adults Beverly Hills CA Sage

Newcomb M D Bentler P M (1989) Substance use and abuse amongchildren and teenagers American Psychologist 44242ndash248

Newcomb M D Harlow L L (1986) Life events and substance useamong adolescents Mediating effects of perceived loss of controland meaninglessness in life Journal of Personality and SocialPsychology 51564ndash577

Newcomb M D Chou C-P Bentler P M Huba G J (1988)Cognitive motivations for drug use among adolescents longitudinaltests of gender differences and predictors of change in drug useJournal of Counseling Psychology 35426ndash438

Newcomb M D Abbott R D Catalano R F Hawkins J DBattin-Pearson S R Hill K (2002) Mediational and deviancetheories of late high school failure Process roles of structural

2010 Sussman et al

ORDER REPRINTS

strains academic competence and general versus specific problem

behaviors Journal of Counseling Psychology 49172ndash186Nezami E Sussman S Pentz M A (2003) Motivation in tobacco use

cessation research Substance Use amp Misuse 3825ndash5Novak S P Clayton R R (2001) The influence of school environment

and self-regulation on transitions between stages of cigarette

smoking Health Psychology 20196ndash207Offord D R (2000) Selection of levels of prevention Addictive

Behaviors 25833ndash842Palinkas L A Atkins C J Miller C Ferreira D (1996) Social skills

training for drug prevention in high-risk female adolescents

Preventive Medicine 25692ndash701Patock-Peckham J A Cheong J-W Balhorn M E Nagoshi C T

(2001) A model of parenting styles self-regulation perceived

drinking control and alcohol use and problems Alcoholism

Experimental and Clinical Research 251284ndash1292Pentz M A (1994) Directions for future research in drug abuse

prevention Preventive Medicine 23646ndash652Pentz M A Dwyer J H MacKinnon D Flay B R Hansen W B

Wang E Y I Johnson C A (1989) A multi-community trial for

primary prevention of adolescent drug abuse effects on drug use

prevalence JAMA 2623259ndash3266Pentz M A Mares D Schinke S Rohrbach L (in press) Political

science public policy and drug abuse prevention Substance Use amp

MisuseProchaska J O DiClemente C C (1982) Transtheoretical therapy

toward a more integrative model of change Psychotherapy Theory

Research and Practice 19275ndash288Pulkkinen L Pitkanen T (1994) A prospective study of the precursors

to problem drinking in young adulthood Journal of Studies on

Alcohol 55578ndash587Rathus S A Nevid J S (1977) Behavior Therapy Strategies for

Solving Problems in Living New York Doubleday and Company

IncResnicow K Botvin G (1993) School-based substance use prevention

programs why do effects decay Preventive Medicine 22484ndash490Rutter M Dunn J Plomin R Simonoff E Pickles A Maughan

B Ormel J Meyer J Eaves L (1997) Integrating nature and

nurture implications of person-environment interactions for

developmental psychopathology Development and Psychopathology

9335ndash364

Motivation Skills and Decision Making 2011

ORDER REPRINTS

Salomon G Stein Y Eisenberg S Klein L (1984) Adolescent

smokers and nonsmokers profiles and their changing structure

Preventive Medicine 13446ndash461Sambrano S (1999) National cross-site evaluation of high risk youth

programs In Interim findings Bulletin Washington DC CSAP

SAMSHA US DHHS May 1ndash16Schinke S P Gilchrist L D (1985) Preventing substance abuse with

children and adolescents Journal of Consulting and Clinical

Psychology 53596ndash602Skara S N Sussman S (2003) A review of 25 long-term adolescent

tobacco and other drug use prevention program evaluations

Preventive MedicineSmith C Lizotte A J Thornberry T P Krohn M D (1995)

Resilient youth identifying factors that prevent high-risk youth

from engaging in delinquency and drug use Delinquency and

Disrepute in the Life Course Greenwich CT John Hagan JAI

press 217ndash247Sommers P V (1972) The Biology of Behavior Australia Pty ltd

Sydney John Wiley amp SonsSt Pierre T L Kaltreider D L Mark M M Aikin K J (1992)

Drug prevention in a community setting a longitudinal study of the

relative effectiveness of a three-year primary prevention program in

boys and girls clubs across the nation American Journal of

Community Psychology 20673ndash706Stein J A Newcomb M D Bentler P M (1987) An eight year study

of multiple influences on drug use and drug use consequences

Journal of Personality and Social Psychology 531094ndash1105Sully J (1884) Outlines of Psychology New York D Appleton amp CoSussman S (1989) Two social influence perspectives of tobacco use

development and prevention Health Education Research Theory

and Practice 4213ndash223Sussman S (1991) Curriculum development in school-based prevention

research Health Education Research Theory and Practice

6339ndash351Sussman S (1996) Development of a school-based drug abuse

prevention curriculum for high risk youth Journal of

Psychoactive Drugs 28169ndash182Sussman S Ames S L (2001) The social psychology of drug abuse

Buckingham GB Open University PressSussman S Unger J (2004) A drug abuse theoretical integration a

transdisciplinary speculation Substance Use amp Misuse

2012 Sussman et al

ORDER REPRINTS

Sussman S Dent C W Burton D Stacy A W Flay B R (1995a)

Developing school-based tobacco use prevention and cessation

programs Thousand Oaks CA Sage Publications IncSussman S Dent C W Simon T R Stacy A W Galaif E R

Moss M A Craig S Johnson C A (1995b) Effectiveness of

social influence substance abuse prevention curricula in compre-

hensive and continuation high schools Drugs and Society 865ndash81Sussman S Dent C W Galaif E R (1997) The correlates of

substance abuse and dependence among adolescents at high risk

for drug abuse Journal of Substance Abuse 9241ndash255Sussman S Dent C W Stacy A W (1996) The relation of pro-drug

use myths with self-reported drug use among youth at continuation

high schools Journal of Applied Social Psychology 26214ndash267Sussman S Dent C W Stacy A Craig S (1998) One-year outcomes

of project towards no drug abuse Preventive Medicine 27632ndash642

(erratum 766)Sussman S Dent C W Stacy S (2002) Project towards no drug

abuse a review of the findings and future directions American

Journal of Health Behavior 26354ndash365Sussman S McCuller W J Dent C W (2003) The associations of

social self-control personality disorders and demographics with

drug use among high risk youth Addictive Behaviors 281159ndash1166Sussman S Rohrbach L Patel R Holiday K (2003) A look at an

interactive classroom-based drug abuse prevention program

Interactive contents and suggestions for research Journal of Drug

Education 33355ndash368Sussman S Sun P McCuller W J Dent C W (2003) Project

towards no drug abuse two year outcomes of a trial that compares

health educator delivery to self-instruction Preventive Medicine

37155ndash162Tarter R E Vanyukov M (1994) Alcoholism a developmental disorder

Journal of Consulting and Clinical Psychology 621096ndash1107Thornton T N Craft C A Dahlberg L L Lynch B S Baer K

(2000) Best Practices of Youth Violence Prevention A Sourcebook

for Community Action Atlanta GA Division of Violence

Prevention Centers for Disease Control and PreventionTobler N S (1986) Meta-analysis of 143 adolescent drug prevention

programs quantitative outcome of program participants compared to

a control or comparison group Journal of Drug Issues 16537ndash567Tobler N S Roona M R Ochshorn P Marshall D G Streke

A V Stackpole K M (2000) School-based adolescent drug

Motivation Skills and Decision Making 2013

ORDER REPRINTS

prevention programs 1998 Meta-analysis The Journal of Primary

Prevention 20275ndash336US Department of Health and Human Services (USDHHS) (2003)

Substance Abuse andMental Health Services Administration Center

for Substance Abuse Prevention Science-based prevention programs and

principles 2002 Rockville MD US DHHS (SMA)03-3764 Also

see httpmodelprogramssamhsagovUnger J Baezconde-Garbanati L Shakib S Palmer P H Nezami

E Mora J (2004) What are the implications of structuralcultural

theory for drug abuse prevention Substance Use amp MisuseUpshaw H S Ostrom T M (1984) Psychological perspective in

attitude research In Eiser J R ed Attitudinal Judgment New

York Springer-Verlag 23ndash42Valente T W Gallaher P Mouttapa M (2004) Using social network

theory to understand and prevent substance use a transdisciplinary

perspective Substance Use amp MisuseVorrath H Brendtro L (1985) Positive peer culture 2nd edn Aldine

ChicagoWaldron H B Slesnick N Brody J L Turner C W Peterson T R

(2001) Treatment outcomes for adolescent substance abuse at 4-

and 7-month assessments Journal of Consulting amp Clinical

Psychology 69(5)802ndash813Watson D L Tharp R G (2002) Self-directed behavior Self-

modification for personal adjustment 8th edn Belmont CA

WadsworthWeissberg R P Caplan M Z Sivo P J (1989) A new conceptual

framework for establishing school-based social competence promo-

tion programs In Bond L A Compas B E eds Primary

Prevention amp Promotion in the Schools Newbury Park CA Sage

255ndash296Wills T A (1986) Stress and coping in early adolescence relationships

to substance use in urban school samples Health Psychology

5503ndash529Wills T A Cleary S D (1995) Stress-coping model for alcohol-

tobacco interactions in adolescence In Fertig J B Allen J P

eds Alcohol and Tobacco From Basic Science to Clinical Practice

Bethesda MD National Institute on Alcohol Abuse and

Alcoholism 107ndash128Wills T A Cleary S D (1999) Peer and adolescent substance use

among 6thndash9th graders Latent growth analyses of influence versus

selection mechanisms Health Psychology 18453ndash463

2014 Sussman et al

ORDER REPRINTS

Wills T A Hirky A E (1996) Coping and substance abuse InZeidner M Endler N S eds Handbook of Coping TheoryResearch and Applications New York Wiley 279ndash302

Wills T A Stoolmiller M (2002) The role of self-control in earlyescalation of substance use a time-varying analysis Journal ofConsulting and Clinical Psychology 70986ndash997

Wills T A Baker E Botvin G J (1989) Dimensions of assertivenessdifferential relationships to substance use in early adolescenceJournal of Consulting and Clinical Psychology 57(4)473ndash478

Wills T A Vaccaro D McNamara G (1994) Novelty seeking risktaking and related constructs as predictors of adolescent substanceuse an application of Cloningerrsquos theory Journal of SubstanceAbuse 61ndash20

Wills T A McNamara G Vaccaro D Hirky A E (1996a)Escalated substance use a longitudinal grouping analysis fromearly to middle adolescence Journal of Abnormal Psychology105166ndash180

Wills T A Pierce J P Evans R I (1996b) Large-scale environmentalrisk factors for substance use American Behavioral Scientist39808ndash822

Wills T A Windle M Cleary S D (1998) Role of temperamentnovelty-seeking and self-control in adolescent substance useJournal of Personality and Social Psychology 74387ndash406

Wills T A Sandy J M Shinar O (1999) Substance use level andproblems in late adolescence a mediational model based on self-control and coping motives Experimental and ClinicalPsychopharmacology 7122ndash134

Wills T A Cleary S D Filer M Shinar O Mariani J Spera K(2001) Temperament and self-control related to early-onsetsubstance use test of a developmental model Prevention Science2145ndash163

Wills T A Sandy J M Yaeger A (2002) Moderators of therelationship between substance use level and problems test of aself-regulation model in adolescence Journal of AbnormalPsychology 1113ndash21

Wills T A Gibbons F X Gerrard M Murry V Brody G (in press-a) Family communication and religiosity related to substance useand sexual behavior in early adolescence Psychology of AddictiveBehaviors

Wills T A Resko J Ainette M Mendoza D (in press-b) The role ofparent and peer support in adolescent substance use a test ofmediated effects Psychology of Addictive Behaviors

Motivation Skills and Decision Making 2015

ORDER REPRINTS

Young P T (1936) Motivation of Behavior New York John Wiley andSons

Zimmerman B J (2000) Attaining self-regulation a social cognitivemodel In Boekaerts M Pintrich P R eds Handbook of Self-Regulation San Diego Academic Press 13ndash39

2016 Sussman et al

Request PermissionOrder Reprints

Reprints of this article can also be ordered at

httpwwwdekkercomservletproductDOI101081JA200034769

Request Permission or Order Reprints Instantly

Interested in copying and sharing this article In most cases US Copyright Law requires that you get permission from the articlersquos rightsholder before using copyrighted content

All information and materials found in this article including but not limited to text trademarks patents logos graphics and images (the Materials) are the copyrighted works and other forms of intellectual property of Marcel Dekker Inc or its licensors All rights not expressly granted are reserved

Get permission to lawfully reproduce and distribute the Materials or order reprints quickly and painlessly Simply click on the Request Permission Order Reprints link below and follow the instructions Visit the US Copyright Office for information on Fair Use limitations of US copyright law Please refer to The Association of American Publishersrsquo (AAP) website for guidelines on Fair Use in the Classroom

The Materials are for your personal use only and cannot be reformatted reposted resold or distributed by electronic means or otherwise without permission from Marcel Dekker Inc Marcel Dekker Inc grants you the limited right to display the Materials only on your personal computer or personal wireless device and to copy and download single copies of such Materials provided that any copyright trademark or other notice appearing on such Materials is also retained by displayed copied or downloaded as part of the Materials and is not removed or obscured and provided you do not edit modify alter or enhance the Materials Please refer to our Website User Agreement for more details

ORDER REPRINTS

Farrell A D Danish S J (1993) Peer drug associations and emotionalrestraint Causes or consequences of adolescent drug use Journal ofConsulting and Clinical Psychology 61327ndash334

Festinger L A (1957) A Theory of Cognitive Dissonance New YorkHarper amp Row

Fuqua J Stokols D Gress J Phillips K Harvey R (2004)Transdisciplinary collaboration as a basis for enhancing the scienceand prevention of substance use and abuse Substance Use ampMisuse

Giuliano J D (1994) A peer education program to promote the use ofconflict resolution skills among at-risk school-age males PublicHealth Reports 109158ndash169

Glynn K Levanthal H Hirschman R (1985) A cognitivedevelopmental approach to smoking prevention In Bell C SBattjes R eds Prevention research Deterring Drug Abuse AmongChildren and Adolescents Rockville MD NIDA ResearchMonograph 63

Glynn T J (1989) Essential elements of school-based smokingprevention programs Journal of School Health 59181ndash188

Goodman R M Burdine J N Meehan E McLeroy K R eds(1993) Community coalitions for health promotion Special issue ofHealth Education Research Theory and Practice 8309ndash453

Goodyear R D Newcomb M D Locke T F (2002) PregnantLatina teenagers psychosocial and developmental determinants ofhow they select and perceive the men who father their childrenJournal of Counseling Psychology 49187ndash201

Gordon R (1987) An operational classification of disease preventionIn Steinberg J A Silverman M M eds Preventing MentalDisorders Rockville MD DHHS 20ndash26

Graham J W Johnson C A Hansen W B Flay B R Gee M(1990) Drug use prevention programs gender and ethnicityevaluation of three seventh-grade project SMART cohortsPreventive Medicine 19305ndash313

Griffin K W Botvin G J Nichols T R Doyal M M (2003)Effectiveness of a universal drug abuse prevention approach foryouth at high risk for substance use initiation Preventive Medicine36(1)1ndash7

Hamilton S (August 20 2000) Views slowly changing on alternativeschools The Sacramento Bee 1ndash3

Hansen W B (1992) School-based substance abuse prevention a reviewof the state of the art in curriculum 1980ndash1990 Health EducationResearch 7403ndash430

Motivation Skills and Decision Making 2007

ORDER REPRINTS

Hansen W B Johnson C A Flay B R Graham J W Sobel J(1988) Affective and social influences approaches to the preventionof multiple substance abuse among seventh grade students resultsfrom project SMART Preventive Medicine 17135ndash154

Hansen W B Graham J W (1991) Preventing alcohol marijuanaand cigarette use among adolescents peer pressure and resistancetraining versus establishing conservative norms PreventiveMedicine 20414ndash430

Hawkins D H Catalano R F Miller J Y (1992) Risk andprotective factors for alcohol and other drug problems inadolescence and early adulthood Implications for substanceabuse prevention Psychological Bulletin 11254ndash105

Hawkins J D Catalano R F Kosterman R Abbott R Hill K G(1999) Preventing adolescent health-risk behaviors by strengthen-ing protection during childhood Archives of Pediatric amp AdolescentMedicine 153226ndash234

Heider F (1958) The Psychology of Interpersonal Relations New YorkWiley

Henggeler S W Pickrel S G Brondino M J Crouch J L (1996)Eliminating (almost) treatment dropout of substance abusing ordependent delinquents through home-based multisystemic therapyAmerican Journal of Psychiatry 153(3)427ndash428

Henggeler S W Melton G B Brondino M J Scherer D GHanley J H (1997) Multisystemic therapy with violent andchronic juvenile offenders and their families the role of treatmentfidelity in successful dissemination Journal of Consulting andClinical Psychology 65(5)821ndash833

Henggeler S W Schoenwald S K Borduin C M Rowland M DCunningham P B (1998) Multisystemic treatment of antisocialbehavior in children and adolescents New York The Guilford Press

Henggeler S W Pickrel S G Brondino M J (1999) Multisystemictreatment of substance-abusing and dependent delinquents out-comes treatment fidelity and transportability Mental HealthServices Residual 1(3)171ndash84

Johnson C A Pentz M A Weber M D Dwyer J H Baer NMacKinnon D P Hansen W B Flay B R (1990) Relativeeffectiveness of comprehensive community programming for drugabuse prevention with high-risk and low-risk adolescents Journalof Consulting and Clinical Psychology 58447ndash456

Kaftarian S J Hansen W B eds (1994) CSAP special issuecommunity partnership program Journal of Community Psychologypages 205

2008 Sussman et al

ORDER REPRINTS

Karoly P (1993) Mechanisms in self-regulation A systems view AnnualReview of Psychology 4423ndash51

Karoly P (1980) Person variables in therapeutic change and develop-ment In Karoly P Steffen J J eds Improving the Long-TermEffects of Psychotherapy New York Gardner Press 195ndash261

Kendall P C Braswell L (1982) Cognitive-behavioral self-controltherapy for children a components analysis Journal of Consultingand Clinical Psychology 50672ndash689

Kerr M Tremblay R E Pagani L Vitaro F (1997) Boysrsquobehavioral inhibition and the risk of later delinquency Archivesof General Psychiatry 54809ndash816

Klein N C Alexander J F Parsons B V (1977) Impact of familysystems intervention on recidivism and sibling delinquency a modelof primary prevention and program evaluation Journal ofConsulting and Clinical Psychology 45(3)469ndash474

Kumpfer K L (1999) Outcomes measures of interventions in the studyof children of substance-abusing parents Pediatrics 1031128ndash1144

Lau R R Hartman K A Ware J E (1986) Health as a valuemethodological and theoretical considerations Health Psychology525ndash43

Lichtenstein E L Glasgow R E (1997) A pragmatic framework forsmoking cessation implications for clinical and public healthprograms Psychology of Addictive Behaviors 11142ndash151

Locke T F Newcomb M D (in press) Childhood maltreatmentparent drug problems polydrug problems and parenting practicesa test of gender differences and four theoretical perspectivesJournal of Family Psychology

McCreary D R Newcomb M D Sadava S W (1999) The male rolealcohol use and alcohol problems a structural modeling examina-tion in adult women and men Journal of Counseling Psychology46109ndash124

McGee L Newcomb M D (1992) General deviance syndromeexpanded hierarchical evaluations at four ages from earlyadolescence to adulthood Journal of Consulting amp ClinicalPsychology 60766ndash776

Miller W R Brown J M (1991) Self-regulation as a conceptual basisfor the prevention of addictive behaviours In Heather N MillerW R Greeley J eds Self-control and the Addictive BehavioursSydney Australia Maxwell Macmillan 3ndash79

Miller W R Leckman A L Delaney H D Tinkcom M (1993)Long-term follow-up of behavioral self-control training forproblem drinkers Journal of Studies on Alcohol 53249ndash261

Motivation Skills and Decision Making 2009

ORDER REPRINTS

Miller W R Rollnick S (1991) Motivational InterviewingPreparing People to Change Addictive Behavior New YorkGuilford Press

Moffitt T E Caspi A Harrington H Milne B J (2002) Males onthe life-course-persistent and adolescence-limited antisocial path-ways follow-up at age 26 years Development and Psychopathology14(1)179ndash207

National Institute on Drug Abuse (NIDA) (1997) Drug abuseprevention What works NIH Publication 97-4110 DHHSNational Institutes of Health National Institute on Drug AbuseOffice of Science Policy and Communications Rockville MD

Newcomb M D (1992a) Substance abuse and control in the UnitedStates ethical and legal issues Social Science and Medicine35471ndash479

Newcomb M D (1992b) Understanding the multidimensional nature ofdrug use and abuse The role of consumption risk factors andprotective factors In Glantz M D Pickens R eds Vulnerabilityto Drug Abuse Washington DC American PsychologicalAssociation 255ndash298

Newcomb M D (1996a) Pseudomaturity among adolescents constructvalidation sex differences and associations in adulthood Journalof Drug Issues 26477ndash504

Newcomb M D (1996b) Adolescence Pathologizing a normal processThe Counseling Psychologist 24482ndash490

Newcomb M D (1997) Psychosocial predictors and consequences ofdrug use a developmental perspective within a prospective studyJournal of Addictive Diseases 1651ndash89

Newcomb M D Bentler P M (1988) Consequences of Adolescent DrugUse Impact on the Lives of Young Adults Beverly Hills CA Sage

Newcomb M D Bentler P M (1989) Substance use and abuse amongchildren and teenagers American Psychologist 44242ndash248

Newcomb M D Harlow L L (1986) Life events and substance useamong adolescents Mediating effects of perceived loss of controland meaninglessness in life Journal of Personality and SocialPsychology 51564ndash577

Newcomb M D Chou C-P Bentler P M Huba G J (1988)Cognitive motivations for drug use among adolescents longitudinaltests of gender differences and predictors of change in drug useJournal of Counseling Psychology 35426ndash438

Newcomb M D Abbott R D Catalano R F Hawkins J DBattin-Pearson S R Hill K (2002) Mediational and deviancetheories of late high school failure Process roles of structural

2010 Sussman et al

ORDER REPRINTS

strains academic competence and general versus specific problem

behaviors Journal of Counseling Psychology 49172ndash186Nezami E Sussman S Pentz M A (2003) Motivation in tobacco use

cessation research Substance Use amp Misuse 3825ndash5Novak S P Clayton R R (2001) The influence of school environment

and self-regulation on transitions between stages of cigarette

smoking Health Psychology 20196ndash207Offord D R (2000) Selection of levels of prevention Addictive

Behaviors 25833ndash842Palinkas L A Atkins C J Miller C Ferreira D (1996) Social skills

training for drug prevention in high-risk female adolescents

Preventive Medicine 25692ndash701Patock-Peckham J A Cheong J-W Balhorn M E Nagoshi C T

(2001) A model of parenting styles self-regulation perceived

drinking control and alcohol use and problems Alcoholism

Experimental and Clinical Research 251284ndash1292Pentz M A (1994) Directions for future research in drug abuse

prevention Preventive Medicine 23646ndash652Pentz M A Dwyer J H MacKinnon D Flay B R Hansen W B

Wang E Y I Johnson C A (1989) A multi-community trial for

primary prevention of adolescent drug abuse effects on drug use

prevalence JAMA 2623259ndash3266Pentz M A Mares D Schinke S Rohrbach L (in press) Political

science public policy and drug abuse prevention Substance Use amp

MisuseProchaska J O DiClemente C C (1982) Transtheoretical therapy

toward a more integrative model of change Psychotherapy Theory

Research and Practice 19275ndash288Pulkkinen L Pitkanen T (1994) A prospective study of the precursors

to problem drinking in young adulthood Journal of Studies on

Alcohol 55578ndash587Rathus S A Nevid J S (1977) Behavior Therapy Strategies for

Solving Problems in Living New York Doubleday and Company

IncResnicow K Botvin G (1993) School-based substance use prevention

programs why do effects decay Preventive Medicine 22484ndash490Rutter M Dunn J Plomin R Simonoff E Pickles A Maughan

B Ormel J Meyer J Eaves L (1997) Integrating nature and

nurture implications of person-environment interactions for

developmental psychopathology Development and Psychopathology

9335ndash364

Motivation Skills and Decision Making 2011

ORDER REPRINTS

Salomon G Stein Y Eisenberg S Klein L (1984) Adolescent

smokers and nonsmokers profiles and their changing structure

Preventive Medicine 13446ndash461Sambrano S (1999) National cross-site evaluation of high risk youth

programs In Interim findings Bulletin Washington DC CSAP

SAMSHA US DHHS May 1ndash16Schinke S P Gilchrist L D (1985) Preventing substance abuse with

children and adolescents Journal of Consulting and Clinical

Psychology 53596ndash602Skara S N Sussman S (2003) A review of 25 long-term adolescent

tobacco and other drug use prevention program evaluations

Preventive MedicineSmith C Lizotte A J Thornberry T P Krohn M D (1995)

Resilient youth identifying factors that prevent high-risk youth

from engaging in delinquency and drug use Delinquency and

Disrepute in the Life Course Greenwich CT John Hagan JAI

press 217ndash247Sommers P V (1972) The Biology of Behavior Australia Pty ltd

Sydney John Wiley amp SonsSt Pierre T L Kaltreider D L Mark M M Aikin K J (1992)

Drug prevention in a community setting a longitudinal study of the

relative effectiveness of a three-year primary prevention program in

boys and girls clubs across the nation American Journal of

Community Psychology 20673ndash706Stein J A Newcomb M D Bentler P M (1987) An eight year study

of multiple influences on drug use and drug use consequences

Journal of Personality and Social Psychology 531094ndash1105Sully J (1884) Outlines of Psychology New York D Appleton amp CoSussman S (1989) Two social influence perspectives of tobacco use

development and prevention Health Education Research Theory

and Practice 4213ndash223Sussman S (1991) Curriculum development in school-based prevention

research Health Education Research Theory and Practice

6339ndash351Sussman S (1996) Development of a school-based drug abuse

prevention curriculum for high risk youth Journal of

Psychoactive Drugs 28169ndash182Sussman S Ames S L (2001) The social psychology of drug abuse

Buckingham GB Open University PressSussman S Unger J (2004) A drug abuse theoretical integration a

transdisciplinary speculation Substance Use amp Misuse

2012 Sussman et al

ORDER REPRINTS

Sussman S Dent C W Burton D Stacy A W Flay B R (1995a)

Developing school-based tobacco use prevention and cessation

programs Thousand Oaks CA Sage Publications IncSussman S Dent C W Simon T R Stacy A W Galaif E R

Moss M A Craig S Johnson C A (1995b) Effectiveness of

social influence substance abuse prevention curricula in compre-

hensive and continuation high schools Drugs and Society 865ndash81Sussman S Dent C W Galaif E R (1997) The correlates of

substance abuse and dependence among adolescents at high risk

for drug abuse Journal of Substance Abuse 9241ndash255Sussman S Dent C W Stacy A W (1996) The relation of pro-drug

use myths with self-reported drug use among youth at continuation

high schools Journal of Applied Social Psychology 26214ndash267Sussman S Dent C W Stacy A Craig S (1998) One-year outcomes

of project towards no drug abuse Preventive Medicine 27632ndash642

(erratum 766)Sussman S Dent C W Stacy S (2002) Project towards no drug

abuse a review of the findings and future directions American

Journal of Health Behavior 26354ndash365Sussman S McCuller W J Dent C W (2003) The associations of

social self-control personality disorders and demographics with

drug use among high risk youth Addictive Behaviors 281159ndash1166Sussman S Rohrbach L Patel R Holiday K (2003) A look at an

interactive classroom-based drug abuse prevention program

Interactive contents and suggestions for research Journal of Drug

Education 33355ndash368Sussman S Sun P McCuller W J Dent C W (2003) Project

towards no drug abuse two year outcomes of a trial that compares

health educator delivery to self-instruction Preventive Medicine

37155ndash162Tarter R E Vanyukov M (1994) Alcoholism a developmental disorder

Journal of Consulting and Clinical Psychology 621096ndash1107Thornton T N Craft C A Dahlberg L L Lynch B S Baer K

(2000) Best Practices of Youth Violence Prevention A Sourcebook

for Community Action Atlanta GA Division of Violence

Prevention Centers for Disease Control and PreventionTobler N S (1986) Meta-analysis of 143 adolescent drug prevention

programs quantitative outcome of program participants compared to

a control or comparison group Journal of Drug Issues 16537ndash567Tobler N S Roona M R Ochshorn P Marshall D G Streke

A V Stackpole K M (2000) School-based adolescent drug

Motivation Skills and Decision Making 2013

ORDER REPRINTS

prevention programs 1998 Meta-analysis The Journal of Primary

Prevention 20275ndash336US Department of Health and Human Services (USDHHS) (2003)

Substance Abuse andMental Health Services Administration Center

for Substance Abuse Prevention Science-based prevention programs and

principles 2002 Rockville MD US DHHS (SMA)03-3764 Also

see httpmodelprogramssamhsagovUnger J Baezconde-Garbanati L Shakib S Palmer P H Nezami

E Mora J (2004) What are the implications of structuralcultural

theory for drug abuse prevention Substance Use amp MisuseUpshaw H S Ostrom T M (1984) Psychological perspective in

attitude research In Eiser J R ed Attitudinal Judgment New

York Springer-Verlag 23ndash42Valente T W Gallaher P Mouttapa M (2004) Using social network

theory to understand and prevent substance use a transdisciplinary

perspective Substance Use amp MisuseVorrath H Brendtro L (1985) Positive peer culture 2nd edn Aldine

ChicagoWaldron H B Slesnick N Brody J L Turner C W Peterson T R

(2001) Treatment outcomes for adolescent substance abuse at 4-

and 7-month assessments Journal of Consulting amp Clinical

Psychology 69(5)802ndash813Watson D L Tharp R G (2002) Self-directed behavior Self-

modification for personal adjustment 8th edn Belmont CA

WadsworthWeissberg R P Caplan M Z Sivo P J (1989) A new conceptual

framework for establishing school-based social competence promo-

tion programs In Bond L A Compas B E eds Primary

Prevention amp Promotion in the Schools Newbury Park CA Sage

255ndash296Wills T A (1986) Stress and coping in early adolescence relationships

to substance use in urban school samples Health Psychology

5503ndash529Wills T A Cleary S D (1995) Stress-coping model for alcohol-

tobacco interactions in adolescence In Fertig J B Allen J P

eds Alcohol and Tobacco From Basic Science to Clinical Practice

Bethesda MD National Institute on Alcohol Abuse and

Alcoholism 107ndash128Wills T A Cleary S D (1999) Peer and adolescent substance use

among 6thndash9th graders Latent growth analyses of influence versus

selection mechanisms Health Psychology 18453ndash463

2014 Sussman et al

ORDER REPRINTS

Wills T A Hirky A E (1996) Coping and substance abuse InZeidner M Endler N S eds Handbook of Coping TheoryResearch and Applications New York Wiley 279ndash302

Wills T A Stoolmiller M (2002) The role of self-control in earlyescalation of substance use a time-varying analysis Journal ofConsulting and Clinical Psychology 70986ndash997

Wills T A Baker E Botvin G J (1989) Dimensions of assertivenessdifferential relationships to substance use in early adolescenceJournal of Consulting and Clinical Psychology 57(4)473ndash478

Wills T A Vaccaro D McNamara G (1994) Novelty seeking risktaking and related constructs as predictors of adolescent substanceuse an application of Cloningerrsquos theory Journal of SubstanceAbuse 61ndash20

Wills T A McNamara G Vaccaro D Hirky A E (1996a)Escalated substance use a longitudinal grouping analysis fromearly to middle adolescence Journal of Abnormal Psychology105166ndash180

Wills T A Pierce J P Evans R I (1996b) Large-scale environmentalrisk factors for substance use American Behavioral Scientist39808ndash822

Wills T A Windle M Cleary S D (1998) Role of temperamentnovelty-seeking and self-control in adolescent substance useJournal of Personality and Social Psychology 74387ndash406

Wills T A Sandy J M Shinar O (1999) Substance use level andproblems in late adolescence a mediational model based on self-control and coping motives Experimental and ClinicalPsychopharmacology 7122ndash134

Wills T A Cleary S D Filer M Shinar O Mariani J Spera K(2001) Temperament and self-control related to early-onsetsubstance use test of a developmental model Prevention Science2145ndash163

Wills T A Sandy J M Yaeger A (2002) Moderators of therelationship between substance use level and problems test of aself-regulation model in adolescence Journal of AbnormalPsychology 1113ndash21

Wills T A Gibbons F X Gerrard M Murry V Brody G (in press-a) Family communication and religiosity related to substance useand sexual behavior in early adolescence Psychology of AddictiveBehaviors

Wills T A Resko J Ainette M Mendoza D (in press-b) The role ofparent and peer support in adolescent substance use a test ofmediated effects Psychology of Addictive Behaviors

Motivation Skills and Decision Making 2015

ORDER REPRINTS

Young P T (1936) Motivation of Behavior New York John Wiley andSons

Zimmerman B J (2000) Attaining self-regulation a social cognitivemodel In Boekaerts M Pintrich P R eds Handbook of Self-Regulation San Diego Academic Press 13ndash39

2016 Sussman et al

Request PermissionOrder Reprints

Reprints of this article can also be ordered at

httpwwwdekkercomservletproductDOI101081JA200034769

Request Permission or Order Reprints Instantly

Interested in copying and sharing this article In most cases US Copyright Law requires that you get permission from the articlersquos rightsholder before using copyrighted content

All information and materials found in this article including but not limited to text trademarks patents logos graphics and images (the Materials) are the copyrighted works and other forms of intellectual property of Marcel Dekker Inc or its licensors All rights not expressly granted are reserved

Get permission to lawfully reproduce and distribute the Materials or order reprints quickly and painlessly Simply click on the Request Permission Order Reprints link below and follow the instructions Visit the US Copyright Office for information on Fair Use limitations of US copyright law Please refer to The Association of American Publishersrsquo (AAP) website for guidelines on Fair Use in the Classroom

The Materials are for your personal use only and cannot be reformatted reposted resold or distributed by electronic means or otherwise without permission from Marcel Dekker Inc Marcel Dekker Inc grants you the limited right to display the Materials only on your personal computer or personal wireless device and to copy and download single copies of such Materials provided that any copyright trademark or other notice appearing on such Materials is also retained by displayed copied or downloaded as part of the Materials and is not removed or obscured and provided you do not edit modify alter or enhance the Materials Please refer to our Website User Agreement for more details

ORDER REPRINTS

Hansen W B Johnson C A Flay B R Graham J W Sobel J(1988) Affective and social influences approaches to the preventionof multiple substance abuse among seventh grade students resultsfrom project SMART Preventive Medicine 17135ndash154

Hansen W B Graham J W (1991) Preventing alcohol marijuanaand cigarette use among adolescents peer pressure and resistancetraining versus establishing conservative norms PreventiveMedicine 20414ndash430

Hawkins D H Catalano R F Miller J Y (1992) Risk andprotective factors for alcohol and other drug problems inadolescence and early adulthood Implications for substanceabuse prevention Psychological Bulletin 11254ndash105

Hawkins J D Catalano R F Kosterman R Abbott R Hill K G(1999) Preventing adolescent health-risk behaviors by strengthen-ing protection during childhood Archives of Pediatric amp AdolescentMedicine 153226ndash234

Heider F (1958) The Psychology of Interpersonal Relations New YorkWiley

Henggeler S W Pickrel S G Brondino M J Crouch J L (1996)Eliminating (almost) treatment dropout of substance abusing ordependent delinquents through home-based multisystemic therapyAmerican Journal of Psychiatry 153(3)427ndash428

Henggeler S W Melton G B Brondino M J Scherer D GHanley J H (1997) Multisystemic therapy with violent andchronic juvenile offenders and their families the role of treatmentfidelity in successful dissemination Journal of Consulting andClinical Psychology 65(5)821ndash833

Henggeler S W Schoenwald S K Borduin C M Rowland M DCunningham P B (1998) Multisystemic treatment of antisocialbehavior in children and adolescents New York The Guilford Press

Henggeler S W Pickrel S G Brondino M J (1999) Multisystemictreatment of substance-abusing and dependent delinquents out-comes treatment fidelity and transportability Mental HealthServices Residual 1(3)171ndash84

Johnson C A Pentz M A Weber M D Dwyer J H Baer NMacKinnon D P Hansen W B Flay B R (1990) Relativeeffectiveness of comprehensive community programming for drugabuse prevention with high-risk and low-risk adolescents Journalof Consulting and Clinical Psychology 58447ndash456

Kaftarian S J Hansen W B eds (1994) CSAP special issuecommunity partnership program Journal of Community Psychologypages 205

2008 Sussman et al

ORDER REPRINTS

Karoly P (1993) Mechanisms in self-regulation A systems view AnnualReview of Psychology 4423ndash51

Karoly P (1980) Person variables in therapeutic change and develop-ment In Karoly P Steffen J J eds Improving the Long-TermEffects of Psychotherapy New York Gardner Press 195ndash261

Kendall P C Braswell L (1982) Cognitive-behavioral self-controltherapy for children a components analysis Journal of Consultingand Clinical Psychology 50672ndash689

Kerr M Tremblay R E Pagani L Vitaro F (1997) Boysrsquobehavioral inhibition and the risk of later delinquency Archivesof General Psychiatry 54809ndash816

Klein N C Alexander J F Parsons B V (1977) Impact of familysystems intervention on recidivism and sibling delinquency a modelof primary prevention and program evaluation Journal ofConsulting and Clinical Psychology 45(3)469ndash474

Kumpfer K L (1999) Outcomes measures of interventions in the studyof children of substance-abusing parents Pediatrics 1031128ndash1144

Lau R R Hartman K A Ware J E (1986) Health as a valuemethodological and theoretical considerations Health Psychology525ndash43

Lichtenstein E L Glasgow R E (1997) A pragmatic framework forsmoking cessation implications for clinical and public healthprograms Psychology of Addictive Behaviors 11142ndash151

Locke T F Newcomb M D (in press) Childhood maltreatmentparent drug problems polydrug problems and parenting practicesa test of gender differences and four theoretical perspectivesJournal of Family Psychology

McCreary D R Newcomb M D Sadava S W (1999) The male rolealcohol use and alcohol problems a structural modeling examina-tion in adult women and men Journal of Counseling Psychology46109ndash124

McGee L Newcomb M D (1992) General deviance syndromeexpanded hierarchical evaluations at four ages from earlyadolescence to adulthood Journal of Consulting amp ClinicalPsychology 60766ndash776

Miller W R Brown J M (1991) Self-regulation as a conceptual basisfor the prevention of addictive behaviours In Heather N MillerW R Greeley J eds Self-control and the Addictive BehavioursSydney Australia Maxwell Macmillan 3ndash79

Miller W R Leckman A L Delaney H D Tinkcom M (1993)Long-term follow-up of behavioral self-control training forproblem drinkers Journal of Studies on Alcohol 53249ndash261

Motivation Skills and Decision Making 2009

ORDER REPRINTS

Miller W R Rollnick S (1991) Motivational InterviewingPreparing People to Change Addictive Behavior New YorkGuilford Press

Moffitt T E Caspi A Harrington H Milne B J (2002) Males onthe life-course-persistent and adolescence-limited antisocial path-ways follow-up at age 26 years Development and Psychopathology14(1)179ndash207

National Institute on Drug Abuse (NIDA) (1997) Drug abuseprevention What works NIH Publication 97-4110 DHHSNational Institutes of Health National Institute on Drug AbuseOffice of Science Policy and Communications Rockville MD

Newcomb M D (1992a) Substance abuse and control in the UnitedStates ethical and legal issues Social Science and Medicine35471ndash479

Newcomb M D (1992b) Understanding the multidimensional nature ofdrug use and abuse The role of consumption risk factors andprotective factors In Glantz M D Pickens R eds Vulnerabilityto Drug Abuse Washington DC American PsychologicalAssociation 255ndash298

Newcomb M D (1996a) Pseudomaturity among adolescents constructvalidation sex differences and associations in adulthood Journalof Drug Issues 26477ndash504

Newcomb M D (1996b) Adolescence Pathologizing a normal processThe Counseling Psychologist 24482ndash490

Newcomb M D (1997) Psychosocial predictors and consequences ofdrug use a developmental perspective within a prospective studyJournal of Addictive Diseases 1651ndash89

Newcomb M D Bentler P M (1988) Consequences of Adolescent DrugUse Impact on the Lives of Young Adults Beverly Hills CA Sage

Newcomb M D Bentler P M (1989) Substance use and abuse amongchildren and teenagers American Psychologist 44242ndash248

Newcomb M D Harlow L L (1986) Life events and substance useamong adolescents Mediating effects of perceived loss of controland meaninglessness in life Journal of Personality and SocialPsychology 51564ndash577

Newcomb M D Chou C-P Bentler P M Huba G J (1988)Cognitive motivations for drug use among adolescents longitudinaltests of gender differences and predictors of change in drug useJournal of Counseling Psychology 35426ndash438

Newcomb M D Abbott R D Catalano R F Hawkins J DBattin-Pearson S R Hill K (2002) Mediational and deviancetheories of late high school failure Process roles of structural

2010 Sussman et al

ORDER REPRINTS

strains academic competence and general versus specific problem

behaviors Journal of Counseling Psychology 49172ndash186Nezami E Sussman S Pentz M A (2003) Motivation in tobacco use

cessation research Substance Use amp Misuse 3825ndash5Novak S P Clayton R R (2001) The influence of school environment

and self-regulation on transitions between stages of cigarette

smoking Health Psychology 20196ndash207Offord D R (2000) Selection of levels of prevention Addictive

Behaviors 25833ndash842Palinkas L A Atkins C J Miller C Ferreira D (1996) Social skills

training for drug prevention in high-risk female adolescents

Preventive Medicine 25692ndash701Patock-Peckham J A Cheong J-W Balhorn M E Nagoshi C T

(2001) A model of parenting styles self-regulation perceived

drinking control and alcohol use and problems Alcoholism

Experimental and Clinical Research 251284ndash1292Pentz M A (1994) Directions for future research in drug abuse

prevention Preventive Medicine 23646ndash652Pentz M A Dwyer J H MacKinnon D Flay B R Hansen W B

Wang E Y I Johnson C A (1989) A multi-community trial for

primary prevention of adolescent drug abuse effects on drug use

prevalence JAMA 2623259ndash3266Pentz M A Mares D Schinke S Rohrbach L (in press) Political

science public policy and drug abuse prevention Substance Use amp

MisuseProchaska J O DiClemente C C (1982) Transtheoretical therapy

toward a more integrative model of change Psychotherapy Theory

Research and Practice 19275ndash288Pulkkinen L Pitkanen T (1994) A prospective study of the precursors

to problem drinking in young adulthood Journal of Studies on

Alcohol 55578ndash587Rathus S A Nevid J S (1977) Behavior Therapy Strategies for

Solving Problems in Living New York Doubleday and Company

IncResnicow K Botvin G (1993) School-based substance use prevention

programs why do effects decay Preventive Medicine 22484ndash490Rutter M Dunn J Plomin R Simonoff E Pickles A Maughan

B Ormel J Meyer J Eaves L (1997) Integrating nature and

nurture implications of person-environment interactions for

developmental psychopathology Development and Psychopathology

9335ndash364

Motivation Skills and Decision Making 2011

ORDER REPRINTS

Salomon G Stein Y Eisenberg S Klein L (1984) Adolescent

smokers and nonsmokers profiles and their changing structure

Preventive Medicine 13446ndash461Sambrano S (1999) National cross-site evaluation of high risk youth

programs In Interim findings Bulletin Washington DC CSAP

SAMSHA US DHHS May 1ndash16Schinke S P Gilchrist L D (1985) Preventing substance abuse with

children and adolescents Journal of Consulting and Clinical

Psychology 53596ndash602Skara S N Sussman S (2003) A review of 25 long-term adolescent

tobacco and other drug use prevention program evaluations

Preventive MedicineSmith C Lizotte A J Thornberry T P Krohn M D (1995)

Resilient youth identifying factors that prevent high-risk youth

from engaging in delinquency and drug use Delinquency and

Disrepute in the Life Course Greenwich CT John Hagan JAI

press 217ndash247Sommers P V (1972) The Biology of Behavior Australia Pty ltd

Sydney John Wiley amp SonsSt Pierre T L Kaltreider D L Mark M M Aikin K J (1992)

Drug prevention in a community setting a longitudinal study of the

relative effectiveness of a three-year primary prevention program in

boys and girls clubs across the nation American Journal of

Community Psychology 20673ndash706Stein J A Newcomb M D Bentler P M (1987) An eight year study

of multiple influences on drug use and drug use consequences

Journal of Personality and Social Psychology 531094ndash1105Sully J (1884) Outlines of Psychology New York D Appleton amp CoSussman S (1989) Two social influence perspectives of tobacco use

development and prevention Health Education Research Theory

and Practice 4213ndash223Sussman S (1991) Curriculum development in school-based prevention

research Health Education Research Theory and Practice

6339ndash351Sussman S (1996) Development of a school-based drug abuse

prevention curriculum for high risk youth Journal of

Psychoactive Drugs 28169ndash182Sussman S Ames S L (2001) The social psychology of drug abuse

Buckingham GB Open University PressSussman S Unger J (2004) A drug abuse theoretical integration a

transdisciplinary speculation Substance Use amp Misuse

2012 Sussman et al

ORDER REPRINTS

Sussman S Dent C W Burton D Stacy A W Flay B R (1995a)

Developing school-based tobacco use prevention and cessation

programs Thousand Oaks CA Sage Publications IncSussman S Dent C W Simon T R Stacy A W Galaif E R

Moss M A Craig S Johnson C A (1995b) Effectiveness of

social influence substance abuse prevention curricula in compre-

hensive and continuation high schools Drugs and Society 865ndash81Sussman S Dent C W Galaif E R (1997) The correlates of

substance abuse and dependence among adolescents at high risk

for drug abuse Journal of Substance Abuse 9241ndash255Sussman S Dent C W Stacy A W (1996) The relation of pro-drug

use myths with self-reported drug use among youth at continuation

high schools Journal of Applied Social Psychology 26214ndash267Sussman S Dent C W Stacy A Craig S (1998) One-year outcomes

of project towards no drug abuse Preventive Medicine 27632ndash642

(erratum 766)Sussman S Dent C W Stacy S (2002) Project towards no drug

abuse a review of the findings and future directions American

Journal of Health Behavior 26354ndash365Sussman S McCuller W J Dent C W (2003) The associations of

social self-control personality disorders and demographics with

drug use among high risk youth Addictive Behaviors 281159ndash1166Sussman S Rohrbach L Patel R Holiday K (2003) A look at an

interactive classroom-based drug abuse prevention program

Interactive contents and suggestions for research Journal of Drug

Education 33355ndash368Sussman S Sun P McCuller W J Dent C W (2003) Project

towards no drug abuse two year outcomes of a trial that compares

health educator delivery to self-instruction Preventive Medicine

37155ndash162Tarter R E Vanyukov M (1994) Alcoholism a developmental disorder

Journal of Consulting and Clinical Psychology 621096ndash1107Thornton T N Craft C A Dahlberg L L Lynch B S Baer K

(2000) Best Practices of Youth Violence Prevention A Sourcebook

for Community Action Atlanta GA Division of Violence

Prevention Centers for Disease Control and PreventionTobler N S (1986) Meta-analysis of 143 adolescent drug prevention

programs quantitative outcome of program participants compared to

a control or comparison group Journal of Drug Issues 16537ndash567Tobler N S Roona M R Ochshorn P Marshall D G Streke

A V Stackpole K M (2000) School-based adolescent drug

Motivation Skills and Decision Making 2013

ORDER REPRINTS

prevention programs 1998 Meta-analysis The Journal of Primary

Prevention 20275ndash336US Department of Health and Human Services (USDHHS) (2003)

Substance Abuse andMental Health Services Administration Center

for Substance Abuse Prevention Science-based prevention programs and

principles 2002 Rockville MD US DHHS (SMA)03-3764 Also

see httpmodelprogramssamhsagovUnger J Baezconde-Garbanati L Shakib S Palmer P H Nezami

E Mora J (2004) What are the implications of structuralcultural

theory for drug abuse prevention Substance Use amp MisuseUpshaw H S Ostrom T M (1984) Psychological perspective in

attitude research In Eiser J R ed Attitudinal Judgment New

York Springer-Verlag 23ndash42Valente T W Gallaher P Mouttapa M (2004) Using social network

theory to understand and prevent substance use a transdisciplinary

perspective Substance Use amp MisuseVorrath H Brendtro L (1985) Positive peer culture 2nd edn Aldine

ChicagoWaldron H B Slesnick N Brody J L Turner C W Peterson T R

(2001) Treatment outcomes for adolescent substance abuse at 4-

and 7-month assessments Journal of Consulting amp Clinical

Psychology 69(5)802ndash813Watson D L Tharp R G (2002) Self-directed behavior Self-

modification for personal adjustment 8th edn Belmont CA

WadsworthWeissberg R P Caplan M Z Sivo P J (1989) A new conceptual

framework for establishing school-based social competence promo-

tion programs In Bond L A Compas B E eds Primary

Prevention amp Promotion in the Schools Newbury Park CA Sage

255ndash296Wills T A (1986) Stress and coping in early adolescence relationships

to substance use in urban school samples Health Psychology

5503ndash529Wills T A Cleary S D (1995) Stress-coping model for alcohol-

tobacco interactions in adolescence In Fertig J B Allen J P

eds Alcohol and Tobacco From Basic Science to Clinical Practice

Bethesda MD National Institute on Alcohol Abuse and

Alcoholism 107ndash128Wills T A Cleary S D (1999) Peer and adolescent substance use

among 6thndash9th graders Latent growth analyses of influence versus

selection mechanisms Health Psychology 18453ndash463

2014 Sussman et al

ORDER REPRINTS

Wills T A Hirky A E (1996) Coping and substance abuse InZeidner M Endler N S eds Handbook of Coping TheoryResearch and Applications New York Wiley 279ndash302

Wills T A Stoolmiller M (2002) The role of self-control in earlyescalation of substance use a time-varying analysis Journal ofConsulting and Clinical Psychology 70986ndash997

Wills T A Baker E Botvin G J (1989) Dimensions of assertivenessdifferential relationships to substance use in early adolescenceJournal of Consulting and Clinical Psychology 57(4)473ndash478

Wills T A Vaccaro D McNamara G (1994) Novelty seeking risktaking and related constructs as predictors of adolescent substanceuse an application of Cloningerrsquos theory Journal of SubstanceAbuse 61ndash20

Wills T A McNamara G Vaccaro D Hirky A E (1996a)Escalated substance use a longitudinal grouping analysis fromearly to middle adolescence Journal of Abnormal Psychology105166ndash180

Wills T A Pierce J P Evans R I (1996b) Large-scale environmentalrisk factors for substance use American Behavioral Scientist39808ndash822

Wills T A Windle M Cleary S D (1998) Role of temperamentnovelty-seeking and self-control in adolescent substance useJournal of Personality and Social Psychology 74387ndash406

Wills T A Sandy J M Shinar O (1999) Substance use level andproblems in late adolescence a mediational model based on self-control and coping motives Experimental and ClinicalPsychopharmacology 7122ndash134

Wills T A Cleary S D Filer M Shinar O Mariani J Spera K(2001) Temperament and self-control related to early-onsetsubstance use test of a developmental model Prevention Science2145ndash163

Wills T A Sandy J M Yaeger A (2002) Moderators of therelationship between substance use level and problems test of aself-regulation model in adolescence Journal of AbnormalPsychology 1113ndash21

Wills T A Gibbons F X Gerrard M Murry V Brody G (in press-a) Family communication and religiosity related to substance useand sexual behavior in early adolescence Psychology of AddictiveBehaviors

Wills T A Resko J Ainette M Mendoza D (in press-b) The role ofparent and peer support in adolescent substance use a test ofmediated effects Psychology of Addictive Behaviors

Motivation Skills and Decision Making 2015

ORDER REPRINTS

Young P T (1936) Motivation of Behavior New York John Wiley andSons

Zimmerman B J (2000) Attaining self-regulation a social cognitivemodel In Boekaerts M Pintrich P R eds Handbook of Self-Regulation San Diego Academic Press 13ndash39

2016 Sussman et al

Request PermissionOrder Reprints

Reprints of this article can also be ordered at

httpwwwdekkercomservletproductDOI101081JA200034769

Request Permission or Order Reprints Instantly

Interested in copying and sharing this article In most cases US Copyright Law requires that you get permission from the articlersquos rightsholder before using copyrighted content

All information and materials found in this article including but not limited to text trademarks patents logos graphics and images (the Materials) are the copyrighted works and other forms of intellectual property of Marcel Dekker Inc or its licensors All rights not expressly granted are reserved

Get permission to lawfully reproduce and distribute the Materials or order reprints quickly and painlessly Simply click on the Request Permission Order Reprints link below and follow the instructions Visit the US Copyright Office for information on Fair Use limitations of US copyright law Please refer to The Association of American Publishersrsquo (AAP) website for guidelines on Fair Use in the Classroom

The Materials are for your personal use only and cannot be reformatted reposted resold or distributed by electronic means or otherwise without permission from Marcel Dekker Inc Marcel Dekker Inc grants you the limited right to display the Materials only on your personal computer or personal wireless device and to copy and download single copies of such Materials provided that any copyright trademark or other notice appearing on such Materials is also retained by displayed copied or downloaded as part of the Materials and is not removed or obscured and provided you do not edit modify alter or enhance the Materials Please refer to our Website User Agreement for more details

ORDER REPRINTS

Karoly P (1993) Mechanisms in self-regulation A systems view AnnualReview of Psychology 4423ndash51

Karoly P (1980) Person variables in therapeutic change and develop-ment In Karoly P Steffen J J eds Improving the Long-TermEffects of Psychotherapy New York Gardner Press 195ndash261

Kendall P C Braswell L (1982) Cognitive-behavioral self-controltherapy for children a components analysis Journal of Consultingand Clinical Psychology 50672ndash689

Kerr M Tremblay R E Pagani L Vitaro F (1997) Boysrsquobehavioral inhibition and the risk of later delinquency Archivesof General Psychiatry 54809ndash816

Klein N C Alexander J F Parsons B V (1977) Impact of familysystems intervention on recidivism and sibling delinquency a modelof primary prevention and program evaluation Journal ofConsulting and Clinical Psychology 45(3)469ndash474

Kumpfer K L (1999) Outcomes measures of interventions in the studyof children of substance-abusing parents Pediatrics 1031128ndash1144

Lau R R Hartman K A Ware J E (1986) Health as a valuemethodological and theoretical considerations Health Psychology525ndash43

Lichtenstein E L Glasgow R E (1997) A pragmatic framework forsmoking cessation implications for clinical and public healthprograms Psychology of Addictive Behaviors 11142ndash151

Locke T F Newcomb M D (in press) Childhood maltreatmentparent drug problems polydrug problems and parenting practicesa test of gender differences and four theoretical perspectivesJournal of Family Psychology

McCreary D R Newcomb M D Sadava S W (1999) The male rolealcohol use and alcohol problems a structural modeling examina-tion in adult women and men Journal of Counseling Psychology46109ndash124

McGee L Newcomb M D (1992) General deviance syndromeexpanded hierarchical evaluations at four ages from earlyadolescence to adulthood Journal of Consulting amp ClinicalPsychology 60766ndash776

Miller W R Brown J M (1991) Self-regulation as a conceptual basisfor the prevention of addictive behaviours In Heather N MillerW R Greeley J eds Self-control and the Addictive BehavioursSydney Australia Maxwell Macmillan 3ndash79

Miller W R Leckman A L Delaney H D Tinkcom M (1993)Long-term follow-up of behavioral self-control training forproblem drinkers Journal of Studies on Alcohol 53249ndash261

Motivation Skills and Decision Making 2009

ORDER REPRINTS

Miller W R Rollnick S (1991) Motivational InterviewingPreparing People to Change Addictive Behavior New YorkGuilford Press

Moffitt T E Caspi A Harrington H Milne B J (2002) Males onthe life-course-persistent and adolescence-limited antisocial path-ways follow-up at age 26 years Development and Psychopathology14(1)179ndash207

National Institute on Drug Abuse (NIDA) (1997) Drug abuseprevention What works NIH Publication 97-4110 DHHSNational Institutes of Health National Institute on Drug AbuseOffice of Science Policy and Communications Rockville MD

Newcomb M D (1992a) Substance abuse and control in the UnitedStates ethical and legal issues Social Science and Medicine35471ndash479

Newcomb M D (1992b) Understanding the multidimensional nature ofdrug use and abuse The role of consumption risk factors andprotective factors In Glantz M D Pickens R eds Vulnerabilityto Drug Abuse Washington DC American PsychologicalAssociation 255ndash298

Newcomb M D (1996a) Pseudomaturity among adolescents constructvalidation sex differences and associations in adulthood Journalof Drug Issues 26477ndash504

Newcomb M D (1996b) Adolescence Pathologizing a normal processThe Counseling Psychologist 24482ndash490

Newcomb M D (1997) Psychosocial predictors and consequences ofdrug use a developmental perspective within a prospective studyJournal of Addictive Diseases 1651ndash89

Newcomb M D Bentler P M (1988) Consequences of Adolescent DrugUse Impact on the Lives of Young Adults Beverly Hills CA Sage

Newcomb M D Bentler P M (1989) Substance use and abuse amongchildren and teenagers American Psychologist 44242ndash248

Newcomb M D Harlow L L (1986) Life events and substance useamong adolescents Mediating effects of perceived loss of controland meaninglessness in life Journal of Personality and SocialPsychology 51564ndash577

Newcomb M D Chou C-P Bentler P M Huba G J (1988)Cognitive motivations for drug use among adolescents longitudinaltests of gender differences and predictors of change in drug useJournal of Counseling Psychology 35426ndash438

Newcomb M D Abbott R D Catalano R F Hawkins J DBattin-Pearson S R Hill K (2002) Mediational and deviancetheories of late high school failure Process roles of structural

2010 Sussman et al

ORDER REPRINTS

strains academic competence and general versus specific problem

behaviors Journal of Counseling Psychology 49172ndash186Nezami E Sussman S Pentz M A (2003) Motivation in tobacco use

cessation research Substance Use amp Misuse 3825ndash5Novak S P Clayton R R (2001) The influence of school environment

and self-regulation on transitions between stages of cigarette

smoking Health Psychology 20196ndash207Offord D R (2000) Selection of levels of prevention Addictive

Behaviors 25833ndash842Palinkas L A Atkins C J Miller C Ferreira D (1996) Social skills

training for drug prevention in high-risk female adolescents

Preventive Medicine 25692ndash701Patock-Peckham J A Cheong J-W Balhorn M E Nagoshi C T

(2001) A model of parenting styles self-regulation perceived

drinking control and alcohol use and problems Alcoholism

Experimental and Clinical Research 251284ndash1292Pentz M A (1994) Directions for future research in drug abuse

prevention Preventive Medicine 23646ndash652Pentz M A Dwyer J H MacKinnon D Flay B R Hansen W B

Wang E Y I Johnson C A (1989) A multi-community trial for

primary prevention of adolescent drug abuse effects on drug use

prevalence JAMA 2623259ndash3266Pentz M A Mares D Schinke S Rohrbach L (in press) Political

science public policy and drug abuse prevention Substance Use amp

MisuseProchaska J O DiClemente C C (1982) Transtheoretical therapy

toward a more integrative model of change Psychotherapy Theory

Research and Practice 19275ndash288Pulkkinen L Pitkanen T (1994) A prospective study of the precursors

to problem drinking in young adulthood Journal of Studies on

Alcohol 55578ndash587Rathus S A Nevid J S (1977) Behavior Therapy Strategies for

Solving Problems in Living New York Doubleday and Company

IncResnicow K Botvin G (1993) School-based substance use prevention

programs why do effects decay Preventive Medicine 22484ndash490Rutter M Dunn J Plomin R Simonoff E Pickles A Maughan

B Ormel J Meyer J Eaves L (1997) Integrating nature and

nurture implications of person-environment interactions for

developmental psychopathology Development and Psychopathology

9335ndash364

Motivation Skills and Decision Making 2011

ORDER REPRINTS

Salomon G Stein Y Eisenberg S Klein L (1984) Adolescent

smokers and nonsmokers profiles and their changing structure

Preventive Medicine 13446ndash461Sambrano S (1999) National cross-site evaluation of high risk youth

programs In Interim findings Bulletin Washington DC CSAP

SAMSHA US DHHS May 1ndash16Schinke S P Gilchrist L D (1985) Preventing substance abuse with

children and adolescents Journal of Consulting and Clinical

Psychology 53596ndash602Skara S N Sussman S (2003) A review of 25 long-term adolescent

tobacco and other drug use prevention program evaluations

Preventive MedicineSmith C Lizotte A J Thornberry T P Krohn M D (1995)

Resilient youth identifying factors that prevent high-risk youth

from engaging in delinquency and drug use Delinquency and

Disrepute in the Life Course Greenwich CT John Hagan JAI

press 217ndash247Sommers P V (1972) The Biology of Behavior Australia Pty ltd

Sydney John Wiley amp SonsSt Pierre T L Kaltreider D L Mark M M Aikin K J (1992)

Drug prevention in a community setting a longitudinal study of the

relative effectiveness of a three-year primary prevention program in

boys and girls clubs across the nation American Journal of

Community Psychology 20673ndash706Stein J A Newcomb M D Bentler P M (1987) An eight year study

of multiple influences on drug use and drug use consequences

Journal of Personality and Social Psychology 531094ndash1105Sully J (1884) Outlines of Psychology New York D Appleton amp CoSussman S (1989) Two social influence perspectives of tobacco use

development and prevention Health Education Research Theory

and Practice 4213ndash223Sussman S (1991) Curriculum development in school-based prevention

research Health Education Research Theory and Practice

6339ndash351Sussman S (1996) Development of a school-based drug abuse

prevention curriculum for high risk youth Journal of

Psychoactive Drugs 28169ndash182Sussman S Ames S L (2001) The social psychology of drug abuse

Buckingham GB Open University PressSussman S Unger J (2004) A drug abuse theoretical integration a

transdisciplinary speculation Substance Use amp Misuse

2012 Sussman et al

ORDER REPRINTS

Sussman S Dent C W Burton D Stacy A W Flay B R (1995a)

Developing school-based tobacco use prevention and cessation

programs Thousand Oaks CA Sage Publications IncSussman S Dent C W Simon T R Stacy A W Galaif E R

Moss M A Craig S Johnson C A (1995b) Effectiveness of

social influence substance abuse prevention curricula in compre-

hensive and continuation high schools Drugs and Society 865ndash81Sussman S Dent C W Galaif E R (1997) The correlates of

substance abuse and dependence among adolescents at high risk

for drug abuse Journal of Substance Abuse 9241ndash255Sussman S Dent C W Stacy A W (1996) The relation of pro-drug

use myths with self-reported drug use among youth at continuation

high schools Journal of Applied Social Psychology 26214ndash267Sussman S Dent C W Stacy A Craig S (1998) One-year outcomes

of project towards no drug abuse Preventive Medicine 27632ndash642

(erratum 766)Sussman S Dent C W Stacy S (2002) Project towards no drug

abuse a review of the findings and future directions American

Journal of Health Behavior 26354ndash365Sussman S McCuller W J Dent C W (2003) The associations of

social self-control personality disorders and demographics with

drug use among high risk youth Addictive Behaviors 281159ndash1166Sussman S Rohrbach L Patel R Holiday K (2003) A look at an

interactive classroom-based drug abuse prevention program

Interactive contents and suggestions for research Journal of Drug

Education 33355ndash368Sussman S Sun P McCuller W J Dent C W (2003) Project

towards no drug abuse two year outcomes of a trial that compares

health educator delivery to self-instruction Preventive Medicine

37155ndash162Tarter R E Vanyukov M (1994) Alcoholism a developmental disorder

Journal of Consulting and Clinical Psychology 621096ndash1107Thornton T N Craft C A Dahlberg L L Lynch B S Baer K

(2000) Best Practices of Youth Violence Prevention A Sourcebook

for Community Action Atlanta GA Division of Violence

Prevention Centers for Disease Control and PreventionTobler N S (1986) Meta-analysis of 143 adolescent drug prevention

programs quantitative outcome of program participants compared to

a control or comparison group Journal of Drug Issues 16537ndash567Tobler N S Roona M R Ochshorn P Marshall D G Streke

A V Stackpole K M (2000) School-based adolescent drug

Motivation Skills and Decision Making 2013

ORDER REPRINTS

prevention programs 1998 Meta-analysis The Journal of Primary

Prevention 20275ndash336US Department of Health and Human Services (USDHHS) (2003)

Substance Abuse andMental Health Services Administration Center

for Substance Abuse Prevention Science-based prevention programs and

principles 2002 Rockville MD US DHHS (SMA)03-3764 Also

see httpmodelprogramssamhsagovUnger J Baezconde-Garbanati L Shakib S Palmer P H Nezami

E Mora J (2004) What are the implications of structuralcultural

theory for drug abuse prevention Substance Use amp MisuseUpshaw H S Ostrom T M (1984) Psychological perspective in

attitude research In Eiser J R ed Attitudinal Judgment New

York Springer-Verlag 23ndash42Valente T W Gallaher P Mouttapa M (2004) Using social network

theory to understand and prevent substance use a transdisciplinary

perspective Substance Use amp MisuseVorrath H Brendtro L (1985) Positive peer culture 2nd edn Aldine

ChicagoWaldron H B Slesnick N Brody J L Turner C W Peterson T R

(2001) Treatment outcomes for adolescent substance abuse at 4-

and 7-month assessments Journal of Consulting amp Clinical

Psychology 69(5)802ndash813Watson D L Tharp R G (2002) Self-directed behavior Self-

modification for personal adjustment 8th edn Belmont CA

WadsworthWeissberg R P Caplan M Z Sivo P J (1989) A new conceptual

framework for establishing school-based social competence promo-

tion programs In Bond L A Compas B E eds Primary

Prevention amp Promotion in the Schools Newbury Park CA Sage

255ndash296Wills T A (1986) Stress and coping in early adolescence relationships

to substance use in urban school samples Health Psychology

5503ndash529Wills T A Cleary S D (1995) Stress-coping model for alcohol-

tobacco interactions in adolescence In Fertig J B Allen J P

eds Alcohol and Tobacco From Basic Science to Clinical Practice

Bethesda MD National Institute on Alcohol Abuse and

Alcoholism 107ndash128Wills T A Cleary S D (1999) Peer and adolescent substance use

among 6thndash9th graders Latent growth analyses of influence versus

selection mechanisms Health Psychology 18453ndash463

2014 Sussman et al

ORDER REPRINTS

Wills T A Hirky A E (1996) Coping and substance abuse InZeidner M Endler N S eds Handbook of Coping TheoryResearch and Applications New York Wiley 279ndash302

Wills T A Stoolmiller M (2002) The role of self-control in earlyescalation of substance use a time-varying analysis Journal ofConsulting and Clinical Psychology 70986ndash997

Wills T A Baker E Botvin G J (1989) Dimensions of assertivenessdifferential relationships to substance use in early adolescenceJournal of Consulting and Clinical Psychology 57(4)473ndash478

Wills T A Vaccaro D McNamara G (1994) Novelty seeking risktaking and related constructs as predictors of adolescent substanceuse an application of Cloningerrsquos theory Journal of SubstanceAbuse 61ndash20

Wills T A McNamara G Vaccaro D Hirky A E (1996a)Escalated substance use a longitudinal grouping analysis fromearly to middle adolescence Journal of Abnormal Psychology105166ndash180

Wills T A Pierce J P Evans R I (1996b) Large-scale environmentalrisk factors for substance use American Behavioral Scientist39808ndash822

Wills T A Windle M Cleary S D (1998) Role of temperamentnovelty-seeking and self-control in adolescent substance useJournal of Personality and Social Psychology 74387ndash406

Wills T A Sandy J M Shinar O (1999) Substance use level andproblems in late adolescence a mediational model based on self-control and coping motives Experimental and ClinicalPsychopharmacology 7122ndash134

Wills T A Cleary S D Filer M Shinar O Mariani J Spera K(2001) Temperament and self-control related to early-onsetsubstance use test of a developmental model Prevention Science2145ndash163

Wills T A Sandy J M Yaeger A (2002) Moderators of therelationship between substance use level and problems test of aself-regulation model in adolescence Journal of AbnormalPsychology 1113ndash21

Wills T A Gibbons F X Gerrard M Murry V Brody G (in press-a) Family communication and religiosity related to substance useand sexual behavior in early adolescence Psychology of AddictiveBehaviors

Wills T A Resko J Ainette M Mendoza D (in press-b) The role ofparent and peer support in adolescent substance use a test ofmediated effects Psychology of Addictive Behaviors

Motivation Skills and Decision Making 2015

ORDER REPRINTS

Young P T (1936) Motivation of Behavior New York John Wiley andSons

Zimmerman B J (2000) Attaining self-regulation a social cognitivemodel In Boekaerts M Pintrich P R eds Handbook of Self-Regulation San Diego Academic Press 13ndash39

2016 Sussman et al

Request PermissionOrder Reprints

Reprints of this article can also be ordered at

httpwwwdekkercomservletproductDOI101081JA200034769

Request Permission or Order Reprints Instantly

Interested in copying and sharing this article In most cases US Copyright Law requires that you get permission from the articlersquos rightsholder before using copyrighted content

All information and materials found in this article including but not limited to text trademarks patents logos graphics and images (the Materials) are the copyrighted works and other forms of intellectual property of Marcel Dekker Inc or its licensors All rights not expressly granted are reserved

Get permission to lawfully reproduce and distribute the Materials or order reprints quickly and painlessly Simply click on the Request Permission Order Reprints link below and follow the instructions Visit the US Copyright Office for information on Fair Use limitations of US copyright law Please refer to The Association of American Publishersrsquo (AAP) website for guidelines on Fair Use in the Classroom

The Materials are for your personal use only and cannot be reformatted reposted resold or distributed by electronic means or otherwise without permission from Marcel Dekker Inc Marcel Dekker Inc grants you the limited right to display the Materials only on your personal computer or personal wireless device and to copy and download single copies of such Materials provided that any copyright trademark or other notice appearing on such Materials is also retained by displayed copied or downloaded as part of the Materials and is not removed or obscured and provided you do not edit modify alter or enhance the Materials Please refer to our Website User Agreement for more details

ORDER REPRINTS

Miller W R Rollnick S (1991) Motivational InterviewingPreparing People to Change Addictive Behavior New YorkGuilford Press

Moffitt T E Caspi A Harrington H Milne B J (2002) Males onthe life-course-persistent and adolescence-limited antisocial path-ways follow-up at age 26 years Development and Psychopathology14(1)179ndash207

National Institute on Drug Abuse (NIDA) (1997) Drug abuseprevention What works NIH Publication 97-4110 DHHSNational Institutes of Health National Institute on Drug AbuseOffice of Science Policy and Communications Rockville MD

Newcomb M D (1992a) Substance abuse and control in the UnitedStates ethical and legal issues Social Science and Medicine35471ndash479

Newcomb M D (1992b) Understanding the multidimensional nature ofdrug use and abuse The role of consumption risk factors andprotective factors In Glantz M D Pickens R eds Vulnerabilityto Drug Abuse Washington DC American PsychologicalAssociation 255ndash298

Newcomb M D (1996a) Pseudomaturity among adolescents constructvalidation sex differences and associations in adulthood Journalof Drug Issues 26477ndash504

Newcomb M D (1996b) Adolescence Pathologizing a normal processThe Counseling Psychologist 24482ndash490

Newcomb M D (1997) Psychosocial predictors and consequences ofdrug use a developmental perspective within a prospective studyJournal of Addictive Diseases 1651ndash89

Newcomb M D Bentler P M (1988) Consequences of Adolescent DrugUse Impact on the Lives of Young Adults Beverly Hills CA Sage

Newcomb M D Bentler P M (1989) Substance use and abuse amongchildren and teenagers American Psychologist 44242ndash248

Newcomb M D Harlow L L (1986) Life events and substance useamong adolescents Mediating effects of perceived loss of controland meaninglessness in life Journal of Personality and SocialPsychology 51564ndash577

Newcomb M D Chou C-P Bentler P M Huba G J (1988)Cognitive motivations for drug use among adolescents longitudinaltests of gender differences and predictors of change in drug useJournal of Counseling Psychology 35426ndash438

Newcomb M D Abbott R D Catalano R F Hawkins J DBattin-Pearson S R Hill K (2002) Mediational and deviancetheories of late high school failure Process roles of structural

2010 Sussman et al

ORDER REPRINTS

strains academic competence and general versus specific problem

behaviors Journal of Counseling Psychology 49172ndash186Nezami E Sussman S Pentz M A (2003) Motivation in tobacco use

cessation research Substance Use amp Misuse 3825ndash5Novak S P Clayton R R (2001) The influence of school environment

and self-regulation on transitions between stages of cigarette

smoking Health Psychology 20196ndash207Offord D R (2000) Selection of levels of prevention Addictive

Behaviors 25833ndash842Palinkas L A Atkins C J Miller C Ferreira D (1996) Social skills

training for drug prevention in high-risk female adolescents

Preventive Medicine 25692ndash701Patock-Peckham J A Cheong J-W Balhorn M E Nagoshi C T

(2001) A model of parenting styles self-regulation perceived

drinking control and alcohol use and problems Alcoholism

Experimental and Clinical Research 251284ndash1292Pentz M A (1994) Directions for future research in drug abuse

prevention Preventive Medicine 23646ndash652Pentz M A Dwyer J H MacKinnon D Flay B R Hansen W B

Wang E Y I Johnson C A (1989) A multi-community trial for

primary prevention of adolescent drug abuse effects on drug use

prevalence JAMA 2623259ndash3266Pentz M A Mares D Schinke S Rohrbach L (in press) Political

science public policy and drug abuse prevention Substance Use amp

MisuseProchaska J O DiClemente C C (1982) Transtheoretical therapy

toward a more integrative model of change Psychotherapy Theory

Research and Practice 19275ndash288Pulkkinen L Pitkanen T (1994) A prospective study of the precursors

to problem drinking in young adulthood Journal of Studies on

Alcohol 55578ndash587Rathus S A Nevid J S (1977) Behavior Therapy Strategies for

Solving Problems in Living New York Doubleday and Company

IncResnicow K Botvin G (1993) School-based substance use prevention

programs why do effects decay Preventive Medicine 22484ndash490Rutter M Dunn J Plomin R Simonoff E Pickles A Maughan

B Ormel J Meyer J Eaves L (1997) Integrating nature and

nurture implications of person-environment interactions for

developmental psychopathology Development and Psychopathology

9335ndash364

Motivation Skills and Decision Making 2011

ORDER REPRINTS

Salomon G Stein Y Eisenberg S Klein L (1984) Adolescent

smokers and nonsmokers profiles and their changing structure

Preventive Medicine 13446ndash461Sambrano S (1999) National cross-site evaluation of high risk youth

programs In Interim findings Bulletin Washington DC CSAP

SAMSHA US DHHS May 1ndash16Schinke S P Gilchrist L D (1985) Preventing substance abuse with

children and adolescents Journal of Consulting and Clinical

Psychology 53596ndash602Skara S N Sussman S (2003) A review of 25 long-term adolescent

tobacco and other drug use prevention program evaluations

Preventive MedicineSmith C Lizotte A J Thornberry T P Krohn M D (1995)

Resilient youth identifying factors that prevent high-risk youth

from engaging in delinquency and drug use Delinquency and

Disrepute in the Life Course Greenwich CT John Hagan JAI

press 217ndash247Sommers P V (1972) The Biology of Behavior Australia Pty ltd

Sydney John Wiley amp SonsSt Pierre T L Kaltreider D L Mark M M Aikin K J (1992)

Drug prevention in a community setting a longitudinal study of the

relative effectiveness of a three-year primary prevention program in

boys and girls clubs across the nation American Journal of

Community Psychology 20673ndash706Stein J A Newcomb M D Bentler P M (1987) An eight year study

of multiple influences on drug use and drug use consequences

Journal of Personality and Social Psychology 531094ndash1105Sully J (1884) Outlines of Psychology New York D Appleton amp CoSussman S (1989) Two social influence perspectives of tobacco use

development and prevention Health Education Research Theory

and Practice 4213ndash223Sussman S (1991) Curriculum development in school-based prevention

research Health Education Research Theory and Practice

6339ndash351Sussman S (1996) Development of a school-based drug abuse

prevention curriculum for high risk youth Journal of

Psychoactive Drugs 28169ndash182Sussman S Ames S L (2001) The social psychology of drug abuse

Buckingham GB Open University PressSussman S Unger J (2004) A drug abuse theoretical integration a

transdisciplinary speculation Substance Use amp Misuse

2012 Sussman et al

ORDER REPRINTS

Sussman S Dent C W Burton D Stacy A W Flay B R (1995a)

Developing school-based tobacco use prevention and cessation

programs Thousand Oaks CA Sage Publications IncSussman S Dent C W Simon T R Stacy A W Galaif E R

Moss M A Craig S Johnson C A (1995b) Effectiveness of

social influence substance abuse prevention curricula in compre-

hensive and continuation high schools Drugs and Society 865ndash81Sussman S Dent C W Galaif E R (1997) The correlates of

substance abuse and dependence among adolescents at high risk

for drug abuse Journal of Substance Abuse 9241ndash255Sussman S Dent C W Stacy A W (1996) The relation of pro-drug

use myths with self-reported drug use among youth at continuation

high schools Journal of Applied Social Psychology 26214ndash267Sussman S Dent C W Stacy A Craig S (1998) One-year outcomes

of project towards no drug abuse Preventive Medicine 27632ndash642

(erratum 766)Sussman S Dent C W Stacy S (2002) Project towards no drug

abuse a review of the findings and future directions American

Journal of Health Behavior 26354ndash365Sussman S McCuller W J Dent C W (2003) The associations of

social self-control personality disorders and demographics with

drug use among high risk youth Addictive Behaviors 281159ndash1166Sussman S Rohrbach L Patel R Holiday K (2003) A look at an

interactive classroom-based drug abuse prevention program

Interactive contents and suggestions for research Journal of Drug

Education 33355ndash368Sussman S Sun P McCuller W J Dent C W (2003) Project

towards no drug abuse two year outcomes of a trial that compares

health educator delivery to self-instruction Preventive Medicine

37155ndash162Tarter R E Vanyukov M (1994) Alcoholism a developmental disorder

Journal of Consulting and Clinical Psychology 621096ndash1107Thornton T N Craft C A Dahlberg L L Lynch B S Baer K

(2000) Best Practices of Youth Violence Prevention A Sourcebook

for Community Action Atlanta GA Division of Violence

Prevention Centers for Disease Control and PreventionTobler N S (1986) Meta-analysis of 143 adolescent drug prevention

programs quantitative outcome of program participants compared to

a control or comparison group Journal of Drug Issues 16537ndash567Tobler N S Roona M R Ochshorn P Marshall D G Streke

A V Stackpole K M (2000) School-based adolescent drug

Motivation Skills and Decision Making 2013

ORDER REPRINTS

prevention programs 1998 Meta-analysis The Journal of Primary

Prevention 20275ndash336US Department of Health and Human Services (USDHHS) (2003)

Substance Abuse andMental Health Services Administration Center

for Substance Abuse Prevention Science-based prevention programs and

principles 2002 Rockville MD US DHHS (SMA)03-3764 Also

see httpmodelprogramssamhsagovUnger J Baezconde-Garbanati L Shakib S Palmer P H Nezami

E Mora J (2004) What are the implications of structuralcultural

theory for drug abuse prevention Substance Use amp MisuseUpshaw H S Ostrom T M (1984) Psychological perspective in

attitude research In Eiser J R ed Attitudinal Judgment New

York Springer-Verlag 23ndash42Valente T W Gallaher P Mouttapa M (2004) Using social network

theory to understand and prevent substance use a transdisciplinary

perspective Substance Use amp MisuseVorrath H Brendtro L (1985) Positive peer culture 2nd edn Aldine

ChicagoWaldron H B Slesnick N Brody J L Turner C W Peterson T R

(2001) Treatment outcomes for adolescent substance abuse at 4-

and 7-month assessments Journal of Consulting amp Clinical

Psychology 69(5)802ndash813Watson D L Tharp R G (2002) Self-directed behavior Self-

modification for personal adjustment 8th edn Belmont CA

WadsworthWeissberg R P Caplan M Z Sivo P J (1989) A new conceptual

framework for establishing school-based social competence promo-

tion programs In Bond L A Compas B E eds Primary

Prevention amp Promotion in the Schools Newbury Park CA Sage

255ndash296Wills T A (1986) Stress and coping in early adolescence relationships

to substance use in urban school samples Health Psychology

5503ndash529Wills T A Cleary S D (1995) Stress-coping model for alcohol-

tobacco interactions in adolescence In Fertig J B Allen J P

eds Alcohol and Tobacco From Basic Science to Clinical Practice

Bethesda MD National Institute on Alcohol Abuse and

Alcoholism 107ndash128Wills T A Cleary S D (1999) Peer and adolescent substance use

among 6thndash9th graders Latent growth analyses of influence versus

selection mechanisms Health Psychology 18453ndash463

2014 Sussman et al

ORDER REPRINTS

Wills T A Hirky A E (1996) Coping and substance abuse InZeidner M Endler N S eds Handbook of Coping TheoryResearch and Applications New York Wiley 279ndash302

Wills T A Stoolmiller M (2002) The role of self-control in earlyescalation of substance use a time-varying analysis Journal ofConsulting and Clinical Psychology 70986ndash997

Wills T A Baker E Botvin G J (1989) Dimensions of assertivenessdifferential relationships to substance use in early adolescenceJournal of Consulting and Clinical Psychology 57(4)473ndash478

Wills T A Vaccaro D McNamara G (1994) Novelty seeking risktaking and related constructs as predictors of adolescent substanceuse an application of Cloningerrsquos theory Journal of SubstanceAbuse 61ndash20

Wills T A McNamara G Vaccaro D Hirky A E (1996a)Escalated substance use a longitudinal grouping analysis fromearly to middle adolescence Journal of Abnormal Psychology105166ndash180

Wills T A Pierce J P Evans R I (1996b) Large-scale environmentalrisk factors for substance use American Behavioral Scientist39808ndash822

Wills T A Windle M Cleary S D (1998) Role of temperamentnovelty-seeking and self-control in adolescent substance useJournal of Personality and Social Psychology 74387ndash406

Wills T A Sandy J M Shinar O (1999) Substance use level andproblems in late adolescence a mediational model based on self-control and coping motives Experimental and ClinicalPsychopharmacology 7122ndash134

Wills T A Cleary S D Filer M Shinar O Mariani J Spera K(2001) Temperament and self-control related to early-onsetsubstance use test of a developmental model Prevention Science2145ndash163

Wills T A Sandy J M Yaeger A (2002) Moderators of therelationship between substance use level and problems test of aself-regulation model in adolescence Journal of AbnormalPsychology 1113ndash21

Wills T A Gibbons F X Gerrard M Murry V Brody G (in press-a) Family communication and religiosity related to substance useand sexual behavior in early adolescence Psychology of AddictiveBehaviors

Wills T A Resko J Ainette M Mendoza D (in press-b) The role ofparent and peer support in adolescent substance use a test ofmediated effects Psychology of Addictive Behaviors

Motivation Skills and Decision Making 2015

ORDER REPRINTS

Young P T (1936) Motivation of Behavior New York John Wiley andSons

Zimmerman B J (2000) Attaining self-regulation a social cognitivemodel In Boekaerts M Pintrich P R eds Handbook of Self-Regulation San Diego Academic Press 13ndash39

2016 Sussman et al

Request PermissionOrder Reprints

Reprints of this article can also be ordered at

httpwwwdekkercomservletproductDOI101081JA200034769

Request Permission or Order Reprints Instantly

Interested in copying and sharing this article In most cases US Copyright Law requires that you get permission from the articlersquos rightsholder before using copyrighted content

All information and materials found in this article including but not limited to text trademarks patents logos graphics and images (the Materials) are the copyrighted works and other forms of intellectual property of Marcel Dekker Inc or its licensors All rights not expressly granted are reserved

Get permission to lawfully reproduce and distribute the Materials or order reprints quickly and painlessly Simply click on the Request Permission Order Reprints link below and follow the instructions Visit the US Copyright Office for information on Fair Use limitations of US copyright law Please refer to The Association of American Publishersrsquo (AAP) website for guidelines on Fair Use in the Classroom

The Materials are for your personal use only and cannot be reformatted reposted resold or distributed by electronic means or otherwise without permission from Marcel Dekker Inc Marcel Dekker Inc grants you the limited right to display the Materials only on your personal computer or personal wireless device and to copy and download single copies of such Materials provided that any copyright trademark or other notice appearing on such Materials is also retained by displayed copied or downloaded as part of the Materials and is not removed or obscured and provided you do not edit modify alter or enhance the Materials Please refer to our Website User Agreement for more details

ORDER REPRINTS

strains academic competence and general versus specific problem

behaviors Journal of Counseling Psychology 49172ndash186Nezami E Sussman S Pentz M A (2003) Motivation in tobacco use

cessation research Substance Use amp Misuse 3825ndash5Novak S P Clayton R R (2001) The influence of school environment

and self-regulation on transitions between stages of cigarette

smoking Health Psychology 20196ndash207Offord D R (2000) Selection of levels of prevention Addictive

Behaviors 25833ndash842Palinkas L A Atkins C J Miller C Ferreira D (1996) Social skills

training for drug prevention in high-risk female adolescents

Preventive Medicine 25692ndash701Patock-Peckham J A Cheong J-W Balhorn M E Nagoshi C T

(2001) A model of parenting styles self-regulation perceived

drinking control and alcohol use and problems Alcoholism

Experimental and Clinical Research 251284ndash1292Pentz M A (1994) Directions for future research in drug abuse

prevention Preventive Medicine 23646ndash652Pentz M A Dwyer J H MacKinnon D Flay B R Hansen W B

Wang E Y I Johnson C A (1989) A multi-community trial for

primary prevention of adolescent drug abuse effects on drug use

prevalence JAMA 2623259ndash3266Pentz M A Mares D Schinke S Rohrbach L (in press) Political

science public policy and drug abuse prevention Substance Use amp

MisuseProchaska J O DiClemente C C (1982) Transtheoretical therapy

toward a more integrative model of change Psychotherapy Theory

Research and Practice 19275ndash288Pulkkinen L Pitkanen T (1994) A prospective study of the precursors

to problem drinking in young adulthood Journal of Studies on

Alcohol 55578ndash587Rathus S A Nevid J S (1977) Behavior Therapy Strategies for

Solving Problems in Living New York Doubleday and Company

IncResnicow K Botvin G (1993) School-based substance use prevention

programs why do effects decay Preventive Medicine 22484ndash490Rutter M Dunn J Plomin R Simonoff E Pickles A Maughan

B Ormel J Meyer J Eaves L (1997) Integrating nature and

nurture implications of person-environment interactions for

developmental psychopathology Development and Psychopathology

9335ndash364

Motivation Skills and Decision Making 2011

ORDER REPRINTS

Salomon G Stein Y Eisenberg S Klein L (1984) Adolescent

smokers and nonsmokers profiles and their changing structure

Preventive Medicine 13446ndash461Sambrano S (1999) National cross-site evaluation of high risk youth

programs In Interim findings Bulletin Washington DC CSAP

SAMSHA US DHHS May 1ndash16Schinke S P Gilchrist L D (1985) Preventing substance abuse with

children and adolescents Journal of Consulting and Clinical

Psychology 53596ndash602Skara S N Sussman S (2003) A review of 25 long-term adolescent

tobacco and other drug use prevention program evaluations

Preventive MedicineSmith C Lizotte A J Thornberry T P Krohn M D (1995)

Resilient youth identifying factors that prevent high-risk youth

from engaging in delinquency and drug use Delinquency and

Disrepute in the Life Course Greenwich CT John Hagan JAI

press 217ndash247Sommers P V (1972) The Biology of Behavior Australia Pty ltd

Sydney John Wiley amp SonsSt Pierre T L Kaltreider D L Mark M M Aikin K J (1992)

Drug prevention in a community setting a longitudinal study of the

relative effectiveness of a three-year primary prevention program in

boys and girls clubs across the nation American Journal of

Community Psychology 20673ndash706Stein J A Newcomb M D Bentler P M (1987) An eight year study

of multiple influences on drug use and drug use consequences

Journal of Personality and Social Psychology 531094ndash1105Sully J (1884) Outlines of Psychology New York D Appleton amp CoSussman S (1989) Two social influence perspectives of tobacco use

development and prevention Health Education Research Theory

and Practice 4213ndash223Sussman S (1991) Curriculum development in school-based prevention

research Health Education Research Theory and Practice

6339ndash351Sussman S (1996) Development of a school-based drug abuse

prevention curriculum for high risk youth Journal of

Psychoactive Drugs 28169ndash182Sussman S Ames S L (2001) The social psychology of drug abuse

Buckingham GB Open University PressSussman S Unger J (2004) A drug abuse theoretical integration a

transdisciplinary speculation Substance Use amp Misuse

2012 Sussman et al

ORDER REPRINTS

Sussman S Dent C W Burton D Stacy A W Flay B R (1995a)

Developing school-based tobacco use prevention and cessation

programs Thousand Oaks CA Sage Publications IncSussman S Dent C W Simon T R Stacy A W Galaif E R

Moss M A Craig S Johnson C A (1995b) Effectiveness of

social influence substance abuse prevention curricula in compre-

hensive and continuation high schools Drugs and Society 865ndash81Sussman S Dent C W Galaif E R (1997) The correlates of

substance abuse and dependence among adolescents at high risk

for drug abuse Journal of Substance Abuse 9241ndash255Sussman S Dent C W Stacy A W (1996) The relation of pro-drug

use myths with self-reported drug use among youth at continuation

high schools Journal of Applied Social Psychology 26214ndash267Sussman S Dent C W Stacy A Craig S (1998) One-year outcomes

of project towards no drug abuse Preventive Medicine 27632ndash642

(erratum 766)Sussman S Dent C W Stacy S (2002) Project towards no drug

abuse a review of the findings and future directions American

Journal of Health Behavior 26354ndash365Sussman S McCuller W J Dent C W (2003) The associations of

social self-control personality disorders and demographics with

drug use among high risk youth Addictive Behaviors 281159ndash1166Sussman S Rohrbach L Patel R Holiday K (2003) A look at an

interactive classroom-based drug abuse prevention program

Interactive contents and suggestions for research Journal of Drug

Education 33355ndash368Sussman S Sun P McCuller W J Dent C W (2003) Project

towards no drug abuse two year outcomes of a trial that compares

health educator delivery to self-instruction Preventive Medicine

37155ndash162Tarter R E Vanyukov M (1994) Alcoholism a developmental disorder

Journal of Consulting and Clinical Psychology 621096ndash1107Thornton T N Craft C A Dahlberg L L Lynch B S Baer K

(2000) Best Practices of Youth Violence Prevention A Sourcebook

for Community Action Atlanta GA Division of Violence

Prevention Centers for Disease Control and PreventionTobler N S (1986) Meta-analysis of 143 adolescent drug prevention

programs quantitative outcome of program participants compared to

a control or comparison group Journal of Drug Issues 16537ndash567Tobler N S Roona M R Ochshorn P Marshall D G Streke

A V Stackpole K M (2000) School-based adolescent drug

Motivation Skills and Decision Making 2013

ORDER REPRINTS

prevention programs 1998 Meta-analysis The Journal of Primary

Prevention 20275ndash336US Department of Health and Human Services (USDHHS) (2003)

Substance Abuse andMental Health Services Administration Center

for Substance Abuse Prevention Science-based prevention programs and

principles 2002 Rockville MD US DHHS (SMA)03-3764 Also

see httpmodelprogramssamhsagovUnger J Baezconde-Garbanati L Shakib S Palmer P H Nezami

E Mora J (2004) What are the implications of structuralcultural

theory for drug abuse prevention Substance Use amp MisuseUpshaw H S Ostrom T M (1984) Psychological perspective in

attitude research In Eiser J R ed Attitudinal Judgment New

York Springer-Verlag 23ndash42Valente T W Gallaher P Mouttapa M (2004) Using social network

theory to understand and prevent substance use a transdisciplinary

perspective Substance Use amp MisuseVorrath H Brendtro L (1985) Positive peer culture 2nd edn Aldine

ChicagoWaldron H B Slesnick N Brody J L Turner C W Peterson T R

(2001) Treatment outcomes for adolescent substance abuse at 4-

and 7-month assessments Journal of Consulting amp Clinical

Psychology 69(5)802ndash813Watson D L Tharp R G (2002) Self-directed behavior Self-

modification for personal adjustment 8th edn Belmont CA

WadsworthWeissberg R P Caplan M Z Sivo P J (1989) A new conceptual

framework for establishing school-based social competence promo-

tion programs In Bond L A Compas B E eds Primary

Prevention amp Promotion in the Schools Newbury Park CA Sage

255ndash296Wills T A (1986) Stress and coping in early adolescence relationships

to substance use in urban school samples Health Psychology

5503ndash529Wills T A Cleary S D (1995) Stress-coping model for alcohol-

tobacco interactions in adolescence In Fertig J B Allen J P

eds Alcohol and Tobacco From Basic Science to Clinical Practice

Bethesda MD National Institute on Alcohol Abuse and

Alcoholism 107ndash128Wills T A Cleary S D (1999) Peer and adolescent substance use

among 6thndash9th graders Latent growth analyses of influence versus

selection mechanisms Health Psychology 18453ndash463

2014 Sussman et al

ORDER REPRINTS

Wills T A Hirky A E (1996) Coping and substance abuse InZeidner M Endler N S eds Handbook of Coping TheoryResearch and Applications New York Wiley 279ndash302

Wills T A Stoolmiller M (2002) The role of self-control in earlyescalation of substance use a time-varying analysis Journal ofConsulting and Clinical Psychology 70986ndash997

Wills T A Baker E Botvin G J (1989) Dimensions of assertivenessdifferential relationships to substance use in early adolescenceJournal of Consulting and Clinical Psychology 57(4)473ndash478

Wills T A Vaccaro D McNamara G (1994) Novelty seeking risktaking and related constructs as predictors of adolescent substanceuse an application of Cloningerrsquos theory Journal of SubstanceAbuse 61ndash20

Wills T A McNamara G Vaccaro D Hirky A E (1996a)Escalated substance use a longitudinal grouping analysis fromearly to middle adolescence Journal of Abnormal Psychology105166ndash180

Wills T A Pierce J P Evans R I (1996b) Large-scale environmentalrisk factors for substance use American Behavioral Scientist39808ndash822

Wills T A Windle M Cleary S D (1998) Role of temperamentnovelty-seeking and self-control in adolescent substance useJournal of Personality and Social Psychology 74387ndash406

Wills T A Sandy J M Shinar O (1999) Substance use level andproblems in late adolescence a mediational model based on self-control and coping motives Experimental and ClinicalPsychopharmacology 7122ndash134

Wills T A Cleary S D Filer M Shinar O Mariani J Spera K(2001) Temperament and self-control related to early-onsetsubstance use test of a developmental model Prevention Science2145ndash163

Wills T A Sandy J M Yaeger A (2002) Moderators of therelationship between substance use level and problems test of aself-regulation model in adolescence Journal of AbnormalPsychology 1113ndash21

Wills T A Gibbons F X Gerrard M Murry V Brody G (in press-a) Family communication and religiosity related to substance useand sexual behavior in early adolescence Psychology of AddictiveBehaviors

Wills T A Resko J Ainette M Mendoza D (in press-b) The role ofparent and peer support in adolescent substance use a test ofmediated effects Psychology of Addictive Behaviors

Motivation Skills and Decision Making 2015

ORDER REPRINTS

Young P T (1936) Motivation of Behavior New York John Wiley andSons

Zimmerman B J (2000) Attaining self-regulation a social cognitivemodel In Boekaerts M Pintrich P R eds Handbook of Self-Regulation San Diego Academic Press 13ndash39

2016 Sussman et al

Request PermissionOrder Reprints

Reprints of this article can also be ordered at

httpwwwdekkercomservletproductDOI101081JA200034769

Request Permission or Order Reprints Instantly

Interested in copying and sharing this article In most cases US Copyright Law requires that you get permission from the articlersquos rightsholder before using copyrighted content

All information and materials found in this article including but not limited to text trademarks patents logos graphics and images (the Materials) are the copyrighted works and other forms of intellectual property of Marcel Dekker Inc or its licensors All rights not expressly granted are reserved

Get permission to lawfully reproduce and distribute the Materials or order reprints quickly and painlessly Simply click on the Request Permission Order Reprints link below and follow the instructions Visit the US Copyright Office for information on Fair Use limitations of US copyright law Please refer to The Association of American Publishersrsquo (AAP) website for guidelines on Fair Use in the Classroom

The Materials are for your personal use only and cannot be reformatted reposted resold or distributed by electronic means or otherwise without permission from Marcel Dekker Inc Marcel Dekker Inc grants you the limited right to display the Materials only on your personal computer or personal wireless device and to copy and download single copies of such Materials provided that any copyright trademark or other notice appearing on such Materials is also retained by displayed copied or downloaded as part of the Materials and is not removed or obscured and provided you do not edit modify alter or enhance the Materials Please refer to our Website User Agreement for more details

ORDER REPRINTS

Salomon G Stein Y Eisenberg S Klein L (1984) Adolescent

smokers and nonsmokers profiles and their changing structure

Preventive Medicine 13446ndash461Sambrano S (1999) National cross-site evaluation of high risk youth

programs In Interim findings Bulletin Washington DC CSAP

SAMSHA US DHHS May 1ndash16Schinke S P Gilchrist L D (1985) Preventing substance abuse with

children and adolescents Journal of Consulting and Clinical

Psychology 53596ndash602Skara S N Sussman S (2003) A review of 25 long-term adolescent

tobacco and other drug use prevention program evaluations

Preventive MedicineSmith C Lizotte A J Thornberry T P Krohn M D (1995)

Resilient youth identifying factors that prevent high-risk youth

from engaging in delinquency and drug use Delinquency and

Disrepute in the Life Course Greenwich CT John Hagan JAI

press 217ndash247Sommers P V (1972) The Biology of Behavior Australia Pty ltd

Sydney John Wiley amp SonsSt Pierre T L Kaltreider D L Mark M M Aikin K J (1992)

Drug prevention in a community setting a longitudinal study of the

relative effectiveness of a three-year primary prevention program in

boys and girls clubs across the nation American Journal of

Community Psychology 20673ndash706Stein J A Newcomb M D Bentler P M (1987) An eight year study

of multiple influences on drug use and drug use consequences

Journal of Personality and Social Psychology 531094ndash1105Sully J (1884) Outlines of Psychology New York D Appleton amp CoSussman S (1989) Two social influence perspectives of tobacco use

development and prevention Health Education Research Theory

and Practice 4213ndash223Sussman S (1991) Curriculum development in school-based prevention

research Health Education Research Theory and Practice

6339ndash351Sussman S (1996) Development of a school-based drug abuse

prevention curriculum for high risk youth Journal of

Psychoactive Drugs 28169ndash182Sussman S Ames S L (2001) The social psychology of drug abuse

Buckingham GB Open University PressSussman S Unger J (2004) A drug abuse theoretical integration a

transdisciplinary speculation Substance Use amp Misuse

2012 Sussman et al

ORDER REPRINTS

Sussman S Dent C W Burton D Stacy A W Flay B R (1995a)

Developing school-based tobacco use prevention and cessation

programs Thousand Oaks CA Sage Publications IncSussman S Dent C W Simon T R Stacy A W Galaif E R

Moss M A Craig S Johnson C A (1995b) Effectiveness of

social influence substance abuse prevention curricula in compre-

hensive and continuation high schools Drugs and Society 865ndash81Sussman S Dent C W Galaif E R (1997) The correlates of

substance abuse and dependence among adolescents at high risk

for drug abuse Journal of Substance Abuse 9241ndash255Sussman S Dent C W Stacy A W (1996) The relation of pro-drug

use myths with self-reported drug use among youth at continuation

high schools Journal of Applied Social Psychology 26214ndash267Sussman S Dent C W Stacy A Craig S (1998) One-year outcomes

of project towards no drug abuse Preventive Medicine 27632ndash642

(erratum 766)Sussman S Dent C W Stacy S (2002) Project towards no drug

abuse a review of the findings and future directions American

Journal of Health Behavior 26354ndash365Sussman S McCuller W J Dent C W (2003) The associations of

social self-control personality disorders and demographics with

drug use among high risk youth Addictive Behaviors 281159ndash1166Sussman S Rohrbach L Patel R Holiday K (2003) A look at an

interactive classroom-based drug abuse prevention program

Interactive contents and suggestions for research Journal of Drug

Education 33355ndash368Sussman S Sun P McCuller W J Dent C W (2003) Project

towards no drug abuse two year outcomes of a trial that compares

health educator delivery to self-instruction Preventive Medicine

37155ndash162Tarter R E Vanyukov M (1994) Alcoholism a developmental disorder

Journal of Consulting and Clinical Psychology 621096ndash1107Thornton T N Craft C A Dahlberg L L Lynch B S Baer K

(2000) Best Practices of Youth Violence Prevention A Sourcebook

for Community Action Atlanta GA Division of Violence

Prevention Centers for Disease Control and PreventionTobler N S (1986) Meta-analysis of 143 adolescent drug prevention

programs quantitative outcome of program participants compared to

a control or comparison group Journal of Drug Issues 16537ndash567Tobler N S Roona M R Ochshorn P Marshall D G Streke

A V Stackpole K M (2000) School-based adolescent drug

Motivation Skills and Decision Making 2013

ORDER REPRINTS

prevention programs 1998 Meta-analysis The Journal of Primary

Prevention 20275ndash336US Department of Health and Human Services (USDHHS) (2003)

Substance Abuse andMental Health Services Administration Center

for Substance Abuse Prevention Science-based prevention programs and

principles 2002 Rockville MD US DHHS (SMA)03-3764 Also

see httpmodelprogramssamhsagovUnger J Baezconde-Garbanati L Shakib S Palmer P H Nezami

E Mora J (2004) What are the implications of structuralcultural

theory for drug abuse prevention Substance Use amp MisuseUpshaw H S Ostrom T M (1984) Psychological perspective in

attitude research In Eiser J R ed Attitudinal Judgment New

York Springer-Verlag 23ndash42Valente T W Gallaher P Mouttapa M (2004) Using social network

theory to understand and prevent substance use a transdisciplinary

perspective Substance Use amp MisuseVorrath H Brendtro L (1985) Positive peer culture 2nd edn Aldine

ChicagoWaldron H B Slesnick N Brody J L Turner C W Peterson T R

(2001) Treatment outcomes for adolescent substance abuse at 4-

and 7-month assessments Journal of Consulting amp Clinical

Psychology 69(5)802ndash813Watson D L Tharp R G (2002) Self-directed behavior Self-

modification for personal adjustment 8th edn Belmont CA

WadsworthWeissberg R P Caplan M Z Sivo P J (1989) A new conceptual

framework for establishing school-based social competence promo-

tion programs In Bond L A Compas B E eds Primary

Prevention amp Promotion in the Schools Newbury Park CA Sage

255ndash296Wills T A (1986) Stress and coping in early adolescence relationships

to substance use in urban school samples Health Psychology

5503ndash529Wills T A Cleary S D (1995) Stress-coping model for alcohol-

tobacco interactions in adolescence In Fertig J B Allen J P

eds Alcohol and Tobacco From Basic Science to Clinical Practice

Bethesda MD National Institute on Alcohol Abuse and

Alcoholism 107ndash128Wills T A Cleary S D (1999) Peer and adolescent substance use

among 6thndash9th graders Latent growth analyses of influence versus

selection mechanisms Health Psychology 18453ndash463

2014 Sussman et al

ORDER REPRINTS

Wills T A Hirky A E (1996) Coping and substance abuse InZeidner M Endler N S eds Handbook of Coping TheoryResearch and Applications New York Wiley 279ndash302

Wills T A Stoolmiller M (2002) The role of self-control in earlyescalation of substance use a time-varying analysis Journal ofConsulting and Clinical Psychology 70986ndash997

Wills T A Baker E Botvin G J (1989) Dimensions of assertivenessdifferential relationships to substance use in early adolescenceJournal of Consulting and Clinical Psychology 57(4)473ndash478

Wills T A Vaccaro D McNamara G (1994) Novelty seeking risktaking and related constructs as predictors of adolescent substanceuse an application of Cloningerrsquos theory Journal of SubstanceAbuse 61ndash20

Wills T A McNamara G Vaccaro D Hirky A E (1996a)Escalated substance use a longitudinal grouping analysis fromearly to middle adolescence Journal of Abnormal Psychology105166ndash180

Wills T A Pierce J P Evans R I (1996b) Large-scale environmentalrisk factors for substance use American Behavioral Scientist39808ndash822

Wills T A Windle M Cleary S D (1998) Role of temperamentnovelty-seeking and self-control in adolescent substance useJournal of Personality and Social Psychology 74387ndash406

Wills T A Sandy J M Shinar O (1999) Substance use level andproblems in late adolescence a mediational model based on self-control and coping motives Experimental and ClinicalPsychopharmacology 7122ndash134

Wills T A Cleary S D Filer M Shinar O Mariani J Spera K(2001) Temperament and self-control related to early-onsetsubstance use test of a developmental model Prevention Science2145ndash163

Wills T A Sandy J M Yaeger A (2002) Moderators of therelationship between substance use level and problems test of aself-regulation model in adolescence Journal of AbnormalPsychology 1113ndash21

Wills T A Gibbons F X Gerrard M Murry V Brody G (in press-a) Family communication and religiosity related to substance useand sexual behavior in early adolescence Psychology of AddictiveBehaviors

Wills T A Resko J Ainette M Mendoza D (in press-b) The role ofparent and peer support in adolescent substance use a test ofmediated effects Psychology of Addictive Behaviors

Motivation Skills and Decision Making 2015

ORDER REPRINTS

Young P T (1936) Motivation of Behavior New York John Wiley andSons

Zimmerman B J (2000) Attaining self-regulation a social cognitivemodel In Boekaerts M Pintrich P R eds Handbook of Self-Regulation San Diego Academic Press 13ndash39

2016 Sussman et al

Request PermissionOrder Reprints

Reprints of this article can also be ordered at

httpwwwdekkercomservletproductDOI101081JA200034769

Request Permission or Order Reprints Instantly

Interested in copying and sharing this article In most cases US Copyright Law requires that you get permission from the articlersquos rightsholder before using copyrighted content

All information and materials found in this article including but not limited to text trademarks patents logos graphics and images (the Materials) are the copyrighted works and other forms of intellectual property of Marcel Dekker Inc or its licensors All rights not expressly granted are reserved

Get permission to lawfully reproduce and distribute the Materials or order reprints quickly and painlessly Simply click on the Request Permission Order Reprints link below and follow the instructions Visit the US Copyright Office for information on Fair Use limitations of US copyright law Please refer to The Association of American Publishersrsquo (AAP) website for guidelines on Fair Use in the Classroom

The Materials are for your personal use only and cannot be reformatted reposted resold or distributed by electronic means or otherwise without permission from Marcel Dekker Inc Marcel Dekker Inc grants you the limited right to display the Materials only on your personal computer or personal wireless device and to copy and download single copies of such Materials provided that any copyright trademark or other notice appearing on such Materials is also retained by displayed copied or downloaded as part of the Materials and is not removed or obscured and provided you do not edit modify alter or enhance the Materials Please refer to our Website User Agreement for more details

ORDER REPRINTS

Sussman S Dent C W Burton D Stacy A W Flay B R (1995a)

Developing school-based tobacco use prevention and cessation

programs Thousand Oaks CA Sage Publications IncSussman S Dent C W Simon T R Stacy A W Galaif E R

Moss M A Craig S Johnson C A (1995b) Effectiveness of

social influence substance abuse prevention curricula in compre-

hensive and continuation high schools Drugs and Society 865ndash81Sussman S Dent C W Galaif E R (1997) The correlates of

substance abuse and dependence among adolescents at high risk

for drug abuse Journal of Substance Abuse 9241ndash255Sussman S Dent C W Stacy A W (1996) The relation of pro-drug

use myths with self-reported drug use among youth at continuation

high schools Journal of Applied Social Psychology 26214ndash267Sussman S Dent C W Stacy A Craig S (1998) One-year outcomes

of project towards no drug abuse Preventive Medicine 27632ndash642

(erratum 766)Sussman S Dent C W Stacy S (2002) Project towards no drug

abuse a review of the findings and future directions American

Journal of Health Behavior 26354ndash365Sussman S McCuller W J Dent C W (2003) The associations of

social self-control personality disorders and demographics with

drug use among high risk youth Addictive Behaviors 281159ndash1166Sussman S Rohrbach L Patel R Holiday K (2003) A look at an

interactive classroom-based drug abuse prevention program

Interactive contents and suggestions for research Journal of Drug

Education 33355ndash368Sussman S Sun P McCuller W J Dent C W (2003) Project

towards no drug abuse two year outcomes of a trial that compares

health educator delivery to self-instruction Preventive Medicine

37155ndash162Tarter R E Vanyukov M (1994) Alcoholism a developmental disorder

Journal of Consulting and Clinical Psychology 621096ndash1107Thornton T N Craft C A Dahlberg L L Lynch B S Baer K

(2000) Best Practices of Youth Violence Prevention A Sourcebook

for Community Action Atlanta GA Division of Violence

Prevention Centers for Disease Control and PreventionTobler N S (1986) Meta-analysis of 143 adolescent drug prevention

programs quantitative outcome of program participants compared to

a control or comparison group Journal of Drug Issues 16537ndash567Tobler N S Roona M R Ochshorn P Marshall D G Streke

A V Stackpole K M (2000) School-based adolescent drug

Motivation Skills and Decision Making 2013

ORDER REPRINTS

prevention programs 1998 Meta-analysis The Journal of Primary

Prevention 20275ndash336US Department of Health and Human Services (USDHHS) (2003)

Substance Abuse andMental Health Services Administration Center

for Substance Abuse Prevention Science-based prevention programs and

principles 2002 Rockville MD US DHHS (SMA)03-3764 Also

see httpmodelprogramssamhsagovUnger J Baezconde-Garbanati L Shakib S Palmer P H Nezami

E Mora J (2004) What are the implications of structuralcultural

theory for drug abuse prevention Substance Use amp MisuseUpshaw H S Ostrom T M (1984) Psychological perspective in

attitude research In Eiser J R ed Attitudinal Judgment New

York Springer-Verlag 23ndash42Valente T W Gallaher P Mouttapa M (2004) Using social network

theory to understand and prevent substance use a transdisciplinary

perspective Substance Use amp MisuseVorrath H Brendtro L (1985) Positive peer culture 2nd edn Aldine

ChicagoWaldron H B Slesnick N Brody J L Turner C W Peterson T R

(2001) Treatment outcomes for adolescent substance abuse at 4-

and 7-month assessments Journal of Consulting amp Clinical

Psychology 69(5)802ndash813Watson D L Tharp R G (2002) Self-directed behavior Self-

modification for personal adjustment 8th edn Belmont CA

WadsworthWeissberg R P Caplan M Z Sivo P J (1989) A new conceptual

framework for establishing school-based social competence promo-

tion programs In Bond L A Compas B E eds Primary

Prevention amp Promotion in the Schools Newbury Park CA Sage

255ndash296Wills T A (1986) Stress and coping in early adolescence relationships

to substance use in urban school samples Health Psychology

5503ndash529Wills T A Cleary S D (1995) Stress-coping model for alcohol-

tobacco interactions in adolescence In Fertig J B Allen J P

eds Alcohol and Tobacco From Basic Science to Clinical Practice

Bethesda MD National Institute on Alcohol Abuse and

Alcoholism 107ndash128Wills T A Cleary S D (1999) Peer and adolescent substance use

among 6thndash9th graders Latent growth analyses of influence versus

selection mechanisms Health Psychology 18453ndash463

2014 Sussman et al

ORDER REPRINTS

Wills T A Hirky A E (1996) Coping and substance abuse InZeidner M Endler N S eds Handbook of Coping TheoryResearch and Applications New York Wiley 279ndash302

Wills T A Stoolmiller M (2002) The role of self-control in earlyescalation of substance use a time-varying analysis Journal ofConsulting and Clinical Psychology 70986ndash997

Wills T A Baker E Botvin G J (1989) Dimensions of assertivenessdifferential relationships to substance use in early adolescenceJournal of Consulting and Clinical Psychology 57(4)473ndash478

Wills T A Vaccaro D McNamara G (1994) Novelty seeking risktaking and related constructs as predictors of adolescent substanceuse an application of Cloningerrsquos theory Journal of SubstanceAbuse 61ndash20

Wills T A McNamara G Vaccaro D Hirky A E (1996a)Escalated substance use a longitudinal grouping analysis fromearly to middle adolescence Journal of Abnormal Psychology105166ndash180

Wills T A Pierce J P Evans R I (1996b) Large-scale environmentalrisk factors for substance use American Behavioral Scientist39808ndash822

Wills T A Windle M Cleary S D (1998) Role of temperamentnovelty-seeking and self-control in adolescent substance useJournal of Personality and Social Psychology 74387ndash406

Wills T A Sandy J M Shinar O (1999) Substance use level andproblems in late adolescence a mediational model based on self-control and coping motives Experimental and ClinicalPsychopharmacology 7122ndash134

Wills T A Cleary S D Filer M Shinar O Mariani J Spera K(2001) Temperament and self-control related to early-onsetsubstance use test of a developmental model Prevention Science2145ndash163

Wills T A Sandy J M Yaeger A (2002) Moderators of therelationship between substance use level and problems test of aself-regulation model in adolescence Journal of AbnormalPsychology 1113ndash21

Wills T A Gibbons F X Gerrard M Murry V Brody G (in press-a) Family communication and religiosity related to substance useand sexual behavior in early adolescence Psychology of AddictiveBehaviors

Wills T A Resko J Ainette M Mendoza D (in press-b) The role ofparent and peer support in adolescent substance use a test ofmediated effects Psychology of Addictive Behaviors

Motivation Skills and Decision Making 2015

ORDER REPRINTS

Young P T (1936) Motivation of Behavior New York John Wiley andSons

Zimmerman B J (2000) Attaining self-regulation a social cognitivemodel In Boekaerts M Pintrich P R eds Handbook of Self-Regulation San Diego Academic Press 13ndash39

2016 Sussman et al

Request PermissionOrder Reprints

Reprints of this article can also be ordered at

httpwwwdekkercomservletproductDOI101081JA200034769

Request Permission or Order Reprints Instantly

Interested in copying and sharing this article In most cases US Copyright Law requires that you get permission from the articlersquos rightsholder before using copyrighted content

All information and materials found in this article including but not limited to text trademarks patents logos graphics and images (the Materials) are the copyrighted works and other forms of intellectual property of Marcel Dekker Inc or its licensors All rights not expressly granted are reserved

Get permission to lawfully reproduce and distribute the Materials or order reprints quickly and painlessly Simply click on the Request Permission Order Reprints link below and follow the instructions Visit the US Copyright Office for information on Fair Use limitations of US copyright law Please refer to The Association of American Publishersrsquo (AAP) website for guidelines on Fair Use in the Classroom

The Materials are for your personal use only and cannot be reformatted reposted resold or distributed by electronic means or otherwise without permission from Marcel Dekker Inc Marcel Dekker Inc grants you the limited right to display the Materials only on your personal computer or personal wireless device and to copy and download single copies of such Materials provided that any copyright trademark or other notice appearing on such Materials is also retained by displayed copied or downloaded as part of the Materials and is not removed or obscured and provided you do not edit modify alter or enhance the Materials Please refer to our Website User Agreement for more details

ORDER REPRINTS

prevention programs 1998 Meta-analysis The Journal of Primary

Prevention 20275ndash336US Department of Health and Human Services (USDHHS) (2003)

Substance Abuse andMental Health Services Administration Center

for Substance Abuse Prevention Science-based prevention programs and

principles 2002 Rockville MD US DHHS (SMA)03-3764 Also

see httpmodelprogramssamhsagovUnger J Baezconde-Garbanati L Shakib S Palmer P H Nezami

E Mora J (2004) What are the implications of structuralcultural

theory for drug abuse prevention Substance Use amp MisuseUpshaw H S Ostrom T M (1984) Psychological perspective in

attitude research In Eiser J R ed Attitudinal Judgment New

York Springer-Verlag 23ndash42Valente T W Gallaher P Mouttapa M (2004) Using social network

theory to understand and prevent substance use a transdisciplinary

perspective Substance Use amp MisuseVorrath H Brendtro L (1985) Positive peer culture 2nd edn Aldine

ChicagoWaldron H B Slesnick N Brody J L Turner C W Peterson T R

(2001) Treatment outcomes for adolescent substance abuse at 4-

and 7-month assessments Journal of Consulting amp Clinical

Psychology 69(5)802ndash813Watson D L Tharp R G (2002) Self-directed behavior Self-

modification for personal adjustment 8th edn Belmont CA

WadsworthWeissberg R P Caplan M Z Sivo P J (1989) A new conceptual

framework for establishing school-based social competence promo-

tion programs In Bond L A Compas B E eds Primary

Prevention amp Promotion in the Schools Newbury Park CA Sage

255ndash296Wills T A (1986) Stress and coping in early adolescence relationships

to substance use in urban school samples Health Psychology

5503ndash529Wills T A Cleary S D (1995) Stress-coping model for alcohol-

tobacco interactions in adolescence In Fertig J B Allen J P

eds Alcohol and Tobacco From Basic Science to Clinical Practice

Bethesda MD National Institute on Alcohol Abuse and

Alcoholism 107ndash128Wills T A Cleary S D (1999) Peer and adolescent substance use

among 6thndash9th graders Latent growth analyses of influence versus

selection mechanisms Health Psychology 18453ndash463

2014 Sussman et al

ORDER REPRINTS

Wills T A Hirky A E (1996) Coping and substance abuse InZeidner M Endler N S eds Handbook of Coping TheoryResearch and Applications New York Wiley 279ndash302

Wills T A Stoolmiller M (2002) The role of self-control in earlyescalation of substance use a time-varying analysis Journal ofConsulting and Clinical Psychology 70986ndash997

Wills T A Baker E Botvin G J (1989) Dimensions of assertivenessdifferential relationships to substance use in early adolescenceJournal of Consulting and Clinical Psychology 57(4)473ndash478

Wills T A Vaccaro D McNamara G (1994) Novelty seeking risktaking and related constructs as predictors of adolescent substanceuse an application of Cloningerrsquos theory Journal of SubstanceAbuse 61ndash20

Wills T A McNamara G Vaccaro D Hirky A E (1996a)Escalated substance use a longitudinal grouping analysis fromearly to middle adolescence Journal of Abnormal Psychology105166ndash180

Wills T A Pierce J P Evans R I (1996b) Large-scale environmentalrisk factors for substance use American Behavioral Scientist39808ndash822

Wills T A Windle M Cleary S D (1998) Role of temperamentnovelty-seeking and self-control in adolescent substance useJournal of Personality and Social Psychology 74387ndash406

Wills T A Sandy J M Shinar O (1999) Substance use level andproblems in late adolescence a mediational model based on self-control and coping motives Experimental and ClinicalPsychopharmacology 7122ndash134

Wills T A Cleary S D Filer M Shinar O Mariani J Spera K(2001) Temperament and self-control related to early-onsetsubstance use test of a developmental model Prevention Science2145ndash163

Wills T A Sandy J M Yaeger A (2002) Moderators of therelationship between substance use level and problems test of aself-regulation model in adolescence Journal of AbnormalPsychology 1113ndash21

Wills T A Gibbons F X Gerrard M Murry V Brody G (in press-a) Family communication and religiosity related to substance useand sexual behavior in early adolescence Psychology of AddictiveBehaviors

Wills T A Resko J Ainette M Mendoza D (in press-b) The role ofparent and peer support in adolescent substance use a test ofmediated effects Psychology of Addictive Behaviors

Motivation Skills and Decision Making 2015

ORDER REPRINTS

Young P T (1936) Motivation of Behavior New York John Wiley andSons

Zimmerman B J (2000) Attaining self-regulation a social cognitivemodel In Boekaerts M Pintrich P R eds Handbook of Self-Regulation San Diego Academic Press 13ndash39

2016 Sussman et al

Request PermissionOrder Reprints

Reprints of this article can also be ordered at

httpwwwdekkercomservletproductDOI101081JA200034769

Request Permission or Order Reprints Instantly

Interested in copying and sharing this article In most cases US Copyright Law requires that you get permission from the articlersquos rightsholder before using copyrighted content

All information and materials found in this article including but not limited to text trademarks patents logos graphics and images (the Materials) are the copyrighted works and other forms of intellectual property of Marcel Dekker Inc or its licensors All rights not expressly granted are reserved

Get permission to lawfully reproduce and distribute the Materials or order reprints quickly and painlessly Simply click on the Request Permission Order Reprints link below and follow the instructions Visit the US Copyright Office for information on Fair Use limitations of US copyright law Please refer to The Association of American Publishersrsquo (AAP) website for guidelines on Fair Use in the Classroom

The Materials are for your personal use only and cannot be reformatted reposted resold or distributed by electronic means or otherwise without permission from Marcel Dekker Inc Marcel Dekker Inc grants you the limited right to display the Materials only on your personal computer or personal wireless device and to copy and download single copies of such Materials provided that any copyright trademark or other notice appearing on such Materials is also retained by displayed copied or downloaded as part of the Materials and is not removed or obscured and provided you do not edit modify alter or enhance the Materials Please refer to our Website User Agreement for more details

ORDER REPRINTS

Wills T A Hirky A E (1996) Coping and substance abuse InZeidner M Endler N S eds Handbook of Coping TheoryResearch and Applications New York Wiley 279ndash302

Wills T A Stoolmiller M (2002) The role of self-control in earlyescalation of substance use a time-varying analysis Journal ofConsulting and Clinical Psychology 70986ndash997

Wills T A Baker E Botvin G J (1989) Dimensions of assertivenessdifferential relationships to substance use in early adolescenceJournal of Consulting and Clinical Psychology 57(4)473ndash478

Wills T A Vaccaro D McNamara G (1994) Novelty seeking risktaking and related constructs as predictors of adolescent substanceuse an application of Cloningerrsquos theory Journal of SubstanceAbuse 61ndash20

Wills T A McNamara G Vaccaro D Hirky A E (1996a)Escalated substance use a longitudinal grouping analysis fromearly to middle adolescence Journal of Abnormal Psychology105166ndash180

Wills T A Pierce J P Evans R I (1996b) Large-scale environmentalrisk factors for substance use American Behavioral Scientist39808ndash822

Wills T A Windle M Cleary S D (1998) Role of temperamentnovelty-seeking and self-control in adolescent substance useJournal of Personality and Social Psychology 74387ndash406

Wills T A Sandy J M Shinar O (1999) Substance use level andproblems in late adolescence a mediational model based on self-control and coping motives Experimental and ClinicalPsychopharmacology 7122ndash134

Wills T A Cleary S D Filer M Shinar O Mariani J Spera K(2001) Temperament and self-control related to early-onsetsubstance use test of a developmental model Prevention Science2145ndash163

Wills T A Sandy J M Yaeger A (2002) Moderators of therelationship between substance use level and problems test of aself-regulation model in adolescence Journal of AbnormalPsychology 1113ndash21

Wills T A Gibbons F X Gerrard M Murry V Brody G (in press-a) Family communication and religiosity related to substance useand sexual behavior in early adolescence Psychology of AddictiveBehaviors

Wills T A Resko J Ainette M Mendoza D (in press-b) The role ofparent and peer support in adolescent substance use a test ofmediated effects Psychology of Addictive Behaviors

Motivation Skills and Decision Making 2015

ORDER REPRINTS

Young P T (1936) Motivation of Behavior New York John Wiley andSons

Zimmerman B J (2000) Attaining self-regulation a social cognitivemodel In Boekaerts M Pintrich P R eds Handbook of Self-Regulation San Diego Academic Press 13ndash39

2016 Sussman et al

Request PermissionOrder Reprints

Reprints of this article can also be ordered at

httpwwwdekkercomservletproductDOI101081JA200034769

Request Permission or Order Reprints Instantly

Interested in copying and sharing this article In most cases US Copyright Law requires that you get permission from the articlersquos rightsholder before using copyrighted content

All information and materials found in this article including but not limited to text trademarks patents logos graphics and images (the Materials) are the copyrighted works and other forms of intellectual property of Marcel Dekker Inc or its licensors All rights not expressly granted are reserved

Get permission to lawfully reproduce and distribute the Materials or order reprints quickly and painlessly Simply click on the Request Permission Order Reprints link below and follow the instructions Visit the US Copyright Office for information on Fair Use limitations of US copyright law Please refer to The Association of American Publishersrsquo (AAP) website for guidelines on Fair Use in the Classroom

The Materials are for your personal use only and cannot be reformatted reposted resold or distributed by electronic means or otherwise without permission from Marcel Dekker Inc Marcel Dekker Inc grants you the limited right to display the Materials only on your personal computer or personal wireless device and to copy and download single copies of such Materials provided that any copyright trademark or other notice appearing on such Materials is also retained by displayed copied or downloaded as part of the Materials and is not removed or obscured and provided you do not edit modify alter or enhance the Materials Please refer to our Website User Agreement for more details

ORDER REPRINTS

Young P T (1936) Motivation of Behavior New York John Wiley andSons

Zimmerman B J (2000) Attaining self-regulation a social cognitivemodel In Boekaerts M Pintrich P R eds Handbook of Self-Regulation San Diego Academic Press 13ndash39

2016 Sussman et al

Request PermissionOrder Reprints

Reprints of this article can also be ordered at

httpwwwdekkercomservletproductDOI101081JA200034769

Request Permission or Order Reprints Instantly

Interested in copying and sharing this article In most cases US Copyright Law requires that you get permission from the articlersquos rightsholder before using copyrighted content

All information and materials found in this article including but not limited to text trademarks patents logos graphics and images (the Materials) are the copyrighted works and other forms of intellectual property of Marcel Dekker Inc or its licensors All rights not expressly granted are reserved

Get permission to lawfully reproduce and distribute the Materials or order reprints quickly and painlessly Simply click on the Request Permission Order Reprints link below and follow the instructions Visit the US Copyright Office for information on Fair Use limitations of US copyright law Please refer to The Association of American Publishersrsquo (AAP) website for guidelines on Fair Use in the Classroom

The Materials are for your personal use only and cannot be reformatted reposted resold or distributed by electronic means or otherwise without permission from Marcel Dekker Inc Marcel Dekker Inc grants you the limited right to display the Materials only on your personal computer or personal wireless device and to copy and download single copies of such Materials provided that any copyright trademark or other notice appearing on such Materials is also retained by displayed copied or downloaded as part of the Materials and is not removed or obscured and provided you do not edit modify alter or enhance the Materials Please refer to our Website User Agreement for more details

Request PermissionOrder Reprints

Reprints of this article can also be ordered at

httpwwwdekkercomservletproductDOI101081JA200034769

Request Permission or Order Reprints Instantly

Interested in copying and sharing this article In most cases US Copyright Law requires that you get permission from the articlersquos rightsholder before using copyrighted content

All information and materials found in this article including but not limited to text trademarks patents logos graphics and images (the Materials) are the copyrighted works and other forms of intellectual property of Marcel Dekker Inc or its licensors All rights not expressly granted are reserved

Get permission to lawfully reproduce and distribute the Materials or order reprints quickly and painlessly Simply click on the Request Permission Order Reprints link below and follow the instructions Visit the US Copyright Office for information on Fair Use limitations of US copyright law Please refer to The Association of American Publishersrsquo (AAP) website for guidelines on Fair Use in the Classroom

The Materials are for your personal use only and cannot be reformatted reposted resold or distributed by electronic means or otherwise without permission from Marcel Dekker Inc Marcel Dekker Inc grants you the limited right to display the Materials only on your personal computer or personal wireless device and to copy and download single copies of such Materials provided that any copyright trademark or other notice appearing on such Materials is also retained by displayed copied or downloaded as part of the Materials and is not removed or obscured and provided you do not edit modify alter or enhance the Materials Please refer to our Website User Agreement for more details