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
(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
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
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
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
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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
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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
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Clinical Psychology 58310ndash316Dent C W Sussman S McCuller W J Stacy A W (2001) Drug
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B G (1994) Preventing adolescent drug abuse and high school
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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
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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
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Hansen W B Graham J W (1991) Preventing alcohol marijuanaand cigarette use among adolescents peer pressure and resistancetraining versus establishing conservative norms PreventiveMedicine 20414ndash430
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Heider F (1958) The Psychology of Interpersonal Relations New YorkWiley
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Kumpfer K L (1999) Outcomes measures of interventions in the studyof children of substance-abusing parents Pediatrics 1031128ndash1144
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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
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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
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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
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Newcomb M D (1996b) Adolescence Pathologizing a normal processThe Counseling Psychologist 24482ndash490
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substance abuse and dependence among adolescents at high risk
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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
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social self-control personality disorders and demographics with
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interactive classroom-based drug abuse prevention program
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A V Stackpole K M (2000) School-based adolescent drug
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Substance Abuse andMental Health Services Administration Center
for Substance Abuse Prevention Science-based prevention programs and
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attitude research In Eiser J R ed Attitudinal Judgment New
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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
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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
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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
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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
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
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
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
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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
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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
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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
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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
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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
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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
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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
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(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
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
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
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
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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
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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
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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
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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
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(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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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
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
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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
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(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
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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
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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
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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
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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
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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
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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
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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
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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
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Cognitive Theory Englewood Cliffs NJ Prentice HallBarton C Alexander J F Waldron H Turner C W Warburton J
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Catalano R F Hawkins J D (2000) Predicting early high school
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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
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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
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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
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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
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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
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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
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B G (1994) Preventing adolescent drug abuse and high school
dropout through an intensive school-based social network devel-
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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
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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
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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
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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
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
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
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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
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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
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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
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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
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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
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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
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Catalano R F Hawkins J D (2000) Predicting early high school
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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
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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
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The high-risk sample Journal of Consulting and Clinical Psychology
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of Mind in the Philosophy Curriculum San Francisco San Francisco
State UniversityCummings K M Hellmann R Emont S L (1988) Correlates of
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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
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B G (1994) Preventing adolescent drug abuse and high school
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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
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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
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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
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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
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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
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strains academic competence and general versus specific problem
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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
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(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
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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
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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
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
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
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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
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Chamberlain P (1994) Family connections A treatment foster caremodel for adolescents with delinquency Eugene OR CastaliaPublishing Company
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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
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Clinical Psychology 58310ndash316Dent C W Sussman S McCuller W J Stacy A W (2001) Drug
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B G (1994) Preventing adolescent drug abuse and high school
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based prevention program Suicide amp Life-Threatening Behavior
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Boulder CO Institute of Behavioral Science Regents of the
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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
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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
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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
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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
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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
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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
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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
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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
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Newcomb M D (1996b) Adolescence Pathologizing a normal processThe Counseling Psychologist 24482ndash490
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research Health Education Research Theory and Practice
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Moss M A Craig S Johnson C A (1995b) Effectiveness of
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Prevention Centers for Disease Control and PreventionTobler N S (1986) Meta-analysis of 143 adolescent drug prevention
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A V Stackpole K M (2000) School-based adolescent drug
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for Substance Abuse Prevention Science-based prevention programs and
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attitude research In Eiser J R ed Attitudinal Judgment New
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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
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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
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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
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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
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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
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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
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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
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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
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(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
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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
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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
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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
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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
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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
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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
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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
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Systems-behavioral intervention with families of delinquents
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Consulting and Clinical Psychology 44(4)656ndash664Alexander J F Parsons B V (1973) Short-term behavioral interven-
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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
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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
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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
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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
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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
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
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Statistical Manual of Mental Disorders 4th edn (DSM-IV)
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competing constructs in the prediction of substance use among
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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
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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
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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
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The high-risk sample Journal of Consulting and Clinical Psychology
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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
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B G (1994) Preventing adolescent drug abuse and high school
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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(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
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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
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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
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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
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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
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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
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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
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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
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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
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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-
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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
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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
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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
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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
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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
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Statistical Manual of Mental Disorders 4th edn (DSM-IV)
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competing constructs in the prediction of substance use among
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Personality and Individual Differences 26987ndash1003Bachman S G Wadsworth K N OrsquoMalley P M Johnston L D
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Three replications The American Journal of Family Therapy
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Catalano R F Hawkins J D (2000) Predicting early high school
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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
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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
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The high-risk sample Journal of Consulting and Clinical Psychology
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of Mind in the Philosophy Curriculum San Francisco San Francisco
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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
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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
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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
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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
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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
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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
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Behaviors 25833ndash842Palinkas L A Atkins C J Miller C Ferreira D (1996) Social skills
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to problem drinking in young adulthood Journal of Studies on
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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
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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
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transdisciplinary speculation Substance Use amp Misuse
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Catalano R F Hawkins J D (2000) Predicting early high school
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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
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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
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The high-risk sample Journal of Consulting and Clinical Psychology
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of Mind in the Philosophy Curriculum San Francisco San Francisco
State UniversityCummings K M Hellmann R Emont S L (1988) Correlates of
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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
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B G (1994) Preventing adolescent drug abuse and high school
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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
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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
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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
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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
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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
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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
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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
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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
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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
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(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
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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
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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
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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
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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
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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
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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
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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
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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-
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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(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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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competing constructs in the prediction of substance use among
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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
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153ndash190Bandura A (1986) Social Foundations of Thought and Action A Social
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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
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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
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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
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Behaviors 25833ndash842Palinkas L A Atkins C J Miller C Ferreira D (1996) Social skills
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nurture implications of person-environment interactions for
developmental psychopathology Development and Psychopathology
9335ndash364
Motivation Skills and Decision Making 2011
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Salomon G Stein Y Eisenberg S Klein L (1984) Adolescent
smokers and nonsmokers profiles and their changing structure
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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
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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
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Psychoactive Drugs 28169ndash182Sussman S Ames S L (2001) The social psychology of drug abuse
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transdisciplinary speculation Substance Use amp Misuse
2012 Sussman et al
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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
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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
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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
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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
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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
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Psychology 11271ndash288
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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
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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
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exploratory effects of network social support Youth and Society
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B G (1994) Preventing adolescent drug abuse and high school
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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
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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
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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
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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
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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
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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
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Motivation Skills and Decision Making 2011
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Salomon G Stein Y Eisenberg S Klein L (1984) Adolescent
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Preventive MedicineSmith C Lizotte A J Thornberry T P Krohn M D (1995)
Resilient youth identifying factors that prevent high-risk youth
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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
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Psychoactive Drugs 28169ndash182Sussman S Ames S L (2001) The social psychology of drug abuse
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transdisciplinary speculation Substance Use amp Misuse
2012 Sussman et al
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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
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(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
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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
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see httpmodelprogramssamhsagovUnger J Baezconde-Garbanati L Shakib S Palmer P H Nezami
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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
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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
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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
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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
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Chamberlain P (1994) Family connections A treatment foster caremodel for adolescents with delinquency Eugene OR CastaliaPublishing Company
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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
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motivation for smoking cessation Journal of Consulting and
Clinical Psychology 58310ndash316Dent C W Sussman S McCuller W J Stacy A W (2001) Drug
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B G (1994) Preventing adolescent drug abuse and high school
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Reducing suicide potential among high-risk youth tests of a school-
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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
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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
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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
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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
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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
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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
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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
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of multiple influences on drug use and drug use consequences
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research Health Education Research Theory and Practice
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Developing school-based tobacco use prevention and cessation
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Moss M A Craig S Johnson C A (1995b) Effectiveness of
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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ORDER REPRINTS
strains academic competence and general versus specific problem
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and self-regulation on transitions between stages of cigarette
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Behaviors 25833ndash842Palinkas L A Atkins C J Miller C Ferreira D (1996) Social skills
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Preventive Medicine 25692ndash701Patock-Peckham J A Cheong J-W Balhorn M E Nagoshi C T
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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
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to problem drinking in young adulthood Journal of Studies on
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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
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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
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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
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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
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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
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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
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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
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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
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(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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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(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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Catalano R F Hawkins J D (2000) Predicting early high school
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Cunningham P B et al (in press) Helping Adolescents at Risk
Prevention of Multiple Problem Behaviors New York NY Guilford
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Clinical Psychology 58310ndash316Dent C W Sussman S McCuller W J Stacy A W (2001) Drug
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B G (1994) Preventing adolescent drug abuse and high school
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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
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Boulder CO Institute of Behavioral Science Regents of the
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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
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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
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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
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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
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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
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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
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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
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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
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(2001) A model of parenting styles self-regulation perceived
drinking control and alcohol use and problems Alcoholism
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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
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science public policy and drug abuse prevention Substance Use amp
MisuseProchaska J O DiClemente C C (1982) Transtheoretical therapy
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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
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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
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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
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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
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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
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(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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Chamberlain P (1994) Family connections A treatment foster caremodel for adolescents with delinquency Eugene OR CastaliaPublishing Company
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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
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Clinical Psychology 58310ndash316Dent C W Sussman S McCuller W J Stacy A W (2001) Drug
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B G (1994) Preventing adolescent drug abuse and high school
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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
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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
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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
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Heider F (1958) The Psychology of Interpersonal Relations New YorkWiley
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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
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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
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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
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Newcomb M D Bentler P M (1988) Consequences of Adolescent DrugUse Impact on the Lives of Young Adults Beverly Hills CA Sage
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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
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research Health Education Research Theory and Practice
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Developing school-based tobacco use prevention and cessation
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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
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(erratum 766)Sussman S Dent C W Stacy S (2002) Project towards no drug
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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
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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
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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
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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
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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
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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
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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
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(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
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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
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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
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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
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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
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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
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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
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recidivism Journal of Abnormal Psychology 3219ndash225American psychiatric association (APA) (1994) Diagnostic and
Statistical Manual of Mental Disorders 4th edn (DSM-IV)
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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
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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
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Three replications The American Journal of Family Therapy
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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
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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
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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
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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
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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
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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
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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
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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
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Statistical Manual of Mental Disorders 4th edn (DSM-IV)
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competing constructs in the prediction of substance use among
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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
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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
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Prevention of Multiple Problem Behaviors New York NY Guilford
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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
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The high-risk sample Journal of Consulting and Clinical Psychology
67631ndash647Conducts Problems Prevention Research Group (CPPRG) (2000)
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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
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B G (1994) Preventing adolescent drug abuse and high school
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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(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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Personality and Individual Differences 26987ndash1003Bachman S G Wadsworth K N OrsquoMalley P M Johnston L D
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Catalano R F Hawkins J D (2000) Predicting early high school
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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
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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
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of Mind in the Philosophy Curriculum San Francisco San Francisco
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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
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exploratory effects of network social support Youth and Society
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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
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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
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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
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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
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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
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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
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Resilient youth identifying factors that prevent high-risk youth
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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
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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
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Psychoactive Drugs 28169ndash182Sussman S Ames S L (2001) The social psychology of drug abuse
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transdisciplinary speculation Substance Use amp Misuse
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Developing school-based tobacco use prevention and cessation
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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
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(erratum 766)Sussman S Dent C W Stacy S (2002) Project towards no drug
abuse a review of the findings and future directions American
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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
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(2000) Best Practices of Youth Violence Prevention A Sourcebook
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Prevention Centers for Disease Control and PreventionTobler N S (1986) Meta-analysis of 143 adolescent drug prevention
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A V Stackpole K M (2000) School-based adolescent drug
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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
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attitude research In Eiser J R ed Attitudinal Judgment New
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theory to understand and prevent substance use a transdisciplinary
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Personality and Individual Differences 26987ndash1003Bachman S G Wadsworth K N OrsquoMalley P M Johnston L D
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Catalano R F Hawkins J D (2000) Predicting early high school
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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
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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
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The high-risk sample Journal of Consulting and Clinical Psychology
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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
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B G (1994) Preventing adolescent drug abuse and high school
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Consulting and Clinical Psychology 44(4)656ndash664Alexander J F Parsons B V (1973) Short-term behavioral interven-
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Statistical Manual of Mental Disorders 4th edn (DSM-IV)
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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
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153ndash190Bandura A (1986) Social Foundations of Thought and Action A Social
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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
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Cunningham P B et al (in press) Helping Adolescents at Risk
Prevention of Multiple Problem Behaviors New York NY Guilford
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BooksBlanton H Gibbons F X Gerrard M Conger K J Smith G E
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prototypes associated with substance use Journal of Family
Psychology 11271ndash288
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Clinical Psychology 58310ndash316Dent C W Sussman S McCuller W J Stacy A W (2001) Drug
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B G (1994) Preventing adolescent drug abuse and high school
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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
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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
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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
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Heider F (1958) The Psychology of Interpersonal Relations New YorkWiley
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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
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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
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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
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Newcomb M D (1996b) Adolescence Pathologizing a normal processThe Counseling Psychologist 24482ndash490
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Drug prevention in a community setting a longitudinal study of the
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Developing school-based tobacco use prevention and cessation
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Moss M A Craig S Johnson C A (1995b) Effectiveness of
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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
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interactive classroom-based drug abuse prevention program
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Prevention Centers for Disease Control and PreventionTobler N S (1986) Meta-analysis of 143 adolescent drug prevention
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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
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Substance Abuse andMental Health Services Administration Center
for Substance Abuse Prevention Science-based prevention programs and
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attitude research In Eiser J R ed Attitudinal Judgment New
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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
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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
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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
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Statistical Manual of Mental Disorders 4th edn (DSM-IV)
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competing constructs in the prediction of substance use among
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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
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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
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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
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The high-risk sample Journal of Consulting and Clinical Psychology
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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
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B G (1994) Preventing adolescent drug abuse and high school
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Catalano R F Hawkins J D (2000) Predicting early high school
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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
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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
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The high-risk sample Journal of Consulting and Clinical Psychology
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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
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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
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B G (1994) Preventing adolescent drug abuse and high school
dropout through an intensive school-based social network devel-
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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
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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
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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
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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
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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
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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
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Behaviors 25833ndash842Palinkas L A Atkins C J Miller C Ferreira D (1996) Social skills
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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
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science public policy and drug abuse prevention Substance Use amp
MisuseProchaska J O DiClemente C C (1982) Transtheoretical therapy
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Research and Practice 19275ndash288Pulkkinen L Pitkanen T (1994) A prospective study of the precursors
to problem drinking in young adulthood Journal of Studies on
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Solving Problems in Living New York Doubleday and Company
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Salomon G Stein Y Eisenberg S Klein L (1984) Adolescent
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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
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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
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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
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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
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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
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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
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B G (1994) Preventing adolescent drug abuse and high school
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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
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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
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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
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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
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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
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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
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(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
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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
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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
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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
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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
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Chamberlain P (1994) Family connections A treatment foster caremodel for adolescents with delinquency Eugene OR CastaliaPublishing Company
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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
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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
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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
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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
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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
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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
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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
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(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
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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
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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
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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
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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
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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
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Preventive Medicine 32514ndash520Dewey J (1886) Psychology New York HarperDishion T J French D C Patterson G R (1995) The development
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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