On June 15, the Senate Health, Education, Labor, and Pensions Subcommittee on Substance Abuse and Mental Health Services held a hearing to discuss substance abuse prevention and treatment issues concerning adolescents. Chair Mike DeWine (R-OH) noted that “providing effective services to adolescents is particularly challenging,” but “if we fail our youth in their developmental years, we may be condemning them to a life of difficulty and lowered expectations.”
Substance Abuse and Mental Health Services Administration (SAMHSA) Administrator Charles Curie detailed the agency’s efforts to provide effective substance abuse treatment to youth. “The data from SAMHSA’s 2002 National Survey on Drug Use and Health provides the scope of the problem. In 2002, there were 2.3 million youths aged 12 to 17 who needed treatment for an alcohol or illicit drug problem. Of this group, only 186,000 received treatment,” he said.
In order to improve its services and programs, SAMHSA created the Strategic Prevention Framework, a “new $45 million competitive grant program that will enable States, Territories, and the District of Columbia to bring together multiple funding streams from multiple sources to create and sustain a community-based, science-based approach to substance abuse prevention and mental health promotion.” Mr. Curie noted that the framework is based on the risk and protective factor approach, saying, “Just as when we are promoting exercise and a healthy diet or advancing vaccination, when we speak about abstinence or rejecting drugs, tobacco, and alcohol and promoting mental health, we really are all working towards the same objective—reducing risk factors and promoting protective factors.”
Other SAMHSA programs include Access to Recovery, which provides a full range of clinical treatment and recovery support services; the Strengthening Communities Youth program, which funds 12 sites to develop a continuum of adolescent services and a system of care for youth; the Effective Adolescent Treatment program, which is being implemented in 38 sites nationwide; and the Juvenile Justice Drug Treatment Courts and the Targeted Capacity Expansion, the Targeted Capacity Expansion/HIV, and HIV Outreach programs operated by SAMHSA’s Center for Substance Abuse Treatment.
Dr. Sandra Brown of the University of California, San Diego discussed the importance of addressing substance abuse at an early age. “NIAAA [National Institute on Alcohol Abuse and Alcohol] and NIDA [National Institute on Drug Abuse]-supported researchers are finding that alcohol and other drug addictions commonly start earlier than previously understood…The age of most prevalent tobacco dependence onset is 15, and for alcohol dependence age 18 is the most common period of first diagnosis of dependence,” she told the subcommittee. Dr. Brown also said that recent neurodevelopment studies have shown neurocognitive deficits in adolescents who are abusing drugs or alcohol: “Even after three weeks of abstinence, alcohol dependent youth display a 10% decrement in delayed memory functions…Neuropsychological testing of these youth followed up to eight years demonstrates that continued heavy drinking during adolescence is associated with diminished memory of verbal and nonverbal material, and poorer performance on tests requiring skills.”
Dr. Brown said that more research is needed on adolescent focused treatment. “Alcohol, tobacco and other drugs affect genders and subpopulations differently, and some groups suffer more adverse effects of alcohol, tobacco and drugs than other groups. For treatment of these youth problems to be optimally effective, research to study the role of gender, ethnicity, socioeconomic status, and other variables determining the effects of various substance abuse interventions is sorely needed.”
Dr. Roger Weissberg of the Collaborative for Academic, Social, and Emotional Learning (CASEL) summarized the current research on school-based prevention programs. He noted a 2003 study, which highlighted six characteristics of effective prevention programs: 1) they use a research-based risk and protective factor framework that involves families, peers, schools, and communities; 2) they are long-term, age-specific, and culturally appropriate; 3) they foster development of individuals who are healthy and fully engaged by teaching them to apply social-emotional skills and ethical values in daily life; 4) they aim to establish policies, institutional practices, and environmental supports that nurture optimal development; 5) they select, train, and support interpersonally skilled staff to implement programming effectively; and 6) they incorporate and adapt evidence-based programming to meet local community needs through strategic planning, ongoing evaluation, and continuous improvement.
Despite these findings, Dr. Weissberg said there is a gap between research and practice due to a number of factors, including fragmentation and lack of coordination among prevention programs, lack of administrator and teacher support and professional development opportunities, and lack of an accountability system. However, he commended the Department of Education’s Office of Safe and Drug-Free Schools for its “efforts to train and support Safe and Drug-Free School Coordinators. Given the crucial role that they play in successful implementation of programs and the host of tasks for which the coordinators are responsible, more funding should be provided for training the coordinators and selecting and hiring more individuals to join in this important endeavor.”
Speaking to the importance of “coalitions as an integral part of adolescent substance abuse prevention and treatment,” Rhonda Ramsey-Molina of the Coalition for a Drug-Free Greater Cincinnati said, “Direct service programs focus on individuals, not the community at large.” As an example, she cited a conversation she had when she was providing direct services to a fourth-grade girl who is being raised by a single, crack-addicted mother. The girl told her, “When I grow up, I am not going to use drugs…When I grow up, I am going to have a baby, then get married and my boyfriend is going to sell drugs so I can be rich.” Ms. Ramsey-Molina told the subcommittee, “The reality is that any program, provided only once a week for fifty minutes over a ten-week period, while valuable, is not able to address the larger community issues that adolescents face the other 23 hours a day they are not participating in the program.”
Ronald Anton of Day One, a facility that provides prevention, intervention, treatment, and aftercare services to Maine youth and their families, described their success. “Treatment through Day One is available across the full continuum, from outpatient services and intensive outpatient, to long-term residential and transitional housing for youth in need. In the last six years, as more and more research has become available, we have…introduced and reinforced the use of evidence-based and other ‘best practices’ in prevention and treatment services to youth,” he said. “We believe that our model, one of the first statewide models in the nation to build a system for adolescents that identifies youth in need of services, expands access to and improves treatment statewide, and engages all collaborative partners, has produced positive results in a relatively short period of time.”
