How to prevent alcohol and other drug use among adolescents remains one of the most challenging questions in the substance abuse and mental health field. Drugs are seen as a threat not only by parents and other concerned adults, but also by young people.

Despite this widespread concern, prevention remains the lowest policy priority. The federal government as well as most states and cities spend less than 15 percent of their total anti-drug budgets on prevention. In the fiscal year 2003 federal drug budget, prevention programs received $2.4 billion, compared to $12.89 billion for domestic law enforcement, interdiction, and international efforts to reduce drug production and trafficking.

Extensive studies over the past two decades have documented the cost-effectiveness of early prevention and education efforts (Caulkins, Rydell, Everingham, Chiesa, & Bushway, 1999; Caulkins, Pacula, Paddock, & Chiesa, 2002). Yet many of the programs currently being used in classrooms across the country have serious limitations. Most of them have not been evaluated using pretest, posttest control group designs that measure actual reductions in tobacco, drug, and alcohol use. Very few programs have demonstrated any sustained impact on youth behavior, and those that do are rarely fully implemented. Moreover, increasingly overcrowded classrooms and overburdened teaching schedules along with severe budget cuts have left little time for prevention teaching in many public schools.

Nonetheless, some progress has been made in reducing marijuana use among teens during the past decade. In 1996, for example, 18 percent of 8th graders reported having used marijuana at least once in the previous year, compared to 14 percent in 2002. Similar small declines occurred among 10th graders (from 34 percent in 1996 to 30 percent in 2002). However, during the same period, marijuana use among 12th graders remained steady at about 36 percent.

In contrast, teen smoking has dropped significantly. Eighth graders reported a 50 percent decrease in smoking from 1996 to 2002 (from 21 percent to 10.7 percent), while high school seniors also reported declines (34 percent to 26.7 percent). These reductions in teen smoking are particularly impressive in view of the heavy promotion of tobacco products. In 2001, the tobacco industry spent $11.2 billion for advertising and promotions, much of it directed toward young people.

Adolescent drinking also has declined somewhat during the past decade; however, alcohol use remains widespread among young teens, despite continuing prevention efforts. In 2002, one in five (20 percent of) 8th-grade students reported regular drinking (i.e., had a drink at least once in the past 30 days) while one in seven reported having been drunk at least once in the previous year. (This is in contrast to regular drinking in 1993 of 24 percent of 8th graders.) However, the reported figures for binge drinking and having been drunk have not dropped: in 2002, one in three high school seniors reported having been drunk in the previous month (MTF, 2003).

Why is adolescent drinking, particularly binge drinking and drunkenness, relatively resistant to prevention efforts? Alcohol, like tobacco, is heavily promoted to youth, even though both are illegal for minors. However, drinking, unlike smoking, is generally an accepted social activity, even if at times dangerous, even fatal. Children tend to discount many of the warnings they hear about alcohol, since they see adults, including their parents, drink every day. The social norms against underage drinking are weak; the laws are often not enforced; and adults frequently turn a blind eye, excusing teen drinking as a rite of passage.

New prevention approaches are needed that will make a real impact on how youth think about drinking. A promising new initiative focuses on teaching youth about the damage that alcohol does to the developing adolescent brain. The idea originated with Hope Taft, now the First Lady of Ohio, who has been for many years a nationally recognized leader in the prevention field. Mrs. Taft is the co-chair of Leadership to Keep Children Alcohol Free, created by state Governors’ spouses to prevent drinking among children ages 9 to 15. At a Leadership meeting several years ago, she heard about groundbreaking research that found that the hippocampus, a portion of the brain responsible for memory, was 10 percent smaller in children with heavy drinking histories than in young people who had little or no exposure to alcohol. Mrs. Taft decided to get the word of this research out through a reality-style video called “Smart and Sober,” centered on a teen group discussion about alcohol’s pervasiveness in their lives, with actor/director Henry Winkler.

The “Smart and Sober” teen group consisted of young people who were alcohol free, others who were currently drinking, and still others who had completed a treatment program for drug and alcohol abuse. The discussion is woven together with individual stories about real people who have to deal with the consequences of alcohol. Two experts on youth addiction give medical opinions about the dangerous costs of drinking for young people. “Smart and Sober” has been acclaimed by educators, students, and other organizations concerned with child and adolescent health. The video recently won a prestigious “Telly” Award that highlights outstanding television video productions and films. Responding to numerous requests from their members, the American Academy of Pediatrics has made the video available on their Web site. Young people who have seen the film say that it works for two reasons: first, the video is not preachy but gives straightforward information about alcohol’s negative consequences, and second, the video puts the decision about drinking squarely on the young person. A companion-piece video aimed at parents has just been released. More information is available at www.smartandsober.org or from Mrs. Hope Taft’s office at 614-995-2000.

Mathea Falco, an attorney, is president of Drug Strategies. She served as Assistant Secretary of State for International Narcotic Matters from 1977-1981.

References
Caulkins, J. P., Rydell, C. P., Everingham, S. S., Chiesa, J., & Bushway, S. (1999). An ounce of prevention, a pound of uncertainty: The cost-effectiveness of school-based drug prevention programs, Santa Monica, CA: RAND, MR-923-RWJ.
Caulkins, J. P., Pacula, R., Paddock, S., & Chiesa, J. (2002). School-based drug prevention: What kind of drug use does it prevent?” Santa Monica, CA: RAND, MR-1459-RWJ.
Monitoring the Future Study (MTF). (2003). Conducted by the University of Michigan Institute for Social Research. Retrieved August 29, 2003, from http://www.
monitoringthefuture.org
MTV. (2003, February 13). Iraq, drug-use issues more important to young people than sex. Retrieved August 29, 2003, from http://www.mtv.com/news/articles/1469947/
02122003/id_0.jhtml

This article is published in Counselor,The Magazine for Addiction Professionals, December 2003, v.4, n.5, pp. 18-19.

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