Maybe the hundreds of millions of dollars spent on advertisements to discourage teen smoking, drinking and illegal drug use are paying dividends.
The latest annual Monitoring the Future survey says that all three behaviors dropped simultaneously last year, the first time that’s happened since the study began in 1975. The findings mirror numerous other studies in recent years that have shown decreases in those behaviors among youth.
While the decreases have been attributed to myriad forces – including a conservative moral shift among youth, anti-drug and anti-tobacco programs, fears of disease, higher cigarette prices and a dose of sobriety after the Sept. 11 attacks – researchers believe the key overall factor is an increase in the “perceived risk” of the behaviors.
Risk perception and peer disapproval “seem to have been particularly strong determinants” of drug use trends, said Lloyd Johnston, the University of Michigan psychology professor who led the study. “When kids start to see a drug as risky,” they avoid it and disapprove of others using it, which eventually translates into lower usage reported in surveys like this.
Media campaigns and news reports seem to be having a significant influence on that perception of risk, researchers say.
“A message is getting out there,” said Dr. Glen Hanson, acting director of the National Institute on Drug Abuse (NIDA).
The annual survey, sponsored by NIDA and conducted by the University of Michigan’s Institute for Social Research, quizzed 43,700 youth in eighth, 10th and 12th grades. It asked about drug use over a lifetime and in the past year and month. Among the findings, released in December:
• Use of any illicit drug in the previous 12 months dropped in all three age groups, although “significantly” only among eighth and 10th graders.
• Ecstasy use in the past year declined significantly among 10th- graders and showed signs of decline among other youth, after rising for several years.
• Marijuana use dropped at least somewhat among all age groups, reaching its lowest rate since 1994 for eighth graders and since 1995 for 10th-graders.
• Cigarette and alcohol use dropped in all three grades, with alcohol use dropping most significantly in the two younger groups.
• The use of heroin and other narcotics, cocaine, crack and steroids remained largely unchanged.
The study also measured the “perceived risk” and “disapproval” of certain substances, which appear to be on the rise. For example, the perceived risk and disapproval of Ecstasy increased among all three age groups. The study also found increases in risk perception for marijuana, LSD and inhalants.
Not all the age groups reported that same perception for all of the behaviors – the risk perception of smoking marijuana actually went down among 12th graders, for instance – but the negative attitudes were strong overall, researchers said.
“We have found increases in the perceived risk of using a drug to be an important leading indicator of downturns in its use,” Johnston said. That’s how researchers foresaw last year’s drop in Ecstasy use. While 38 percent of 12th-graders said there was a great risk of harm in trying the drug in 2000, that figure rose to 46 percent in 2001 and to 52 percent last year.
Campaigns Have Impact
Why the attitude change on drugs? “It’s difficult to separate out all the different [factors], some of which happen simultaneously,” Johnston said. But he pointed particularly to the role of the mass media: news coverage of drug arrests, deaths and other negative consequences, and anti-drug media campaigns.
Some campaigns appear to have contributed to declines in specific drug use among teens over the years, Johnston says, citing a drop in inhalant abuse after ad campaigns in the mid-1990s.
The most widely touted campaign in recent years has been the American Legacy Foundation’s anti-smoking campaign, funded by the 1998 lawsuit settlement between major tobacco companies and most of the states.
The campaign, which relies heavily on public service announcements (PSAs), has coincided with declines in teen smoking, and several studies (including Monitoring the Future in 2001) have cited those PSAs as among the factors. A study released last year by the Legacy Foundation and the U.S. Centers for Disease Control and Prevention said that smoking prevalence among high schoolers who had “high exposure” to the campaign had declined 29 percent in two years.
But media campaigns can also fall flat. After spending $930 million over several years on anti-drug PSAs, the U.S. Office of National Drug Control Policy (ONDCP) admitted last year that the ads had little effect. A federally funded study by the Westat research firm and the Annenberg School for Communication showed that the PSAs had some impact on parents – getting them to talk with their kids about drugs and keep better tabs on their children’s activities – but had no overall impact on youth themselves.
It’s not that such PSAs can’t work. The American Journal of Public Health reported in February 2001 that well-designed anti-marijuana PSAs reduced use among certain youth in Kentucky and Tennessee, partly because the ads seemed realistic.
“The important thing is that the message-givers have to have credibility with youth,” Johnston said. The Legacy PSAs are designed largely by youth themselves.
ONDCP Director John Walters pledged last year that future ads would be tested for effectiveness before being aired. (See “Drug Czar Pans Ads,” June.) The tests include using focus groups of teenagers.
As for the countless anti-drug programs being delivered by community agencies and schools around the country, Hanson said that measuring their impact is difficult because they vary so widely in quality and form. Monitoring the Future asks youths if such programs have affected their drug use, but Johnston said the results are “not very encouraging.”
He noted, however, that the shift in recent years to curricula built on scientific evaluations of effectiveness might increase the quality of many of those programs.
Contact: Monitoring the Future survey, www.monitoringthefuture.org; Institute for Social Research, (734) 764-8354.
Feds Seek Rx for Prescription Abuse
By Andrew D. Beadle
Alarmed by the rise in prescription drug abuse, especially among young people, the federal government last month unveiled a modest education campaign to warn potential users of the deadly side effects.
“Young adults, even teens, are taking opiods, anti-depressants and stimulants for recreation,” said Dr. H. Westley Clark, director of the U.S. Center for Substance Abuse Treatment at the Substance Abuse and Mental Health Services Administration (SAMHSA). “They do not seem to realize that this misuse can lead to serious problems with addiction.”
Clark pointed to new numbers released from SAMHSA’s Drug Abuse Warning Network (DAWN), which tracks drug abuse using emergency room statistics, and the 2001 National Household Survey on Drug Abuse. The DAWN report and a prescription drug supplemental report show an increased use of prescription drugs among young people ages 12 to 25.
Pain killers are the prescription drugs most abused by this group, Clark said. One of the most popular pain killers is oxycodone, marketed as Oxycontin. The opiate-based drug is used to ease chronic pain by releasing drugs into the body over 12 hours.
Abusers have taken to crushing the pills and snorting, ingesting or injecting themselves with the drug. Release of the entire dose at once causes an intense euphoria akin to that of heroin, experts said.
That single dose can also be fatal, said Dr. John Jenkins, director of the Food and Drug Administration’s (FDA) Office of New Drugs. That’s the message the government wants youth to hear.
“Abuse them [prescription drugs], or mix them with illegal drugs or alcohol, and you can wind up dead,” Jenkins said.
SAMHSA estimated that Oxycontin abuse among youth grew from 41,000 youth in 2000 to 83,000 the next year, while abuse among young adults rose from 178,000 to 388,000.
Abuse of Hydrocodone, which is a four-hour dose and a precursor to the 12-hour, time-released dose in Oxycontin, was higher. SAMHSA said the number of youth abusing it grew from 147,000 in 2000 to 186,000 the next year, while abuse among young adults grew from 729,000 to 910,000 over the same period.
Youth workers and prevention activists have noticed the increase in youth prescription drug abuse, especially Oxycontin.
Oxycontin “was a big thing in our area,” said Leeanna Lee, education director of the Coalition for Drug Abuse Prevention in Winston-Salem, N.C. “They [youth] are getting hold of prescription drugs and using them and getting into trouble.”
Prescription drug abuse was the focus of a police briefing at the coalition’s monthly meeting in September, Lee said. The coalition is a community-based prevention network started in 1988 by a former police chief.
She thinks an ad campaign is a good idea. “You have to keep throwing these things in their faces until they really get it,” she said.
The first step of the education effort, run by the FDA and SAMHSA, is a campaign of posters, pamphlets and print public service announcements (PSAs). The PSAs include the messages, “The Buzz Takes Your Breath Away” and “It’s to Die For.”
They are expected to run in several publications, including Boys’ Life, Seventeen, CosmoGIRL!, Teen Newsweek, Teen People, Tiger Beat, American Cheerleader and ELLEgirl.
SAMHSA also has a new website for prescription abuse, which includes two 30-second videos that could be used later as PSAs. The site provides directions for ordering the brochure and posters.
Clark and Jenkins acknowledged that the campaign is small, with a budget of about $150,000, but called it a first step toward making people more aware of prescription drug abuse.
The campaign does not mention that misusing certain prescription drugs is illegal. Clark and Jenkins said the campaign focuses on the social and health consequences, not the legal ramifications.
New Guide Pinpoints Teen Treatment Programs
By Andrew D. Beadle
Parents and youth workers seeking to place adolescents with substance abuse problems have a new resource: a national guide to teen drug treatment centers broken down by geographical region.
The guide, “Treating Teens: A Guide to Adolescent Drug Programs,” was released last month by the nonprofit research institute Drug Strategies. Its authors touted the publication as “the first-ever comprehensive guide to drug treatment programs for teens.”
“Teenagers are not just younger versions of adults, and they can’t be treated as such,” said Dr. Robert Millman, chairman of the Treating Teens advisory board and the guide’s primary author. “Drug treatment programs for teens have to address adolescent development and family issues, which play an enormous role in the lives of young people and have an impact on their drug use and recovery.”
To compile the guide, Drug Strategies established a 22-member advisory board, drawing on academics, researchers, treatment providers and adolescent development experts. Panel members helped to determine nine elements that they say are crucial to effective adolescent treatment:
• Assessment and treatment matching.
• A comprehensive, integrated treatment approach.
• Family involvement in treatment.
• A developmentally appropriate program.
• Methods to engage and retain teens in treatment.
• Qualified staff.
• Staff with gender and cultural competence.
• A process of continuing care.
• Evidence-based treatment outcomes.
Drug Strategies also sought suggestions from the panel members, 20 national organizations – including the American Medical Association, the American Academy of Pediatrics and the National Institute on Drug Abuse – and each state’s drug abuse agency director.
Each of the 144 programs was sent an extensive survey requesting information about such things as capacity, treatment approach, average length of stay and cost. Drug Strategies interviewed personnel at each of the programs, but made site visits to only seven facilities.
Using the information from the surveys, Drug Strategies compiled profiles of the recommended programs, including how the programs incorporate each of the nine key treatment elements.
Some information is not addressed in the guide, such as the rate at which each program accepts potential clients or specific admission criteria beyond the screening process. In addition, completion rates did not include the criteria used to determine successful “graduation” from the programs.
The guide divides the programs into four geographic areas. A simple table provides information about each, including accreditation, services, length of stay and capacity. Icons are included if the programs demonstrated exceptionally strong use of any of the nine elements.
In addition, the guide includes in-depth reviews of seven programs: Phoenix Academy of Westchester, Shrub Oak, N.Y.; Chestnut Health Systems, Bloomington, Ill.; the Hazelden Center for Youth and Families, Plymouth, Minn.; Multidimensional Family Therapy at the University of Miami; Multisystemic Therapy, Mount Pleasant, S.C.; Catherine Freer Wilderness Therapy Expeditions, Albany, Ore.; and Thunder Road Adolescent Treatment Centers, Oakland, Calif.
No exemplary programs were listed for Alaska, Delaware, Georgia, Michigan, Missouri, Nebraska, Nevada, Texas or Washington, D.C.Drug Strategies cautioned that the guide is not an exhaustive review of the nation’s treatment centers, and that it is informational only.
“We don’t endorse these programs,” said Drug Strategies President Mathea Falco. Programs were not rated, she said, because “There are very few programs in the country that have scientific-based outcomes.”
Charles G. Curie, administrator of the U.S. Substance Abuse and Mental Health Services Administration, said his agency is trying to strengthen the evaluation process to include systematic, clinical and life-outcome data. “It’s a long hard road getting there,” said Curie, who was on hand for the release of the guide and praised it as a valuable tool for helping youths who need treatment.
It will probably help the agencies that appear in it as well.
“It really tells that we have a mission and philosophy of care [in] working with kids,” said Chas Fedorco, director of Cornell Abraxas of Ohio in Shelby, part of the Houston-based for-profit service provider.
“It’s very advisable to have a resource like this available to people, to let them know where” to turn for treatment, said Frank Ross, executive director of Elm Acres Youth and Family Services, in Pittsburg, Kan.
“I suspect that as the word gets out about this book across the country, programs will get more calls” from parents and youth workers, he said.
The guide was supported by a two-year, $451,000 grant from the Robert Wood Johnson Foundation and is available for $16.95 from Drug Strategies.
Contact: Drug Strategies, 1150 Connecticut Ave. NW, Suite 800, Washington, DC 20036. (202) 289-9070, www.drugstrategies.org.