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The Impact of Substance Abuse on the Adolescent Population Essay Example for Free
The Impact of Substance Abuse on the Adolescent Population Essay Introduction Understanding the scope of drug use and addiction in the world includes knowing the prevalence among various populations and researching the many health and social consequences. The United States is both the largest producer of drug research in the world and the world’s only â€Å"drug-control superpower.†The simultaneous leadership in social science and world agenda setting is not the result of a symbiotic relationship between American research and policy making.During adolescence, friends and peers become far more influential than before, and intimate dating relationships become primary interests (Laursen Williams, 1997). Along with these important developmental changes, however, come increased risks of pregnancy, sexually transmitted disease, and abuse by and toward dating partners (Leaper Anderson, 1997). As well, alcohol and drug use and abuse enters the picture, which may contribute to the occurrence of the other risk behaviors (Milgram, 1993; National Center on Addiction and Substance Abuse, 1999). Although some of these developments are harmless, there is a growing awareness of the importance of education and prevention to increase teens personal safety and responsibility. Not surprisingly, prominent adolescent risk behaviors are alcohol and drug abuse, unsafe sexual behavior, and dating violence-share many of the same contributing risk factors, although to important and differing degrees. These include problems related to the family, such as family conflict and violence, poor relationship attachment, early and persistent behavior problems, as well as peer and academic problems, such as school failure, peer rejection, and exposure to community violence. In addition to the above, teen pregnancy, early sexual intercourse, and risky sexual behaviors are associated with early onset of puberty, truancy, and delinquency (Kilpatrick, Acierno, Saunders, Resnick, Best, 2000). In the absence of compensatory factors, such as education and social competence, these varied risk factors can contribute to or become risk behaviors (e.g., alcohol use is associated with teen pregnancy and violence). Common Elements A common family element found among teens who engage in these high risk behaviors is the amount of time spent without proper adult involvement or supervision (Dishion, Capaldi, Spracklen, Li, 2005). Not surprisingly, children who grow up in caring and supportive homes are more likely to resist risky behaviors, while children who have grown up witnessing or experiencing alcohol abuse or violence in their homes, having poor family structure and insecure attachment-related experiences are more likely to be less resistant to these same risky, unhealthy behaviors. A description of the age, gender, and ethnic identities of youth who engage in high risk behavior is provided by the Youth Risk Behavior Surveillance, which tracks data regarding many health risk behaviors for adolescents in the United States. According to this data, black youth, for example, report significantly higher rates of sexual intercourse before age 13 than do Whites and Hispanics, while White youth report the highest levels of forced sexual intercourse. Black youth also report less alcohol consumption at last sexual intercourse and higher condom use than do White and Hispanic youth. Not surprisingly, males report more alcohol use before the age of 13 than females, across all ethnic groups (YRBSS). However, these data on prevalence of self-reported adolescent risk behaviors is descriptive only, and tells little about the contextual factors contributing to such risk. While looking closer at some of the factors that may contribute to the mentioned risk behaviors, the one can see that alcohol use among teenagers remains prevalent in todays society. A national probability sample of 4,023 adolescents between the ages of 12 and 17 found that 15% of the sample used alcohol, 10% used marijuana, and 2% reported hard drug use in the past year (Kilpatrick et al. 2000). Although some alcohol consumption among adolescents is considered normative, there is great concern for the number of teens who are exhibiting signs of alcohol abuse or dependence with 7% of the above sample meeting diagnostic criteria for alcohol, marijuana, or hard drug abuse or dependence. Trends in alcohol use reported in the Youth Risk Behavior Survey indicate that binge drinking (five or more drinks on one occasion during the 30 days prior to the survey) has shown little variation over the past several years, ranging from 31.3% in 1991 to 33.4% in 1997 to 31.5% in 1999 (Centers for Disease Control, 2000). Binge drinking continues to be a problem among youth and needs to be targeted specifically. Importantly, studies have found that alcohol use influenced the practice or involvement in a number of other high-risk behaviors. Sexual activity, smoking, and drinking and driving were significantly related to heavy drinking. Another study examining trauma experiences among adolescents found that those who reported alcohol abuse or dependence were 6-12 times more likely to have a history of childhood physical abuse, and 18-21 times more likely to have a sexual abuse history (Clark, Lesnick, Hegedus, 2001). The continued increase in alcohol consumption among teenagers is cause for concern, particularly as it relates to and influences other risk factors and behaviors. Teen Addiction, Recovery and Relapse            These three (3) aspects are critical elements of this discussion because they are more closely related to reach other than originally recognized. Teen addiction has often been linked to the risk factors that will be discussed in the later segments of this paper (Kilpatrick et al. 2000). Teen addiction is often correlated to exposure to risk factors. The causal link that has been found is that the risk activities that teens are exposed to often lead to drug addiction and dependency. Alternatively, those that find themselves in drug related problems are often also found to take part in risk activities. The second element, teen recovery is also connected to all of these factors in that the success of recovery treatment depends highly not solely on the teen’s non-exposure to drugs but also with the withdrawal from all of those risk factors such as drinking, smoking and healthier dating relationships. Finally, this section will also shed light on the relapse rate which has also been found to be closely related to alcohol and smoking problems. As found in most studies, continued use of non-drug addictive substances also increases the relapse rate especially among teens.            As previously mentioned, teen addiction is often attributed to many different factors. The foremost among these factors remain peer pressure, troubled childhood and lack of parental and substitute parental guidance (e.g. teachers). These are well documented causes of teen drug addiction which will only be briefly discussed.            While there are theories that suggest it may not be just one single element that promotes teen drug addiction, it cannot be denied that the aforementioned factors when taken together do increase the chances of teen drug addiction. Given this fact, once these factors are added with the risk factors such as social acceptance which leads to increased sexual activity, drug addiction not only becomes guaranteed but continued substance abuse well into the late teens is also certified. In the book entitled, â€Å"Care of Drug Users in General Practice: a harm reduction approach†, it has been found that addiction to drugs is not always the primary addictive element and that in certain cases the addiction is to the other benefits derived from drug addiction that individuals find more appealing such as social acceptance and increased sexual activity (Phillips 2004).            The issue of recovery, as discussed in â€Å"Care of Drug Users in General Practice: a harm reduction approach†often cites that recovery is based on the same factors that caused the addiction but to a varying extent (Phillips 2004). This basically means that in order for one to enter voluntarily, which has been found to have to lowest relapse rate, into drug rehabilitation programs, there is a need for the external aid. The cause which began the substance abuse must also be willing to aid the individual in the rehabilitation stage. An example of this would be sexually active teenagers who attempt rehabilitation but fail due to one of the partner’s refusal to enter the same program.            Teens are at a very impressionable stage and in order to be able to reach out to them one must be able to reach out to their peers. This is easier said than done, however, since the clannish nature of most teenagers makes it almost impossible to be able to get on a more comfortable personal level with any of them (Phillips 2004). Most drug rehabilitation programs have begun implementing peer outreach programs where the former successful teen patients volunteer to help the centers in reaching out to the troubled youth.            Finally, the problem of relapse must also be discussed. Relapse is often a greater problem than getting the addict to rehabilitation. The reason for this is that maintaining the dissociation with drugs and the related elements requires constant vigilance without outside intervention (Phillips 2004). Most of the problems that teen addicts face after rehabilitation lies in breaking away from comfortable and familiar ties who are often still exposed to the drug elements to which the teen seeks to break ties from.            There is a lot of literature on this matter which suggests that drug rehabilitation programs should equally pay attention to the â€Å"check out†stage of most recovered addicts. While there is success in getting the addict to quit, for the time being, success can only be measured in its entirety. In this dangerous and socially important aspect, partial success does not count as a victory (Phillips 2004). What truly matters is getting the teen to totally isolate himself or herself from any factor which may bring about a relapse.            In order to tackle this problem, it is important to maintain peer programs such as the AA and the like that have constant monitors on their members. There are programs that have already instituted these types of programs but most have failed due to the lack of commitment by most of its members (Phillips 2004). Teen drug addiction is not an easy problem to admit as most teens often find themselves in denial of their addiction and take it instead as a growing pain that everyone goes through (Phillips 2004). Yet, as revealed earlier, the teen drug abuse rates reveal a different story. Therefore, in order to address the problem of drug relapse, most teenagers must be able to realize that the addiction was not just a part of growing up but rather an experience that is avoidable and must not be repeated. Teen Treatment Systems            This section will briefly tackle the issue on treatment systems such as counseling or outpatient services and its effects on the adolescent population whether it is helpful or only helpful when combined. At the onset, it must be stated that as a part of the rehabilitation system, the issue on counseling and/or outpatient services is critical.            As previously mentioned in the prior section, many of the treatment systems that have been implemented do not focus solely on counseling alone but also include other treatments such as outpatient services and extracurricular activities (Philips 2004). Counseling, as discussed in a number of studies, is only effective up to a certain extent. While generally considered as a more passive approach to treatment, newer and more dynamic systems have also been added to the treatment (Botvin 2005). It has been found that counseling is only the initial step in teen substance abuse rehabilitation. It must be complemented by more dynamic systems as teen outreach programs.            The value of an addict for his or her life is greatly increased when seen in the context of aiding the community. These new treatment systems have been developed specifically to target teens. The reason for this is that it allows for the effective isolation from the harmful and detrimental substance abuse elements and allows the addict or individual to be â€Å"reintroduced†as a productive member of society and the community (Botvin 2005).            The second step in this process is the outpatient service that is offered. The problem of relapse is common among teenagers and as such effective outpatient services to monitor the teens is necessary. The greatest danger comes from not being able to maintain the positive and productive environment for the adolescent. This is perhaps the single most important step in keeping the teens from relapsing into substance abuse (Botvin 2005). Teen Addiction and Risk Factors As such, it is also relevant to discuss how addiction manifests itself in relation to certain aspects such as risky behavior because certain studies have shown that drug addiction is intensified by these elements as well. Dating Relationships Teens generally begin dating, either singly or in small groups, between 13 and 18 years of age, with a range of variability regarding frequency, level of intimacy, seriousness, and importance of these relationships. An illustration of dating, intimacy, and sexual experiences and expectations is provided by an in-depth survey conducted by the Kaiser Family Foundation and YM Magazine, involving 650 boys and girls ages 13-18 years (Henry J. Kaiser Family Foundation and YM Magazine, 1999). They discovered levels or stages of intimacy that developed by age of the youth; that is, intimacy progressed as the youth developed in age chronologically, not as the relationship progressed in length. Most 13-14-year-old teens (72%) reported that it is typical for dating couples their age to kiss, with 45% reporting that French kissing, petting (15%), and intercourse (4%) are expected. Adolescents 15-16 years of age expected an increased level of sexual activity, with 93% reporting kissing, and slightly higher rates of French kissing (71%), petting (48%), and intercourse (28%) as normative. Couples at this age typically spend more time alone together. Older teens (ages 17-18 years) have significantly more sexual experience, with 57% reporting petting to be typical and slightly more than half (52%) reporting intercourse to be typical of their dating relationships. Just as intimacy becomes more involved and prevalent in older teens relationships, so does the significance of the relationship. Although teens continue to value relationships with parents, siblings, other family members, and nonrelated adults, relationships with dating partners begin to gain in importance. Gender differences emerge in how relationships develop in significance and closeness during the adolescent years. A study of the network of relationships among younger adolescents found that dating partners were ranked 6th out of 7 in terms of support received (i.e., companionship, intimacy, instrumental help, affection, enhancement of worth, nurturance of the other, and reliable alliance). By mid-adolescence, dating partners were tied for second place with mothers and, in college, males rated their dating partner as the most supportive person in their network, while females gave equally high ratings to partners, same sex friends, siblings, and mothers (Furman Buhrmester, 2002). A similar study comparing dating and non-dating adolescents found older adolescents and males interacted more frequently with romantic Clinical Issues in Intervention dating partners, whereas younger adolescents and females divided their social interaction time among several relationships (Laursen Williams, 1997). What is not clearly understood, however, is how these relationships emerge in early adolescence, and how these relationships transform over the course of adolescence. Gender differences in expectations and closeness may lead to conflict and tension in dating relationships, if these expectations are not clearly understood or reciprocated. Patterns for more high-risk youth (e.g., those involved in dropout prevention and alternative school programs) stand in contrast to these normative patterns. Of high-risk youth, 35% report being 13 years or younger at first intercourse, 33% were 14-15 years old, and 13% were 16 years or older (OHara et al., 2003). Obviously, youth with other risk behaviors (such as alcohol abuse or school problems) are more likely to also engage in high-risk sexual behavior. Monitoring dating abuse and violence among adolescents is fairly new. Surveys of high school students report 36%-45% of students experience any form of violence in the relationship as a victim or perpetrator (OKeefe Treister, 2003). Recently, a measure of physical abuse in dating relationships has been added to the Youth Risk Behavior Survey. Intentional physical violence, including being hit, slapped, or physically hurt on purpose by a boyfriend or girlfriend, was reported by 8.8% of youth in the 2005 Youth Risk Behavior survey (YRBSS, 2005). A series of focus group studies with adolescent males and females ages 14-19 years regarding teen dating relationships revealed many disturbing attributions regarding harassment and abuse in dating relationships. Factors that caused violence as reported by the teens were grouped into individual, couple, and social levels (Lavoie, Robitaille, Hebert, 2000). Individual factors attributed to the aggressor included jealousy, the boys need for power, and alcohol and drug use. During focus group discussions, youth identified factors attributed to the victim including provocation by the girl, previous experience with violence, a victim personality type (i.e., one who is easily preyed upon), and a strong need for affiliation. Factors attributed to the couple included communication problems and sadomasochism. There was endorsement for consensual violent sex, meaning that a little force during intimacy was considered acceptable as long as both partners agreed. Although consensual, the youth did regard this as sometimes being problematic because partners have agreed to the violence, but may not be sure when one or the other has then crossed the line. Teens in this study frequently attributed blame for violence in the relationship to the victim. Importantly, physical violence in a dating relationship has different ramifications for males and females. While there is a trend to believe that males and females are equally violent, there is evidence that females perpetrate more violence than males out of self-defense. There are also differences in the severity of violence experienced, as well as the impact it has on the victim (Foshee, 2006). A study of high school dating violence revealed that girls experienced significantly more severe physical violence than boys (Jackson, Cram, Seymour, 2000). Females were more likely to be punched and to be forced into sexual activity, whereas males were more likely to be pinched, slapped, scratched, and kicked. The physical effects of the violence were more severe for females, with 48% reporting that it â€Å"hurt a lot†or caused bruises (29%). Males (56%) more frequently reported that it did not hurt at all. Reaction to the worst incident of violence in the relationship also was assessed. Males most frequently reported that they laughed (54%) in reaction to the situation, while females reported a number of other responses: crying (40%), running away (11%), and fighting back (36%); 12% reported that they obeyed their partner. Sexual assault and forced sexual intercourse also occur at an alarming rate during adolescence (9-10% of first sexual intercourse experiences were forced). Males perpetrate more sexual dating violence than females, and females sustain more sexual violence than males (Foshee, 2006). Sexual Activity among Adolescents While it is easy to track female pregnancy rates, adolescent males are typically not researched or surveyed regarding their histories of fathering pregnancies. A study of urban African-American male youth regarding pregnancy history and other health-risk behaviors indicated that 24.2% reported a pregnancy history. These males were 14 times more likely to report three or more sex partners in the last year, more than five times as likely to report a sexually transmitted disease history, and more than three times more likely to test positive for drugs than males without a pregnancy history. Safe sex practices also seem to be of little concern to these males, as they were 2.5 times as likely to be inconsistent or nonusers of condoms during sexual intercourse (Guagliardo, Huang, DAngelo, 2006). Disturbingly, a study of youth in dropout prevention and alternative school programs assessed for risk of HIV/AIDS prevention found that use of alcohol and drugs and age of sexual initiation were significantly associated with a high risk profile ile for AIDS/HIV (OHara et al., 2003). Males (29%) were more likely than females (14%) to use alcohol and drugs before having sex and were more than likely to have had sex with two or more partners (males, 78%; females, 22%). Early onset of sexual intercourse is cause for concern, particularly as it increases the likelihood of increased numbers of sexual partners and condom nonuse during the adolescent. Increased numbers of sexual intercourse partners has been correlated with risk behaviors such as unintended pregnancy, HIV/AIDS, and other sexually transmitted diseases. Connections between dating violence and alcohol use were found to be among the strongest predictors for an increased number of sexual intercourse partners for Black and White adolescent males and females (Valois, Oeltmann, Waller, Hussey, 2003). Younger dating youth who have older partners may be at greater risk of experiencing dating violence. Not including cases where physical force was threatened or used at first sexual intercourse, 34% of male partners of 11-12 year old females were five or more years older; 12% of male partners of 13-15 year old females were five or more years older; and 7% of male dating partners of 16-18 year olds were five years or more older (Leitenberg Saltzman, 2000). Although the disparity in age range between the male and female partners seems to decrease as females get older, such disparity has important prevention implications. Information about onset of sexual intercourse is available, but information is scarce about feelings regarding the experience, planning for the event, and discussion regarding birth control or safe sex practices before intercourse has occurred (Henry J. Kaiser Family Foundation and YM Magazine, 1999). Females tend to feel more pressure to participate in some form of sexual activity and are more concerned about what friends, peers, and the dating partner think of them. Motivation for initiation of sexual intercourse has not been significantly examined. Predictors for early initiation of sexual intercourse include a belief that they are more mature than their peers, early physical maturity, a tendency to use hard drugs, and a desire for earlier autonomy from parents (Rosenthal, Smith, de Visser, 1999). Research regarding individual risk factors and risk behaviors has been conducted primarily in isolation. Recently, research into how these many behaviors are related has begun to take place. Making the links between these factors and behaviors may have important consideration when designing prevention programs. Making the Links The links between adolescent risk behaviors described above merit careful investigation. While it is understood that these behaviors do not usually occur in isolation, there seems to be no clear understanding of how they operate together, and what the ramifications might be for adolescent dating relationships. The survey data presented earlier shows that some adolescents begin drinking at an early age, and many begin to experience sexual intercourse at an early age. Undoubtedly, there are serious health ramifications to these issues (i.e., potential for pregnancy, sexually transmitted diseases, alcohol and other drug dependence, and increased aggression). Typically, researchers have considered these ramifications in the context of the individual, a lot depends on the occurrence of these behaviors in peer and dating relationships, and the possible impact on individuals and relationships. Linking Alcohol and Sexual Activity A report written by the Center on Addiction and Substance Abuse used data from two prominent surveys in the United States: the 1997 Youth Risk Behavior Survey; and the 1995 National Longitudinal Study of Adolescent Health, regarding adolescent risk behaviors to develop a comprehensive and in-depth analysis of the connections among alcohol, drug use, and all aspects of sexual activity and violence (National Center on Addiction and Substance Abuse, 1999). Again, the links among dating violence and alcohol and sex are not explicit. However, significant findings from this report reveal that teens who use alcohol and drugs are more likely to have sexual intercourse, initiate sexual intercourse at an earlier age, have multiple sex partners, and be at greater risk for sexually transmitted diseases and pregnancy. Early onset of drug use and number of years of sexual intercourse has been found to be associated with increased numbers of sex partners. In addition, students with more partners are more likely to be heavier drug users. The Kaiser Family Foundation study found that almost two in ten (17%) teens, aged 13-18, who have had an intimate encounter, admit having done something sexual while under the influence of drugs or alcohol that they otherwise might not have done. One in three (32%) girls, 17-18 years of age, have had this experience. Linking Alcohol and Intimate Violence The links between alcohol use and marital aggression have been documented, but the same attention has not been shown to adolescent dating relationships. Only recently have questions regarding dating violence been added to the Youth Risk Behavior Survey (Centers for Disease Control, 2000). Substance abuse is frequently linked with sexual violence. Alcohol has been named the primary culprit for date rape on college campuses (National Center on Addiction and Substance Abuse, 1999). A study of college men and women found that 78% of undergraduate women experienced sexual aggression, and 57% of men reported being sexually aggressive. Dates that included sexual aggression were more likely to include heavy drinking or drug use, in comparison to the last date that did not include sexual aggression. Among high school students, experiencing dating violence has been identified as a salient risk factor for females for using alcohol or street drugs, and increases the odds 20-fold for alcohol and drug use (Wekerle, Hawkins, Wolfe, 2001). There is a move toward establishing a better understanding of the significance and links among adolescent risk behaviors. With this understanding comes a need to develop new prevention programs that deal with these risk behaviors in a broader sense, rather than in isolation. Adolescent Risk Behavior and Drug Prevention Programs Prevention programs developed over the past decade have been targeted specifically at adolescents for a number of risk behaviors: dating violence, alcohol abuse, drug abuse, pregnancy prevention, safe sex programs, and prevention of sexually transmitted diseases, to name a few. Literature reviews and program evaluation studies point to the conclusion that programs may be successful at providing information and delaying onset of the risk activity, but long-term prevention of the focused risk behavior is seldom achieved. Evaluation of prevention programs in all of these areas has been limited due to methodological problems, such as inadequate standardized measures, ambiguity of terms (e.g., defining dating relationships), lack of multiple informants and control groups, lack of trained facilitators, and long-term follow-up issues. Some programs are developed for universal prevention, while others are targeted at groups considered to be at greater risk based on presence of known risk factors. Undoubtedly, good prevention programs are derived from theory, input from youth, and practice. There are several theories that have contributed to the creation of prevention programs for dating violence, substance abuse, and pregnancy or safe sex education. Social learning theory postulates that youth are vulnerable as a result of the social environment in which they are raised. Negative family, peer, and community influences will contribute to risk for adapting to negative behaviors. Problem behavior theory relies on the belief that some youth may have a natural tendency for deviance or nonconformity and, therefore, may be more likely to engage in problem behaviors. Adolescents may engage in alcohol consumption or early onset of sexual intercourse because they perceive it as a means to achieve a goal, that is, peer acceptance, or to cope with boredom, unhappiness, anxiety, or rejection (Botvin Botvin, 2002) Theory and model testing of problem behaviors in a recent study of early adolescents found support for a model that included specific factors related to aggression, drug use, and delinquent behaviors, and a higher order problem behavior factor (Farrell, Kung, White, Valois, 2006). Life-skills training programs that have been developed based on problem behavior theory are built on the philosophy that targeting the underlying determinants (such as personal and social competence skills) will affect the factors that cause the risk behavior. Similarly, social bonding theory links healthy attachments to family and school as factors that protect youth from deviant behavior; unhealthy attachments are regarded as risk factors (Farrell, Kung, White, Valois, 2006). Instead of focusing on preventing something negative from happening to youth, some recent programs emphasize youth involvement and empowerment, which shifts the focus to promoting positive youth development. In this approach, youth are considered as assets and resources rather than problems or â€Å"targets.†Prevention programs, such as the Youth Relationships Program have expanded the role of theory to include youth empowerment as a central theme in educating youth about positive, healthy relationships program and the avoidance of violence and abuse. Several factors have been identified as being essential components of prevention programs among adolescents, regardless of the topic. The location of the program is often debated as to whether schools or other community service agencies are better. In the case of sexuality and education prevention programs, there is no question that these programs should be offered in schools; however, what programs should be taught remain a concern (Kirby Coyle, 1997). Some groups favor teaching abstinence until marriage only, while others favor education regarding contraception and sexuality. Similarly, dating violence prevention programs have been offered in schools and in community service agencies with varying degrees of success. These programs may be most effective when embedded in a declared school context of â€Å"zero tolerance†for any type of school violence. The advantages of school-based programs include access to youth, space, and time, and staffing support. The disadvantages include concerns that truant youth, who may need the program most, are not available in the schools; disclosures of abuse in the classroom may not be handled well in a large classroom situation; a large group may not be a safe place to discuss personal beliefs and attitudes; and learning may be limited to only the school context of the individuals life. These concerns notwithstanding, the main advantage of community-based programs has been the development of community partnerships. Although the advantages may not be inherently evident in the results of the prevention program itself (i.e., preventing something bad is hard to prove), such programs appear to reduce duplication of services, increase cooperation and efficiency among service providers, and help integrate services into the community. In turn, communities that have a â€Å"face†-a reputation for cooperative and active prevention-have significantly reduced the perceived and actual levels of violence, even in the poorest neighborhoods (Sampson Morenoff, 1997). Advocates of prevention programs favor sustained, long-term efforts in education to make prevention successful. Programs should be on-going from kindergarten to the final year of high school, and should be especially intensive just prior to the age of initiation of substance use or similar risk behaviors. Unfortunately, it seems that this does not transfer readily into practice. In the case of sexuality education in Canada, a report by the Council of Ministers of Education indicates that curriculum time in schools available for sexuality education has been reduced as health education becomes combined with physical and career education. Fewer public health nurses in schools also severely reduced the quality and availability of preventive sexual health education services to adolescents (Council of Ministers of Education of Canada, 1999). Pregnancy prevention and sexuality education programs, while deemed extremely important in reducing teen pregnancy rates and incidence of sexually transmitted disease, are critically received by a number of groups and agencies when being implemented in communities. Differing views regarding how to handle this issue conflict with effective program implementation. For example, some religious and moral beliefs dictate that youth should remain abstinent during adolescence, that parents are responsible for protecting their children from negative influences, and that education will positively influence knowledge, attitudes, and beliefs. Programs that focus on abstinence or pregnancy prevention have typically been delivered to females only. While females need to take responsibility for their choices and actions, males also need to be educated about the same issues in order to make responsible choices as well. Males who have unprotected sex are also at risk of becoming fathers and contracting sexually transmitted diseases (Pierre, Shrier, Emans, DuRant, 2006). Substance abuse prevention programs have typically been school-based and education focused (Botvin Botvin, 2002). Evaluations of earlier programs have consistently found them to be ineffective. One school-based intervention was able to show significant reductions in drug use enduring for six years after implementation of the program. The success of this program was attributed to teaching a combination of resistance and social competence skills, the proper implementation of the program, and sufficient length for program with at least two years of booster implementations (Botvin, Schinke, Epstein, Diaz, Borvin, 2005). The Center for Substance Abuse Prevention (Brounstein Zweig, 2000) has identified six prevention strategies that can be used in combination to develop prevention programs that focus on risk and protective factors for substance abuse, including: information dis semination, prevention education, alternatives, problem identification and referral, community-based process, and environmental approaches. The Center for Substance Abuse Prevention has recently completed an analysis of substance abuse prevention programs that have been evaluated. Rigorous statistical criteria for evaluation were adopted, resulting in the definition of eight model programs which have adopted a combination of these prevention strategies, representing a number of age groups, as well as universal, selective, and indicated prevention for children and youth (Brounstein Zweig, 2000). Of all these programs, only one included information regarding sex or health education, and one provided information and skills for violence and gang prevention and conflict resolution. Although these programs were successful in reducing risk factors and increasing protective factors, they did not demonstrate alcohol and drug use prevention. Unfortunately, there are no existing programs that address alcohol and dating violence prevention together. Although some alcohol abuse prevention programs do discuss or deal with aggression, it is usually in the context of community violence not intimate interpersonal violence. A review of prevention programs that focus on teenage sexual risk behavior indicated that they also were narrowly focused to one aspect of this behavior, that is, abstinence only, contraception programs, and HIV/AIDS awareness programs (Kirby Coyle, 2007). It is time to begin linking these risk behaviors together in universal and targeted prevention efforts, focusing on the intimate and personal effects of these risk behaviors on teenage dating relationships. Adolescence provides an opportunity to enter into discussions regarding the impact, consequence, and prevalence of these behaviors and explore the perceived benefits and drawbacks of these risk behaviors. Prevention programs can offer an opportunity for youth and adults to engage in discussions regarding the motivators for initiating these behaviors and relevant information regarding short term effects. Prevention of specific risk behaviors requires community coordination and varied input. Parents, teachers, school officials, health care workers, and community workers need to be part of strategies to prevent risk behaviors. Community organizations and resources have learned to work collaboratively on a number of issues, including violence, alcohol, drug use, and the prevention of pregnancy. Collaboration and coordination helps to reduce costs and improve efficiency as well as build community. The growing research provides evidence that youth may possess a number of concurrent risk factors for any of the behaviors that are outlined in this chapter. There is overlap among the risk factors and behaviors and, therefore, prevention programs need to better consider the clustering of these components and develop programs that will address a number of these issues simultaneously (Saner Ellickson, 2006). However, intervention and prevention programs have been weak in helping youth to manage risk and anticipate risky situations in advance. Because all risks cannot be eliminated, youth need to learn how to manage them. Prevention programs that make youth aware of how they may be at increased risk in certain situations and provide skills to deal with or avoid the situation may be most promising. References Botvin, G.J. Botvin, E.M. (2002). Adolescent tobacco, alcohol, and drug abuse: Prevention strategies, empirical findings, and assessment issues. Developmental and Behavioral Pediatrics,13(4) 290-301. Botvin, G.J., Schinke, S., Orlandi, M.A. (2005). School-based health promotion: Substance abuse and sexual behavior. Applied Preventive Psychology,4, 167-184. Brounstein, P.J., Zweig, J.M. (2000). Understanding substance abuse prevention. Toward the 21st century: A primer on effective programs. Washington, DC: Substance Abuse and Mental Health Services Administration. Centers for Disease Control. (June 9, 2000) Youth risk behavior surveillance-United States 1999. Morbidity and Mortality Weekly Report, 49, 1-96. Clark, D.B., Lesnick, L., Hegedus, A.M. (1997). 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