Gil Kerlikowske, Director of the Office of National Drug Control Policy
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Communities that use science-based approaches can significantly reduce adolescents' problem behaviors, including tobacco and
alcohol use and delinquent acts, up to 33%, finds a national institutes of health-sponsored study of 4,407 adolescents over
four years (Archives of Pediatrics and Adolescent Medicine (2009;163:789).).
At the same time, the lead researcher notes that most communities don't have science-based approaches, but that pediatricians
can be critical in moving their localities to programs proven to work.
In a webinar with federal officials showcasing the research, the new administration's drug czar Gil Kerlikowske said, "We
know that evidence-based prevention programs can be very effective. We know that they can save money. For instance, for every
dollar invested in prevention programs, you could get up to a $10 savings in substance abuse treatment."
For the study, 24 small and medium-sized towns in seven states were randomly divided into 12 towns that implemented the "Communities
That Care" activity (https://preventionplatform.samhsa.gov/) and 12 similar towns that did not. The CTC work started by targeting children in the fifth grade. By the eighth grade,
CTC community children were 32% less likely to have begun using alcohol, 33% less likely to have started smoking or begun
using smokeless tobacco, and 25% less likely to have started delinquent behavior, according to their self-reports on surveys.
The rates were also significantly lower for alcohol and smokeless tobacco use in the last 30 days, binge drinking in the last
two weeks, and delinquent behavior over the last year.
However, even with the positive outcomes, it was tough to make a difference in some areas, according to the study results.
There were no significant differences in the levels of adolescents beginning to use marijuana or inhalants. Also, the percentages
of students who had used cigarettes, inhalants, marijuana, prescription drugs, and other illicit drugs in the last 30 days
(as opposed to having ever used them) were lower in the CTC communities, but not significantly.
The CTC approach differs from some programs tackling adolescent problems, NIH notes. In CTC, trained coalitions of community
stakeholders use epidemiological data to assess their own prevention needs, including elevated risk factors and depressed
preventive factors, then choose from a list of tested programs that target those needs, and finally evaluate the progress
via surveys.
The list of programs includes, for example, prevention of drug and alcohol use and violence, reducing family conflict, life
skills training, HIV/AIDS prevention, dating safety, tobacco control, and anger management.
Lead researcher David Hawkins, PhD, said, after children are first surveyed, "If academic failure or low commitment to school
was a risk factor, [communities] might choose individual tutoring for young people falling behind in school. If they found
rebelliousness or children needing more skills to resist drug offers was a problem, they might implement life skills training
or the Olweus bullying prevention program in the schools."
Frances Harding, the head of the Center for Substance Abuse Prevention, said, "We know that one size doesn't fit all. The
science has helped us to focus in on the individual issues that each community presents." Her agency funds several evidence-based
prevention programs.
Hawkins also stressed the need for repeated surveys on how the programs are working: "So if we have been trying to target
poor family management as a risk factor, and still a large proportion of kids say, 'My parents don't know where I am and who
I am with when I am not at home,' that means that we are not really being successful yet with our programming."
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