Substance use is prevalent among school-age children, with up to 70% having experimented with substances, and the rates of abuse have been steady at approximately 6% from 1996 - 1999. There are numerous situations that influence the likelihood of a child using a substance, ranging from school to home to peers, with each offering both risk and protective factors. Drug abuse education programs vary widely, and their implementation can take many forms, with interactive, multimodal approaches working the best.
Substance abuse is prevalent in today's school-age children. Historically, the rates of use rose from the mid to late 1970's, leveled out in the 1980's and began rising again in the 1990's (Johnson, O'Malley, and Bachman, 1995). Overall, the numbers of students meeting the criteria for having a substance abuse disorder (SUD) remained fairly steady between 1996 and 1999 with youth in both years meeting the DSM-III-R criteria for a substance abuse disorder at a rate of 6.2% in a general community sample (Kandel, Johnson, & Bird, 1999; Rohde, Lewinsohn, & Seely, 1996).
The rates, however, rise sharply when specific populations are considered. With environmental factors, children involved in the juvenile justice system had a lifetime prevalence rate of a SUD of 62.1% and those involved with child welfare a lifetime prevalence of 19.2%. When looking at mental/emotional factors, children had a lifetime prevalence rate of 40.8% of a SUD if they were being seen for mental health issues, and a lifetime prevalence rate of 23.6% if they were classified as having a serious emotional disturbance (Aarons, Brown, Hough, Garland & Wood, 2001).
The most troubling figure, however, is the trend in which teens are asked if they would ever try illegal drugs. This number has been decreasing, with 86% saying they would never try illegal drugs in 1995, 51% in 1996, and 46% in 1997 (Bruner & Fishman, 1998).
The most abused substance is alcohol in adolescents, followed by cigarettes and marijuana (Johnson, O'Malley and Bachman, 1994). Crome (1997) found that at least 30% of secondary school students drink alcohol regularly, with 10% drinking more than moderately. 10 - 20% of the students smoke cigarettes regularly, 70% have tried at least one illicit drug, with 2.5% using an illicit drug at least weekly. When only a single month is looked at, 33% of 12th graders and 9% of 8th graders reported being drunk at least one time in the past month in the study conducted by Johnston, O'Malley, & Bachman (1999). They also found that 23% of high-school seniors and 10% of 8th graders reported using marijuana in the last month. This is an increase of 9% and 7% over the last 8 years. Cigarette usage in the last month also increased, to 35% of seniors and 18% of 8th graders. This is an increase of 7 and 4% respectively over the last 8 years.
School and Employment Factors
Nutbeam and Aaro (1991) found in their studies that general dissatisfaction with school increased the likelihood that school-age children would be to smoke on a weekly basis, as does academic stress (Hee-Soon, Yeanghee, Jung-Ja, 1995). Conversely, Oakley, Biannen, and Dodd (1992) found that scholastic satisfaction had beneficial effects on the decrease in smoking behaviors. Karatzias, Power and Swanson (2001) found that school stress was the factor that most accurately predicted a student's likelihood to try alcohol.
Students who have decided that school is not an appropriate role, or one that what do not wish to undertake are also more likely to be involved in substance use. High school seniors who expected to attend college had a significantly lower rate of substance use than those who did not expect to attend college (Johnston, O'Malley, & Bachman, 1985). Hawkins, Catalano and Miller (1992) also found a negative relationship between the level of attachment and commitment to school and the levels of substance use. Academic achievement has also been shown to have a direct relationship with substance use. In their study, Maguin and Loeber (1996) found that there was a significantly greater risk for substance use among those students who achieved poorly academically.
The more that adolescents work during the school year, the greater their risk of substance abuse, according to Valois (2000). Those who work in excess of fifteen hours per week have higher rates of substance abuse, from binge drinking to marijuana to cocaine usage.
Family and Environmental Factors
Oakley, Biannen and Dodd (1992) found that general stress and uncertainty could lead to an increase in smoking behaviors in adolescents and children. More specifically, Baer, Garmezy, McLaughlin, Pokorny and Wernick (1987) found a positive correlation between the levels of alcohol use and abuse and the amount of daily stress and conflict within the family. One example of familial stress and uncertainty is pointed to in that children from less-intact families (single parent household, single parent with multiple partners, drug/alcohol dependence in a family member) have higher rates of substance use (Gabel, Stallings, Young, Schmitz, Crowley & Fulker, 1998). Self-esteem was found by Karatzias, Power and Swanson (2001) to be the factor that had the greatest influence on whether a student smoked cigarettes regularly. They also found peer self-esteem most accurately provided the prediction of whether a student would drink alcohol on a regular basis, as well as whether the student would try illicit drugs.
The home is also the primary source of alcohol for the school-age child, and where they will begin to draw their views as to its appropriate use. Sons of alcoholic men have a 25% chance of becoming an alcoholic themselves, in part because of genetics and in part because of the family acceptability of drinking to excess (Cloninger, 1983). The family view on the use of alcohol will play a large part in the development of the child's views toward it's use. If the family accepts and encourages drinking to excess, and/or if an older sibling encourages this, the child is more likely to develop a problem than in the family who drinks alcohol in moderation (Kandel, 1985). Additionally, it has been shown that older siblings are frequently a source of alcohol and drugs for younger siblings (Needle, McCubbin, Wilson, & Reineck, 1986)
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