Über die Autorin bzw. den Autor

Anthony Biglan, PhD, is Senior Scientist at Oregon Research Institute, where he conducts research on the prevention of child and adolescent problem behavior and on the childrearing practices that affect child and adolescent development. His current work focuses on contextual analyses of childrearing practices in communities.

Patricia A. Brennan, PhD, is on the faculty of the Department of Psychology at Emory University. Her research interests include the study of etiological factors of aggression and violence from a biological perspective, and parental psychopathology (depression/schizophrenia) and its effect on child diagnostic, neurological, and behavioral outcomes.

Sharon L. Foster, PhD, is Professor in the California School of Professional Psychology at Alliant International University. Dr. Foster is the author of three books as well as numerous articles and book chapters on children's peer relations, assessment and treatment of parent/n-/adolescent conflict, and research methodology.

Harold D. Holder, PhD, is Senior Research Scientist at the Prevention Research Center, Berkeley, California. His research has explored two major areas: prevention of alcohol problems and costs and benefits of alcoholism treatment. Dr. Holder was the 1995 recipient of the Jellinek Memorial Award for his research on social and economic factors in alcohol consumption.

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Helping Adolescents at Risk

Guilford Publications

Chapter One

Sixteen-year-old Michael has just ended a stay in a juvenile detention center. Arrested twice-once for breaking and entering and once for an assault that followed a night of heavy drinking-Michael has problems other than his encounters with the legal system. He attends high school erratically and no doubt will soon drop out entirely. He smokes almost a pack of cigarettes a day and smokes marijuana frequently. Recently he has begun to experiment with harder drugs. Now, Michael has another surprise in store for him-his girlfriend is pregnant and she plans to tell him this as soon as she sees him after his release.

We have written this book for Michael and for the many other young people headed for deeply troubled lives. Research has helped us understand much about young people with multiple behavior problems and the cost of their actions to themselves and society. Research and clinical work have also helped us to identify numerous promising strategies to work with these multiproblem youth and to begin to reduce the number of teens who end up on a downward spiral. In this book, we lay out what we know about these young people. Our goal is to demonstrate actions that are more effective in order to alter the destructive path these children travel.

The existence of a small group of multiproblem youth has been clear, at least since Jessor and Jessor (1977) first described the phenomenon of deviance-prone youth. However, despite literally hundreds of studies showing that delinquency, substance use, and high-risk sexual behavior co-occur, the implications of this phenomenon for policy, practice, and research are not clear. They have been unclear because no one has brought all this information together and spelled out its significance for research and practice. Prevention and treatment strategies typically focus only on a subset of problems. For example, we have programs to prevent academic failure, but we know little about whether these programs can prevent delinquency or drug abuse. In addition, we know that the family, schools, peers, and the community may (either positively or negatively) influence what happens to these teens. For example, with protective factors, such as a stable home life, involved parents, and teachers at school who never give up, even a teen beginning to get involved in problematic behavior can pull out of the downward spiral. Yet, when the child's father abandons the family, the mother works two jobs, and the child's acting out in school lands him or her in the principal's office more often than not, avenues narrow for the opportunity to resist the negative pull. We know that influences on the development of the multiproblem pattern begin while the child is still in the womb. Obviously, the time to intervene is when the potential for the developmental of problems is in its infancy. Despite our knowledge, we have not instituted widespread comprehensive, evidence-based approaches geared to deal with these problems before they lead to a cascade of increasingly destructive behavior patterns.

In Chapter 2, we document the extent to which multiproblem youth account for a large proportion of the occurrence of serious antisocial behavior, risky sexual behavior, drug and alcohol misuse, and tobacco use. In that chapter, we also show how multiple behavior problems lead to many problematic outcomes such as suicide and unwanted pregnancy. In Chapter 3, we show how to estimate the social costs attributable to the behavior of multiproblem youth. In Chapter 4, we identify the major factors that influence young people to develop these problems. Chapters 5-8 describe empirically evaluated interventions shown to reduce one or more of the problems that concern us. Chapter 5 focuses on interventions that target preadolescent influences on the development of multiple problem behaviors. It documents numerous strategies to follow for prevention of these problems and to promote successful adolescent development. Chapter 6 describes interventions designed to prevent problem behaviors among all adolescents. Chapters 7 and 8 describe interventions focused on helping adolescents who are already showing signs of problematic behavior. The final chapter examines issues involved in applying these scientific findings to help communities develop programs and policies to help not only youths in trouble but also those headed in that direction.

ADOLESCENT PROBLEM BEHAVIORS

We have chosen to focus on five adolescent problem behaviors: antisocial behavior (including aggressive social behavior and more serious acts such as stealing and assault), cigarette smoking, alcohol and drug misuse, and sexual behavior that risks pregnancy or disease. We chose these behaviors for several reasons. First, they represent the five most costly problems our society faces. Second, young people who engage in any one of these problem behaviors are highly likely to engage in the others. Third, many of the same biological and environmental factors influence the development of each these problems. Fourth, many of the prevention and treatment interventions previously developed have an impact on more than one of these problems. It is clear to us, therefore, that our society's efforts to lower the rates and costly consequences of each of these problems will benefit from comprehensive and coordinated strategies that simultaneously address the entire set of problems.

Most typical adolescents engage in some of these behaviors to some extent. For example, the majority of adolescents report committing some form of delinquent behavior at some point in their adolescence (Elliott, Huizinga, & Menard, 1989). Similarly, by the age of 17, 70-75% of adolescents drink alcohol, 25% have smoked marijuana, and 80% have engaged in sexual intercourse (Huizinga, Loeber, & Thornberry, 1993). Although we may argue about the desirability of these behaviors in any form, we would all have to concur that, at serious levels, these behaviors are deeply problematic for everyone concerned and can only lead to more difficulties. Therefore, we focus on types of behavior that most would agree are problematic because of the serious consequences they can and often do produce.

We call youth who engage in two or more of these behaviors "multiproblem youth." Because large numbers of youth begin to engage in these serious behavior problems only after they reach adolescence, our primary focus is on children between the ages of 11 and 18, although we look also at early precursors of these problems and the corresponding prevention strategies for use with younger children.

Serious Antisocial Behavior

Antisocial behavior consists of aggressive and criminal acts. The most serious forms of antisocial behavior are so-called index crimes, identified by the FBI as murder, aggravated assault, sexual assault, gang fights, car theft, theft of something worth more than $50, breaking and entering, or strong arming someone (Elliott et al., 1989). In addition, antisocial behavior is generally defined to include less severe delinquent offenses, such as buying stolen goods; carrying a hidden weapon; stealing something worth less than $5; prostitution; selling marijuana; hitting a teacher, parent, or student; disorderly conduct; selling hard drugs; joyriding; stealing something worth $5 to $50; and panhandling (Elliott et al., 1989). Some also distinguish violent from nonviolent crimes. Typically, they consider robbery, assault, rape/sexual assault, murder, and attempted murder as violent crimes. In this volume, we consider "serious antisocial behavior" to include index offenses as well as physical aggression perpetrated against other individuals.

Perhaps the most serious antisocial behavior is murder. Snyder and Sickmund (1999) estimate that juveniles committed 2,300 murders in 1997 in the United States, or 12% of all murders. The rate of murders committed by juveniles increased substantially between 1984 and 1993 but has declined since then to the same level as in 1986 (Snyder & Sickmund, 1999). Males account for most murders committed by adolescents and the recent decline in the murder rate resulted from changes in the rate among adolescent males. Juveniles are responsible for an even higher proportion of violent crimes besides homicide. Based on the National Crime Victimization Survey conducted by the Bureau of Justice, juveniles were involved in 14% of sexual assaults, 30% of robberies, and 27% of aggravated assaults in 1997. Similar to the pattern for murder, the rate of other serious violent crime increased from 1986 to 1993 but declined back to its 1986 level (Snyder & Sickmund, 1999). Nonetheless, juvenile involvement in violent crime is still an important and costly issue.

Cigarette Smoking

Cigarette smoking is the number one preventable cause of disease and death in the United States (U.S. Department of Health and Human Services [USDHHS], 2001). More than 400,000 Americans die each year of smoking-related illnesses (Centers for Disease Control and Prevention [CDC], 1989) and an additional 50,000 die from chronic exposure to secondhand smoke (CDC, 1989). This results in premature mortality that translates into 6 million years of life lost each year (Smoking-Related Deaths, 1993).

Adolescent smoking is a particularly important problem because most smokers begin smoking before the age of 18 (USDHHS, 1994). Estimates suggest that one-third of adolescents who begin smoking will eventually die of a smoking-related illness (Pierce, Gilpin, & Choi, 1999). Most of the problems associated with adolescent smoking appear later in life. However, some health consequences of smoking in adolescents are detectible, including increased respiratory infections and lessened lung capacity (USDHHS, 1994). Thus, preventing adolescent smoking is a high priority for public health (USDHHS, 2001).

Researchers have defined adolescent smoking in various ways, mostly in terms of self-reported smoking in the previous week or the previous month. Unlike occasional alcohol use, there appears to be no level of tobacco use that is advisable. Recent evidence, for example, shows that after even a couple of cigarettes, adolescents begin to exhibit some signs of addiction (DiFranza, 2000). However, most adolescents do not believe that tobacco is addictive until they are already addicted (Slovic, 2000). Figure 1.1 presents the monthly prevalence of smoking among 8th, 10th, and 12th graders from nationally representative samples of schools for the years 1991 to 2001. The data come from Monitoring the Future, a project that obtains data on adolescent problem behaviors from a nationally representative sample of high schools and middle schools (Johnston, O'Malley, & Bachman, 2000a, 2000b, 2000c; Monitoring the Future, 2003). The prevalence of youth smoking increased steadily from 1991 to 1996 in all grades and continued to increase for 12th-grade students in 1997. Further, despite much clamor about the problem, considerable activity designed to reduce youth smoking, and acknowledging that prevalence has shown a steady decline over the past 4 years, its prevalence was still higher in 2001 than it was in 1993 for 8th and 10th graders. On a positive note, there is a decrease shown in 12th graders in 2001 compared to the percentage shown for them in 1991 (Johnston, O'Malley, & Bachman, 2001).

Alcohol Misuse

Once considered a rite of passage, youthful high jinks, or "better than using drugs," underage drinking is now recognized as a serious public health problem. The National Household Survey on Drug Abuse, conducted by the USDHHS, is the only national household survey of drug and alcohol use in the country and involves annual interviews of between 15,000 and 17,000 respondents (Substance Abuse and Mental Health Services Administration [SAMHSA], 1998). Data from this survey indicate that 52% of 8th graders and 80% of 12th graders reported having used alcohol at least once. By ninth grade, 25% of students reported having five or more drinks in a row in the previous month. Just less than one-third of 8th graders and half of all 10th graders report being drunk at least once. Girls now consume alcohol at the same rate as boys.

Binge drinkers are also responsible for a majority of the alcohol consumed by young people. Recent analyses (Office of Juvenile Justice and Delinquency Prevention [OJJDP], 2000) of data from the 1997 U.S. National Household Survey on Drug Abuse (SAMHSA, 1998) show that binge drinkers constituted 2.4% of 12- to 14-year-olds in that survey but drank 82% of the alcohol consumed by that age group. They comprised 12.1% of 15- to 17-year-olds, but drank 88.5% of the alcohol consumed by this age group.

A large number of teenagers binge drink at least on occasion (see Figure 1.2). In 2001, 29.7% of 12th graders, 24.9% of 10th graders, and 13.2% of 8th graders reported consuming five or more drinks in a row at least once in the 2 weeks before the survey. What is most alarming about these data is that the prevalence of binge drinking has varied little within subsets over the past 10 years. The percentage of 10th graders having "been drunk" in the past month is the highest since 1991, when Monitoring the Future started including students in the 10th grade. The trends over the past 10 years demonstrate the frequent pattern of this high-risk drinking by grade level (Johnston, O'Malley, & Bachman, 2001; http://monitoringthefuture.org/pubs/monographs/ overview2000.pdf).

Drug Dependence and Abuse

The terms "drug abuse" and "drug dependence" refer to patterns of drug use problematic for the user or for those around them (American Psychiatric Association, 1994). Abuse involves serious consequences of use, including one or more of the following: (1) failure to fulfill major role obligations; (2) absence, suspensions, or expulsions from school or work; (3) recurrent substance use in hazardous situations (e.g., while driving); (4) recurrent substance-related legal problems; (5) continued use despite persistent problems; or (6) conflict caused or exacerbated by use.

Dependence refers to an even more serious pattern in which a person uses a substance to the extent that it causes impairment or distress. At least three of the following can indicate dependence: (1) increased tolerance of the substance, requiring more to achieve the same effect; (2) withdrawal symptoms when not used; (3) greater or longer use than intended; (4) persistent desire for the substance; (5) much time spent seeking or using the substance; (6) reductions in social, recreational, or work activities; or (7) continuing substance use despite physical or psychological problems.



Continues...

Excerpted from Helping Adolescents at Riskby Anthony Biglan Copyright © 2005 by Anthony Biglan. Excerpted by permission.
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