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Young people experimenting with drugs and alcohol is nothing new; however, social networking sites are offering new and dangerous opportunities for adolescents to be exposed to drugs. Teens are uniquely vulnerable to the effects of what they see on social media, as this age group is highly susceptible to peer influences and pressure. Sites like Instagram, Facebook, and Snapchat provide an environment where kids are exposed to famous and normal people alike engaging in risky behaviors involving drugs and alcohol.

Celebrities such as Justin Bieber, Drake, and Cardi B consistently post pictures of themselves drinking and getting high on a variety of platforms, and that's starting to influence the young people that are viewing it. Additionally, adolescents are not only exposed to celebrities and "influencers" engaging in this behavior, but also their friends and families. This kind of content normalizes and glamorizes behavior such as illicit and prescription drug use as well as binge drinking, making teens wrongly believe it's appropriate to do the same.

A study conducted by the National Center on Addiction and Substance Abuse at Columbia University found that teenagers who regularly use popular social media outlets were more likely to drink, use drugs, and buy tobacco than adolescents who either did not use social media or used it less frequently. The survey asked 2,000 adolescents about their drug use and social media habits and 70% said that they use social media on any given day. Researchers found that, compared to nonusers or infrequent users of social media, this group was:

5 times more likely to buy cigarettes

3 times more likely to drink

2 times as likely to use marijuana

In addition to drug exposure through marketing and advertising, social media is the catalyst for many mental health problems that can lead to substance abuse. Social media perpetuates social comparison in a world where everything is curated, which is particularly problematic for teens who are more prone to depressive cognitions in the face of social comparison. Social media use is associated with mental health issues including depression, sleep disturbance, and disordered eating among young people.

Social media use amongst teens is nearly universal today. About 92% of adolescent users report checking social networking sites more than once a day. Facebook, Instagram, and Snapchat are the top social media platforms for young adults.

For young, impressionable people, seeing their friends and family in Facebook posts or Instagram pictures having fun while partying can tempt them to make risky choices in an effort to fit in. For others, it can depress them to the point that they turn to drugs or alcohol for solace.

Recent studies show that 75% of teenagers seeing photos on social networking sites of other young people smoking weed or drinking alcohol encourages them to experiment in the same way.

Although drinking and smoking amongst teens has been an age-old issue, social media has begun to desensitize children to these activities at a younger age - 90% of the kids surveyed saw these types of photos of their peers online before they were even 16 years old. Nearly half of all teens who have seen such pictures perceived that the kids in the photos "are having a good time." Teens who have come across these kinds of photos are 4 times more likely to have used marijuana and 3 times more likely to have consumed alcohol compared to kids who had not viewed this type of picture.

In addition to being exposed to these acts by their peers, the ads found on social media can also encourage underage drinking and drug use. Tobacco, electronic cigarettes (especially those marketed by Juul), and alcohol manufacturers have widely integrated social media platforms into marketing strategies that are fully accessible to teens. Through the use of social media advertising, these industries are able to market to youth, despite the fact that direct marketing to minors is against the law.

A study performed by Michigan State University found that people who were shown Facebook ads promoting beer were more likely to indulge in an alcoholic beverage than those who viewed bottled water ads. After seeing the Facebook ads, the 121 test subjects were given a choice between receiving a gift card for a coffee shop or a bar as compensation for their participation in the study. While 73% of those who saw the beer ads chose the bar gift certificate, only 55% of those who viewed water ads selected the bar as well. Exposure to substance use imagery is associated with subsequent onset in use, which is why there are limitations on advertising such products in the media to minors; however, social media is proving harder to regulate.

Celebrities also promote drug and alcohol use on social media sites, which young people see and are often encouraged by. Celebrity advertising makes smoking and drinking seem like fun, cool activities, which can subtly pressure teens to experiment with the same products. Many digital ads use celebrities, music industry personnel, and attractive young models to promote their products - all of which have been shown to be effective marketing strategies among children and teenagers. In fact, research has revealed that advertising may be responsible for up to 30% of adolescent tobacco and alcohol use.

Research has shown that there is an undeniable link between social media use, negative mental health, and low self-esteem - all of which can drive underage substance use. When teens are struggling with emotional problems, they will often turn to drugs or alcohol as a coping mechanism to help manage their difficult feelings. Frequently checking social media platforms and comparing oneself to others can make young people feel increasingly unhappy and isolated.

Social media not only can cause unhappiness and a general dissatisfaction with life in users, but also increase the risk of developing mental health issues such as anxiety and depression. In fact, an estimated 27% of children who spend 3 or more hours a day on social media exhibit symptoms of poor mental health. Kids who are depressed or suffer from anxiety (both of which are often exacerbated by social media use) may then attempt to use alcohol or other drugs to cheer themselves up.

Children with adolescent depression know there's something wrong with them. They're not taking pleasure in things; they're not feeling happy. So if their peers are offering a drug that makes them happy, that's often the first thing they turn to.

- Dr. Sarper Taskiran, MD, Child and Adolescent Psychiatrist

In addition to feelings of social isolation and depression, social media has also been found to be associated with negative body image in young adults. The ongoing exposure to unrealistic beauty standards through visual sites like Instagram can affect how teenagers perceive themselves and cause them to develop low self-esteem or eating disorders. Much like adolescent depression, individuals with low self-esteem may have trouble overcoming negative thoughts and feelings. Subsequently, in an effort to forget or change those feelings, they turn to drugs or alcohol as means of escape. Substance use can seemingly help to quiet the negative thoughts in young users with poor mental health. However, self-medicating with drugs and alcohol only temporarily alleviates those symptoms, and chronic use actually makes them worse.

Social media is providing increased opportunities for both the marketing and display of risky behaviors regarding drugs and alcohol for young people. With social media increasingly integrated into the lives of today's teens, what they view on these sites is more important than ever.

The best way to protect your children from these influences is by having open communication and educating them on the risks of substance abuse. However, if your child is struggling with excessive alcohol or drug use, simply talking to them might not be enough and may require professional help. If you're worried about the path that your teen is headed down, contact a dedicated treatment provider and learn about your treatment options today.

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The Influence of Social Media on Teen Drug Use - Addiction Center

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Young people experimenting with drugs and alcohol is nothing new; however, social networking sites are offering new and dangerous opportunities for adolescents to be exposed to drugs. Teens are uniquely vulnerable to the effects of what they see on social media, as this age group is highly susceptible to peer influences and pressure.

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Introduction

Adolescence and Risky Behaviors

Adolescence is characterized by high psychosocial vulnerability ( Hatano et al., 2018). It is a specific moment of the development of young people engaging in a great deal of personal and interpersonal exploration to understand themselves, their significant others, and their social world. Concomitantly, many physical, behavioral, and cognitive changes occur in the teenage years. Moreover, risk-taking behavior is common and is often associated with the engagement in unlawful acts and conducts ( Gonzales et al., 2017).

In this perspective, the family system assumes the role of protective or risk factors, especially referred to the family climate, communication, and parental support. According to this perspective, it is important to consider the meaning that risky behaviors could have for adolescents, especially in the study of delinquency and substance abuse conduct, which often involve young people ( Johnston et al., 2017, 2018). This aspect is important to evaluate adolescents' risky trajectories, incorporating the developmental perspective.

Substance Abuse: Some Definitions

Juvenile involvement in risky behaviors continues to be a sensitive issue. Substance abuse is among the most common risky behaviors widespread in adolescence. For this reason, a definition of the term is needed.

Substance abuse could be described "as a maladaptive pattern of drug use leading to clinically significant impairment or distress" ( Kpae, 2019). According to some authors ( Mamman et al., 2014), the term usually refers to illegal drugs. However, substance abuse is also related to the degree of social acceptance of substances, such as alcohol, prescription medicine, and other legal substances, which are viewed as illicit and less harmful. Indeed, it may also be defined as the use of psychotherapeutic and medical drugs in the presence or in the absence of a specific diagnosis ( Fareo, 2012). According to the Diagnostic and Statistical Manual of Mental Disorders DSM-III-R ( American Psychiatric Association [APA], 1987), "psychoactive substance abuse" is defined as "a maladaptive pattern of use indicated by. continued use despite the knowledge of having a persistent or recurrent social, occupational, psychological, or physical problem that is caused or exacerbated by the use (or by) recurrent use in situations in which it is physically hazardous." The definition of "substance abuse," instead, is not included in the fifth version of DSM ( American Psychiatric Association [APA], 2013). DSM 5 identifies the "Substance-related and addictive disorders" section, including "Substance use disorders," "Substance-related disorders," and "Substance/medication-induced mental disorders." Moreover, due to the ambiguity in its definition, ICD-10 use the term "abuse" only in the case of non-dependence-producing substances. The WHO ( WHO Expert Committee on Drug Dependence and World Health Organization, 1969) also highlights the same as the hazardous and harmful use of illicit drugs could result in the dependence syndrome that is derived from the repeated use of substances and leads to a "strong desire to take the drug, difficulty in controlling its use, (and) persisting in its use despite harmful consequences" ( Kpae, 2019). In fact, both legal and illegal drugs have chemicals, which can influence the behavior and cognition of individuals.

There is consensus among researchers about the consistent and overdose intake of illicit drugs affects the brain and causes biological changes to the body. It creates the craving and excitement for things such as food and sex ( Koob and Volkow, 2010) and can make, especially adolescents, not to weigh the consequences of their actions, affecting their development ( Volkow et al., 2019).

Theories of Drug Abuse

Mamman et al. (2014) proposed different theories explaining the origin of drug abuse: (1) sociocultural theory, (2) personality theory, (3) biological theory, and (4) learning theory. These theories describe the abuse of drug as influenced by several factors, emphasizing the personal motivation in using a specific substance. The key role of these theories is derived from the evaluation of the peculiarity of the relationship between the subject and the drug. This evaluation avoids any form of simplification and generalization in explaining drug abuse behaviors and might be useful for intervention and prevention programs based on drug abuse at different levels of influence.

The authors (Ibid) specified these theories in detail as follows:

(1) Sociocultural theory of drug abuse postulates that substance abuse is derived from the values shared by a specific society and context, which are culturally determined. For instance, in some cultures, adolescents are permitted to consume alcohol and smoke marijuana, and in other cultures they are not permitted to do so. Moreover, in such cultures, alcohol and tobacco are considered as a normal product, and used by youth and adults in everyday life and as a social activity or a way to spend time and have fun within the peer group, considering drug use as a life experience. Among some tribes in Nigeria, alcohol is also used in cultural activities ( Mamman et al., 2014), whereas it is forbidden by the law in the north of Nigeria. Cultural norms and social attitude toward such drugs influence the personal and community perception of a specific substance. Foley et al. (2004), in a cross-sectional telephone survey among white, black and Latino youth, found that adults' approval of alcohol use can increase or decrease adolescents' drinking behavior according to the cultural and social perception of the context. As the social and cultural context promote the use of certain substances, the perception of risk decreases, especially among young people who tend to imitate the behavior of adults and to adapt to their context. This is also true for an illicit substance. Indeed, the data from an epidemiological study conducted in Australia indicates that the consumption of illicit substances by young people has recently increased as in United Kingdom. According to Howard Parker's "normalization thesis" ( Parker et al., 1998), youth no longer use drugs as a form of transgressive conduct but perceive this as a habit, which enriches their leisure time." Today is no longer possible to attribute the use of drugs to a subcultural world described as bad or dysfunctional because drug abuse is more culturally normalized and ordinary. According to this theory, the inclusion of a concept introduced in the social cognitive theory by Bandura (1986) is needed. In fact, the etiology of the substance abuse can be described as the triadic reciprocity influence of the behavioral, environmental and personal factors.

Social Stigma and Poverty: Negative Identity and Crime

In adolescence, teens develop their identity, a coherent, homogeneous, and continuous image of the essence of their future personality ( Erikson and Erikson, 2018). This process is derived from an interiorization and symbolization of models and the roles assumed during life experiences. A criminal or poor environment, offense involvement, justice-involved or drug abuser parents, relatives, or friends, and living in a poverty condition are some of the main social factors that can impact an adolescent development. Teens who suffered from one or more of these risk factors could receive negative expectations from others and interiorize a self-image based on the proposed perception of self. This is called "prophecy that is self-fulfilling" and derived from the labeling theory ( McIntosh and Rock, 2018), which investigates the complexity and multidimensionality of individuals and their social interactions ( Lemert, 1974). These concepts are linked to the stigma and the criminal stereotype ( Ciampi, 2017).

According to this theory, juveniles labeled as "criminal" or "drug addicted" are more likely to suffer from marginalization, isolation, stigmatization, and imprisonment. They are confirmed of their negative identity by society, peer group, and family, creating a social stigma ( Goffman, 1961; Chapman, 1968). In several cases, teens with justice-involved or drug abuser parents or adolescents who live in a disadvantaged neighborhood develop a sense of stigmatization, which leads them to assume criminal and antisocial conduct and to maintain it in adulthood ( Adlaf et al., 2009; Luther, 2016; Massarwi and Khoury-Kassabri, 2017). Stigmatization is one of the most adverse consequences of parental incarceration ( Phillips and Gates, 2011). Youth who have justice-involved parents are adversely affected and can develop emotional and behavioral issues ( Al Gharaibeh, 2008). Similarly, drug abuse within the family negatively influences the perception of the adolescent on the substance and increment the others' prejudice ( Mehta and Farina, 2011). Goffman (1963) referred to this attitude with the term "stigma of courtesy," which was also defined as secondary or associative stigma ( Furst and Evans, 2015). Courtesy stigma indicates that the label affects the safety and well-being of family members, significant others, roommates, and others who are associated with a stigmatized individual, passing for association from the stigmatized people to the members of their social network ( Goffman, 1963; Mehta and Farina, 2011).

Another theory explaining delinquency through the multifactorial interaction of factors is Wikstrom' situational action theory (SAT) ( Wikstrom, 2009). According to this model, it is important to evaluate the criminal actions by considering the individual, environmental, situational, and behavioral elements. Wikstrom analyzes an individual's reactions to a given situation, asserting that the commission of a crime is derived from the interaction between the mentioned elements. Thus, criminality could be derived from desensitization, resulting in a natural tendency to act on the learned behavior (Ibid). Wikstrom conducted a longitudinal study on youth belonging to disadvantaged contexts, highlighting that the criminal context does not imply a tendency to commit a crime per se but rather stems from youth with prolonged exposure to it, thus, mostly influencing a deviant behavior ( Wikstrom and Sampson, 2003). Similarly, Shaw and McKay (1942) developed the social disorganization theory to define the study of areas with a higher rate of crime and poverty as criminal areas. According to these studies, criminal areas consist of neighborhoods with a high need for economic assistance, unemployment, and general discomfort. Mostly, families decide to live in such conditions because they have no choice ( Leventhal and Brooks-Gunn, 2000). These areas, therefore, become an attractive center for those who are looking for a permissive and an adequate environment for delinquent status ( Krohn et al., 2009).

Despite these findings, we know that not all those who live in criminal and disadvantaged areas develop a deviant career, as shown by Oreopoulos' study ( Oreopoulos, 2003). The author studied two groups. In one group, the author analyzed the experiences of adults who were involved as children to a housing project in the Toronto metropolitan area. This area comprises a wide neighborhood location and services. The second group was composed of adults living in public houses with a higher exposure to crime and poverty. In comparing these two groups, Oreopoulos found that different living conditions did not play a significant role in determining the youth behavior and that the family factors were more powerful in influencing their behavior. Similarly, Jacob (2005) explored the experiences of youth relocated by the Chicago Housing Authority from public housing to private-market housing. The author found no evidence of the adverse effects of public housing poverty and disadvantage conditions, comparing the group of youths who moved in other places with the group of youths lodged in a public house. These results show the importance of considering other factors, such as individual and family elements, which may play a moderating role in the adulthood outcomes, especially during development.

Social stigma derived from justice-involved or drug abuser parent and a neighborhood with a high rate of crime and poverty could lead to delinquent behaviors to become a channel of transmission of criminal values, especially in childhood and early adolescence. Moreover, the criminal history of a neighborhood or of a family increases the social stigma and affects the probability of obtaining a higher education and employment, developing into the only possible career, criminality.

Aim of This Study

This narrative review (NR) aims to: (a) document the reciprocal interaction among family relations, substance abuse, and criminal conduct and (b) evaluate the connection between substance abuse and criminality, focusing on the different types of offenses and drug-related conducts.

Materials and Methods

For this reason, the current review includes the articles, reviews, and reports published in English between 2010 and 2020. The Articles that used the definitions of substance abuse as discussed in Section "Substance Abuse: Some Definitions" and the articles that conceptualized drug use as a risk factor in developing substance abuse conduct were included in our analysis, whereas the studies discussing drug misuse or drug addiction were excluded from the review.

Of the 150 articles returned from the search, 61 were retained for the current review after screening their titles and abstracts.

Results

Family Relationships, Substance Abuse, and Delinquency in Adolescence

Adolescents are more likely to be involved in behaviors such as drug abuse and criminal acts. These behaviors impact not only the individuals but also their family, schools, and social context. In adolescence, risky behaviors are common among individuals who have a problematic family system and difficulties in relationships with parents ( Kam and Middleton, 2013), aggressive and risky acts among adolescents can be used as habitual ways to communicate. Such perpetual patterns of behavior need to be understood by going beyond the apparent meaning of risky actions ( Saladino et al., 2020a).

The influence of these factors is associated with the family context change according to the substance. For instance, the abuse of marijuana seems to be more linked to the relationships with parents, as shown by a comparison between frequent marijuana users and never or less frequent lifetime marijuana users, where the first category of users is more likely to perceive a lack of parental support ( De Looze et al., 2015). Binge drinking, instead, seems to be associated with less parental supervision and the absence of parent, the availability of alcohol at home, and parents who drink alcohol ( Martínez-Montilla et al., 2020). The Canadian Institute of Health Research and the Heart and Stroke Foundation of Canada ( De Looze et al., 2015) confirmed these results, showing an association between the frequency of alcohol consumption and parental drinking. Adolescents whose parents drink alcohol are more at risk in becoming alcohol and polysubstance users. This survey shows that the parent-children relationship assumes a mediator role in risky behaviors connected to substance abusive conduct among youth. Indeed, a positive relationship with parents might decrease the odd to develop an addiction in adulthood, and not depend on contextual variables, such as where adolescents attend schools in high- or low-at-risk neighborhoods ( De Looze et al., 2015).

Regarding parent involvement in crime and its connection with an increased risk of substance abuse and delinquency, this factor is often related to a history of physical abuse, maltreatment, parental neglect, a negative family climate, which, as mentioned above, is strongly associated with criminality and substance abuse ( Lee et al., 2012; LoBraico et al., 2020; Saladino et al., 2020b). The data from the 2016 Minnesota Student Survey on 126,868 youth in public schools found that parental incarceration could determine an increased occurrence of externalizing behaviors among teens ( Ruhland et al., 2020). NeMoyer et al. (2020) confirmed these results, linking parental incarceration with self-reported delinquent acts of youth. Parental incarceration is also associated with an increased risk of developing substance abuse as the Baltimore Prevention Project discovered ( Furr-Holden et al., 2011). According to this study, adolescents who have incarcerated fathers (13% of the sample) are more at risk of drug abuse and delinquency, compared with adolescents without justice-involved fathers ( Furr-Holden et al., 2011). Kjellstrand et al. (2019) confirmed that parents formally incarcerated can lead to problematic developmental trajectories, such as suicide ideation, suicide attempt, adolescent delinquency, and substance abuse ( Kjellstrand et al., 2019).

Good family communication and disclosure are also important in preventing risky behaviors among youth ( Savage, 2014; Pettigrew et al., 2017). A strong sense of openness within the family context increases social and emotional skills among teens ( Haverfield and Theiss, 2017), and decreases risky behavior ( Harris et al., 2017; Massarwi and Khoury-Kassabri, 2017). Positive communication with parents is an antidrug socialization agent ( Shin and Miller-Day, 2017). In this regard, parental drug-talk styles, especially in early adolescence, assume a key role in preventing substance abuse ( Choi et al., 2017; Pettigrew et al., 2018). Shin et al. (2019) identified four types of parent's drug-talk styles, considering Miller-Day and Kam (2010) parent-offspring drug-talk model (PODT): situated direct, ongoing direct, situated indirect, and ongoing indirect style. In the situated direct style of PODT, parents talk one time with explicit comments about substance use and abuse; in the ongoing direct style, parents express their opinion on drugs systematically; in the situated indirect style, they hint at the drug talk, showing their disappointment through non-verbal communication, and in the ongoing indirect style, they communicate repeatedly the opinions and feelings on drugs using verbal and non-verbal messages. Parents change their drug-talk style according to the specific age of their children and to the situation. According to the authors, parent drug-talk styles are influenced by family environments, which could be characterized by expressiveness, structural traditionalism, and conflict avoidance. The first dimension is characterized by openness and closeness, the second instead by a sense of control and power by parents and of obedience by children; and the third one tends to suppress conflicts to maintain family harmony. Shin et al. (2019) examined the relationships among parent-adolescent drug-talk styles, family communication environments, and substance use and abuse (alcohol, cigarette, marijuana, and chewing tobacco), and the main results of the study showed that the ongoing direct style has a more positive outcome than other drug-talk styles on substance abuse behaviors of youth. Regarding the family environment, compared to other dimensions, expressiveness can predict more positive family outcomes and interactions ( Burns and Pearson, 2011), can influence more the personal anti-substance-use perception of youth ( Shin and Miller-Day, 2017), and is significantly related to lower levels of use while conflict avoidance is related to higher levels of drug abuse.

Similarly, Reimuller et al. (2011) found that alcohol-specific communication characterized by permissive messages leads adolescents to a higher risk of alcohol abuse than alcohol-negative messages. Communication, in general, and parent drug-talk influence the personal perception of adolescents and their future choices in adulthood as well.

As suggested by the data, parental support, communication, and family climate can protect teens from risky behaviors ( Haverfield and Theiss, 2017; Pereyra and Bean, 2017; Saladino et al., 2020b). It is important to consider the complexity of the relationship between parents and adolescents and their bidirectional influence on the developmental trajectories. An example of this perspective derived from the family-based therapy approaches that are focused on family in a multidimensional level. This approach is composed of three frameworks that help therapists and health professionals to think in terms of mutual interaction between different factors, including the influence on adolescents' behavior. The first one is the protective factor framework, which includes family, social, and individual domains. Clinicians must know the interaction between these factors to facilitate positive adaptation during the main critical phases of the development. A framework of protective factors is based on interpreting each situation according to the current life circumstances of the adolescent's family. The second one is a developmental perspective framework, which focuses on developmental psychology distinguishing the typical development from the dysfunctional development in terms of psychopathology and maladaptive behaviors. The last one is an ecological framework based on an ecological approach as it studies the human behavior in a specific context. The most used and effective family-based therapy considers and integrates these frameworks by taking care of the individual and his/her family system. One of the family-based models that have considerable effectiveness among teens involved in drug abuse and criminality is the multidimensional family therapy (MDFT). According to this model, the family is the principal arena and shapes the individual in both intrapersonal and intrafamilial dynamics through a modeling process, playing a role in reinforcing behaviors, both negative and positive ( Liddle, 2010). For this reason, the family is considered as a starting point to improve the living quality of adolescents who present any form of behavioral problems. MDFT is based on indirectly helping family members to implement new ways of interacting with one another and supporting their family member's drug-free lifestyle and facilitating a change of perspective. Furthermore, MDFT also involves other influencing systems, which maintain drug abuse, through the "extrafamilial" work. As reported by Liddle et al. (2011), MDFT engaged 97% of youth drug users as compared with 55% in services as usual (SAU) and retained 87% of these teens in at least 3 months after release compared with 23% in SAU. Compared to other approaches, MDFT has a higher long-term effect on both adolescent drug use and family functioning ( Rowe, 2012). Another approach based on multilevel domains and focusing on the family system is the brief strategic family therapy (BSFT), which has an evidence base of effectiveness for drug abuse and related behavioral problems in adolescence. This approach, based on the work of Minuchin and Haley ( Robbins et al., 2011), has a common perspective and the goals of MDFT, which aims at reducing adolescent behavioral problems by promoting good relationships among individual, family, and other systems, such as school and peers; supporting personal skills; and improving the new coping capacity in both adolescents and parents. Robbins et al. (2011) have conducted a study to compare BSFT with treatment as usual (TAU) including a sample of 480 adolescents and their family members using a specific and practical approach. The results showed that the group treated with BSFT reported higher levels of attendance and reduced probability to drop out than that treated with TAU. Moreover, participants treated with BSFT have shown a greater improvement in family functioning, also reported for adolescents, than that with TAU.

Finally, another model based on the behavioral and systemic approach is the functional family therapy (FFT). This model aims to identify and modify the maladaptive family patterns that maintain the problem. FFT changes the family interactions through positive reinforcements by introducing new problem-solving strategies. This therapy reduces recidivism among criminal teens and decreases antisocial behavior, as shown by a study on adolescent inmates with callous-unemotional (CU) traits who have committed violent and propriety crimes ( White et al., 2013). The participants and their families were involved in FFT, and according to the evaluation pre-post treatment, the association between CU traits and recidivism was lower after the treatment as well as the aggressive and violent behaviors reported by parents ( White et al., 2013). The same results were obtained by analyzing 917 families from both rural and urban settings in 14 different counties ( Sexton and Turner, 2010). Most of the participants committed weapon crimes, had some gang involvement and a history of running away from home, were school dropouts, and used alcohol and marijuana. Criminal onset was in early adolescence between 12 and 17 years old. The participants were divided into two groups; one received FFT and the other TAU in traditional probation services in their local county. When the therapist was adherent to FFT, the results showed a reduction in serious crimes 1 year after treatment, and when the therapist was not adherent to FFT, the recidivism rates were significantly higher compared to the TAU group ( Sexton and Turner, 2010).

The effectiveness of family-based models for adolescence drug abuse and other related problems has been demonstrated. The strength of these treatments is their focus on the interaction of several factors that trigger the vicious circle of crime and addiction in adolescence, and the results appear to have a broader outcome compared to the traditional family therapy approaches. Family-based therapy clients are less likely to be arrested, to relapse after a treatment, and to experiment internalizing and externalizing symptoms and in other co-occurring problems ( Liddle et al., 2011). These data explained the reciprocal influence between parents and adolescents and highlighted the important implications for future clinical practice.

Substance Abuse and Criminal Conduct

Drug dealing is almost the most common crimes spread in adolescence. It could have different interpretations and motivations. The small drug dealing is often an extension of consumption and is understood as a sharing between friends who get the substance acquires prestige. Thus, the illegal act is specific to a certain phase of adolescence and does not continue into adulthood. Additionally, when drug dealing is associated with the youth culture and combined with personal and social problems, it may be used to have fun during a party with friends or to face feelings of sadness or insecurity. Adolescents who sell drugs in a specific context and situation are more likely to develop a drug addiction in adulthood rather than to become professional drug dealers. In other situations, the drug dealing may take place in non-disadvantaged social contexts, where the parents' expectations lead the adolescent to look for alternative routes that become a sort of escape from family rules. Drug dealing can become dangerous for the development of an addiction rather than a criminal career because it is linked to a specific need for autonomy and recognition of one's identity. On the contrary, when drug dealing is considered as a form of work and survival for those who come from contexts in which they do not perceive alternatives or when adolescents are hired by an organized crime group to carry out drug dealing activities, they are more likely to become professional drug dealers and to perpetuate this criminal behavior during adulthood ( Johnston et al., 2018). Shook et al. (2013) documented that young drug dealers are also more likely to be engaged in other risky and delinquent behaviors. These results have been replicated in other studies with community and population samples ( Vaughn et al., 2011a, b) and in research using the samples of justice-involved youth ( Gunter et al., 2011; Magyar et al., 2011; Jeffrey et al., 2013).

The data suggest that the relationship between individuals and their context is fundamental for studying drug selling behaviors. Specifically, psychological, family, peer, and economic context are associated with differences among groups of young drug dealers. The literature studies converge in considering the drug-related conduct associated to antisocial behavior, delinquency, and criminality, including violent offending ( Coretta, 2012). The choice of an individual to engage in such offenses, mostly exposing youth to incur in criminal sanctions, such as arrest. However, as the types and frequency of drug-related behaviors influence the link between drug-related behaviors and criminal offending, the explanatory mechanisms are complex to identify ( Shook et al., 2013).

Additionally, to analyze the involvement of adolescents in drug-related behaviors, Phillips (2017) created a classification of these behaviors, considering the level of adolescents' involvement measured on a continuum. Thus, it is possible to study the relationship between drug dealing and criminal conduct according to a categorical approach.

The link between drug abuse and criminal behavior was recently studied in an undergraduate student sample in Nigeria ( Patrick and Okwukwe, 2019). Respondents of the survey affirmed that (the percentage of respondents is indicated in brackets): people who use drugs behaves aggressive (44.1%), use violent and bad language (9.5%), are school dropouts (9.2%), and are more likely to lose control (29.5%). Mostly, the respondents agree that substance abuse involves an organized crime (95%) and an armed robbery (97%), especially among youth, whereas 92% of the respondents think that substance abuse, among female students, leads to prostitution. Another study conducted in Nigeria ( Mamman et al., 2014) confirmed these results, showing that adolescents who are drug abuser are more likely to be involved in gang formation and armed robbery.

The results of a few studies ( Mamman et al., 2014; Patrick and Okwukwe, 2019) also showed some risk factors toward the development of drug abuse among students: peer group influence, curiosity, stress, family problem management, and high availability of the substance. Authors discussed the types and effects of this unhealthy practice among students, highlighting the need for the government, parents, teachers, counselors, and other members of the society to actively get involved in the fight against drug abuse not only by condemning it but also by living an exemplary lifestyle. The need for the proper education of parents on adolescent behavior was stressed out. The adolescent themselves should also be educated early enough about the dangers of addiction and parents on their side should try to watch their children very closely. By doing so, they can easily detect early issues in their own or other's behaviors.

Discussion

Principal Findings

Resorting to violence could be a strategy to survive at specific situations in which adolescents perceive parents as not supportive and absent in their lives ( Lee et al., 2012; Kann et al., 2016; LoBraico et al., 2020; Saladino et al., 2020b). These negative feelings also contribute to developing poor confidence in others, negatively impacting the adolescents' capacity to manage negative emotions ( Garrido et al., 2018). Risky conducts become the only strategy to communicate their feelings and oversee their emotions ( Myers et al., 2018). Another important finding is in regard to parent justice involvement, which is often associated with a lower perception of support and cohesion among family members, the absence of parents, and the lack of family communication. All these factors impact adolescent's life, who might become a drug experimenter or emulate parents' behaviors, being involved in criminal conducts ( Saladino et al., 2020b). Furthermore, parents in prison negatively influence behaviors of youth, leading to more externalizing acts ( Ruhland et al., 2020). This result shows a strong tendency of children to imitate parents' behaviors, evaluating those conducts correct or justified. In this way, adolescents learn to react to frustration and to solve problems using violence and crime ( Furr-Holden et al., 2011; Kjellstrand et al., 2019; NeMoyer et al., 2020).

Likewise, the availability of drugs at home and the perception of parents about drugs can influence substance abuse conduct among youth ( Saladino et al., 2020a). Specially, binge drinking, more than marijuana use, seems to be related to low parental supervision and the absence of parent. This finding is interesting and may be related to the common use of alcohol among parents at home and with their low perception of risks in using it ( Martínez-Montilla et al., 2020). Indeed, parental drinking is associated with more probability to become a drinker in adolescence and adulthood ( De Looze et al., 2015). The use of drugs among youth is also related to parental drug-talk styles. Indeed, general good family communication and disclosure can prevent risky behaviors among youth ( Savage, 2014; Pettigrew et al., 2017; Shin and Miller-Day, 2017), specifically, if parents are confident in talking about drugs ( Choi et al., 2017; Pettigrew et al., 2018). According to the PODT ( Miller-Day and Kam, 2010), the most favorable drug-talk style in preventing drug abuse is an ongoing direct style, in which parents express their opinion on drugs systematically ( Shin et al., 2019). In the same way, a family environment characterized by expressiveness (openness and closeness among family members) could predict more positive family outcomes ( Burns and Pearson, 2011), decreasing the risk of substance abuse and criminal acts more than other environments, such as structural traditionalism, and conflict avoidance, based on parents' control and power, and a tendency to avoid conflicts ( Shin and Miller-Day, 2017).

According to the main findings discussed above, drug abuse in adolescence is a complex problem, which involves the individual and social and environmental levels as revealed in developmental psychology and psychopathology research studies. Studies in this field have the common aim to identify the critical "markers" to prevent and treat the abuse of drugs as well as the illicit conduct diffused among both categories of teens: the convict and the student. Consistent research findings support the reciprocal interaction between positive family functioning and positive outcomes in desistance from crime and drug abuse in adolescents and adults ( Hochstetler et al., 2010; Robertson et al., 2010).

Limitations

This review presents some limitations. As noted, gender differences and social environment were not considered in criminal behavior and the abuse of substances. Moreover, even though the studies presented are European, the majority are conducted in the United States, probably because of the high rates of criminality and risky behaviors compared with other countries. Our review did not consider the influence of the culture in the main findings of research. Family relationships, the quality of communication, and support are also culturally determined.

This review did not consider recent changes in the illicit/licit drug definition, an important issue especially in the United States, in which most of the studies on crime and deviance are published. For example, recently, a change in the consideration of marijuana occurred: in reviewing a series of WHO recommendations on cannabis and its derivatives, the Commission on Narcotic Drugs (CND) removed cannabis from Schedule IV of the 1961 Single Convention on Narcotic Drugs-where it was listed alongside specific deadly, addictive opioids, including heroin, recognized as having little to no therapeutic purposes.

We believe that future research linking family relations with drug abuse and deviance should be based on a solid experimental design to avoid spuriousness and to incorporate the recent advancements in drug classification.

Lastly, consistent with most narrative reviews, we did not appraise the quality of the included studies because our primary goal was to provide a broad perspective on the association of the family system, substance abuse, and crime in adolescence.

Future Implications: A Multidimensional Approach

These results could be useful in structuring programs on substance abuse and criminality prevention for the whole family system, both parents and youth. For instance, measures and programs focusing on adolescents are needed, based on the following indications and according to a perspective that considers the familial, educational, and social level and can be applied to both parents and youth:

(1) Familial interventions should be based on the direct involvement of parents, developing programs of support and parent training for families to improve their relationship with their children, and on decreasing the risk factors for youth associated with the dysfunctional family system. Familial interventions can help parents to establish positive communication, reduce conflicts within the family, promote a parenting style based on active listening, affection, and rules, lead parents to understand the effects of neglection, physical and psychological violence, and systematic exposure to a criminogenic context on the child's development. These interventions could have a double aim: the treatment for families with drug-addicted and justice-involved parents or relatives and the prevention for conflictual families with dysfunctional communication and negative climate.

(2) Educational interventions for youth aim to develop more awareness among juveniles on the consequences of drug abuse and crime. These interventions could promote a joint and coordinated effort of family and school, which collaborate to reduce the spread of drug abuse and crime among youth. Educational projects can be the target considering gender and age differences. Teachers could organize lectures, seminars, rallies, and films, which teach alternative behaviors than the risky ones. Moreover, it could be useful to include a psychological support service at school for youth with family issues or who have parents involved in crime or drug addicted, to give a space in which they can disclose with a professional, reducing the risk to violent or self-harming acting out.

(3) Community interventions aim to promote social awareness through antidrug and anti-crime campaigns, especially on new drugs, drug selling websites on the dark web, legal consequences, and life in prisons. These interventions can use social media and social networks to diffuse a good policy on the topic and prevent from drug-addiction and juvenile justice involvement. It could be useful to establish a national and an international policy of intervention based on scientific divulgation of the main research findings to create best practices for schools and families in high-risk areas.

(4) Future researches are needed, especially focusing on longitudinal monitoring of the effect of long-term exposure to the risk factors mentioned in our and in the previous research. Also, psychologists, sociologists, and researchers in this field should be focused on identifying criminal areas in which young people are more likely to be exposed to violence, poverty, substances, and dissatisfaction with familial relationships to enrich the knowledge of the factors that can affect young people. Finally, it could be useful to stimulate a scientific debate with European and non-European countries to evaluate the topic according to a different cultural point of view and to enrich the discussion about possible interventions.

Conclusion

The main findings of this review suggest that adolescents whose parents are involved in illegal behavior and the use of drugs are more likely to be involved in delinquency and substance abuse conduct. Furthermore, the perception of lacking family support, negative climate, and communication and of having justice-involved parents might contribute to the development of risky trajectories among young people. Moreover, there is a connection between criminal activities and substance abuse, which can lead to a future criminal career and addiction in later adolescence and adulthood.

The parent-children relationship seems to have a key role in risky behaviors among youth. Therefore, positive and supportive relationships with parents may reduce these risks. For this reason, we consider it useful for future research and interventions to place the focus on family in a multidimensional level. For instance, the so-called family-based approach therapy in treating and preventing drug abuse and criminal behavior among youth provides such possibilities.

Moreover, according to an overview of a systematic review about interventions for adolescent substance abuse ( Das et al., 2016), school programs based on the promotion of social competence and the antidrug information were effective. However, there was poor empirical evidence in the evaluation of the long-term efficacy and the sustainability of substance abuse programs for adolescents.

Future research should focus on evaluating the effectiveness of specific intervention components with standardized intervention and outcome measures. Furthermore, the inclusion of gender differences in the family system influencing substance abuse and criminal conducts and of higher quality evidence, especially from low- and middle-income countries on effective interventions, to prevent and manage substance abuse among adolescents will be useful.

Author Contributions

All the authors equally contributed to developing the project of present research, and to writing the manuscript. VS: conceptualization. VS, OM, and CC: methodology. VS and OM: investigation and writing-original draft preparation. LH, CC, ML, FP, and VV: writing-review and editing. VV, CC, ML, and FP: supervision. All authors have read and agreed to the published version of the manuscript.

Funding

The publication of this article was funded by the Department of Education, Psychology, Philosophy, University of Cagliari (Italy). The research was funded by the Department of Human, Social and Health Sciences, University of Cassino and Southern Lazio (Italy), and the Institute for the Study of Psychotherapy of Rome (Italy).

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's Note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

References

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Frontiers | The Vicious Cycle: Problematic Family Relations, Substance Abuse, and Crime in Adolescence: A Narrative Review

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Despite the copiousness of studies on the risky behaviors of adolescents, we cannot establish with certainty the leading aspects involved in teens' substance...

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"Just Say No" didn't work, but experts are employing new holistic programs to help steer kids away-or at least keep them from dying-from illicit substances.

Cite This Article

Abrams, Z. (2024, March 1). More teens than ever are overdosing. Psychologists are leading new approaches to combat youth substance misuse. Monitor on Psychology, 55(2). https://www.apa.org/monitor/2024/03/new-approaches-youth-substance-misuse

For years, students in middle and high schools across the country were urged to "just say no" to drugs and alcohol. But it's no secret that the Drug Abuse Resistance Education (D.A.R.E.) program, which was typically delivered by police officers who urged total abstinence, didn't work. A meta-analysis found the program largely ineffective and one study even showed that kids who completed D.A.R.E. were more likely than their peers to take drugs ( Ennett, S. T., et al., American Journal of Public Health, Vol. 84, No. 9, 1994; Rosenbaum, D. P., & Hanson, G. S., Journal of Research in Crime and Delinquency, Vol. 35, No. 4, 1998).

"We know that the 'Just Say No' campaign doesn't work. It's based in pure risks, and that doesn't resonate with teens," said developmental psychologist Bonnie Halpern-Felsher, PhD, a professor of pediatrics and founder and executive director of several substance use prevention and intervention curriculums at Stanford University. "There are real and perceived benefits to using drugs, as well as risks, such as coping with stress or liking the 'high.' If we only talk about the negatives, we lose our credibility."

Partially because of the lessons learned from D.A.R.E., many communities are taking a different approach to addressing youth substance use. They're also responding to very real changes in the drug landscape. Aside from vaping, adolescent use of illicit substances has dropped substantially over the past few decades, but more teens are overdosing than ever-largely because of contamination of the drug supply with fentanyl, as well as the availability of stronger substances ( Most reported substance use among adolescents held steady in 2022, National Institute on Drug Abuse).

"The goal is to impress upon youth that far and away the healthiest choice is not to put these substances in your body, while at the same time acknowledging that some kids are still going to try them," said Aaron Weiner, PhD, ABPP, a licensed clinical psychologist based in Lake Forest, Illinois, and immediate past-president of APA's Division 50 (Society of Addiction Psychology). "If that's the case, we want to help them avoid the worst consequences."

While that approach, which incorporates principles of harm reduction, is not universally accepted, evidence is growing for its ability to protect youth from accidental overdoses and other consequences of substance use, including addiction, justice involvement, and problems at school. Psychologists have been a key part of the effort to create, test, and administer developmentally appropriate, evidence-based programs that approach prevention in a holistic, nonstigmatizing way.

"Drugs cannot be this taboo thing that young people can't ask about anymore," said Nina Christie, PhD, a postdoctoral research fellow in the Center on Alcohol, Substance Use, and Addictions at the University of New Mexico. "That's just a recipe for young people dying, and we can't continue to allow that."

Changes in drug use

In 2022, about 1 in 3 high school seniors, 1 in 5 sophomores, and 1 in 10 eighth graders reported using an illicit substance in the past year, according to the National Institute on Drug Abuse's (NIDA) annual survey (Monitoring the Future: National Survey Results on Drug Use, 1975-2022: Secondary School Students, NIDA, 2023 [PDF, 7.78MB]). Those numbers were down significantly from prepandemic levels and essentially at their lowest point in decades.

Substance use during adolescence is particularly dangerous because psychoactive substances, including nicotine, cannabis, and alcohol, can interfere with healthy brain development ( Winters, K. C., & Arria, A., Prevention Research, Vol. 18, No. 2, 2011). Young people who use substances early and frequently also face a higher risk of developing a substance use disorder in adulthood ( McCabe, S. E., et al., JAMA Network Open, Vol. 5, No. 4, 2022). Kids who avoid regular substance use are more likely to succeed in school and to avoid problems with the juvenile justice system ( Public policy statement on prevention, American Society of Addiction Medicine, 2023).

"The longer we can get kids to go without using substances regularly, the better their chances of having an optimal life trajectory," Weiner said.

The drugs young people are using-and the way they're using them-have also changed, and psychologists say this needs to inform educational efforts around substance use. Alcohol and cocaine are less popular than they were in the 1990s; use of cannabis and hallucinogens, which are now more salient and easier to obtain, were higher than ever among young adults in 2021 ( Marijuana and hallucinogen use among young adults reached all-time high in 2021, NIDA).

"Gen Z is drinking less alcohol than previous generations, but they seem to be increasingly interested in psychedelics and cannabis," Christie said. "Those substances have kind of replaced alcohol as the cool thing to be doing."

Young people are also seeing and sharing content about substance use on social media, with a rise in posts and influencers promoting vaping on TikTok and other platforms ( Vassey, J., et al., Nicotine & Tobacco Research, 2023). Research suggests that adolescents and young adults who see tobacco or nicotine content on social media are more likely to later start using it ( Donaldson, S. I., et al., JAMA Pediatrics, Vol. 176, No. 9, 2022).

A more holistic view

Concern for youth well-being is what drove the well-intentioned, but ultimately ineffective, "mad rush for abstinence," as Robert Schwebel, PhD, calls it. Though that approach has been unsuccessful in many settings, a large number of communities still employ it, said Schwebel, a clinical psychologist who created the Seven Challenges Program for treating substance use in youth.

But increasingly, those working to prevent and treat youth substance use are taking a different approach-one that aligns with principles Schwebel helped popularize through Seven Challenges.

A key tenet of modern prevention and treatment programs is empowering youth to make their own decisions around substance use in a developmentally appropriate way. Adolescents are exploring their identities (including how they personally relate to drugs), learning how to weigh the consequences of their actions, and preparing for adulthood, which involves making choices about their future. The Seven Challenges Program, for example, uses supportive journaling exercises, combined with counseling, to help young people practice informed decision-making around substance use with those processes in mind.

"You can insist until you're blue in the face, but that's not going to make people abstinent. They ultimately have to make their own decisions," Schwebel said.

Today's prevention efforts also tend to be more holistic than their predecessors, accounting for the ways drug use relates to other addictive behaviors, such as gaming and gambling, or risky choices, such as fighting, drag racing, and having unprotected sex. Risk factors for substance use-which include trauma, adverse childhood experiences, parental history of substance misuse, and personality factors such as impulsivity and sensation seeking-overlap with many of those behaviors, so it often makes sense to address them collectively.
[Related: Psychologists are innovating to tackle substance use]
"We've become more sophisticated in understanding the biopsychosocial determinants of alcohol and drug use and moving beyond this idea that it's a disease and the only solution is medication," said James Murphy, PhD, a professor of psychology at the University of Memphis who studies addictive behaviors and how to intervene.

Modern prevention programs also acknowledge that young people use substances to serve a purpose-typically either social or emotional in nature-and if adults expect them not to use, they should help teens learn to fulfill those needs in a different way, Weiner said.

"Youth are generally using substances to gain friends, avoid losing them, or to cope with emotional problems that they're having," he said. "Effective prevention efforts need to offer healthy alternatives for achieving those goals."

Just say "know"

At times, the tenets of harm reduction and substance use prevention seem inherently misaligned. Harm reduction, born out of a response to the AIDS crisis, prioritizes bodily autonomy and meeting people where they are without judgment. For some harm reductionists, actively encouraging teens against using drugs could violate the principle of respecting autonomy, Weiner said.

On the other hand, traditional prevention advocates may feel that teaching adolescents how to use fentanyl test strips or encouraging them not to use drugs alone undermines the idea that they can choose not to use substances. But Weiner says both approaches can be part of the solution.

"It doesn't have to be either prevention or harm reduction, and we lose really important tools when we say it has to be one or the other," he said.

In adults, harm reduction approaches save lives, prevent disease transmission, and help people connect with substance use treatment ( Harm Reduction, NIDA, 2022). Early evidence shows similar interventions can help adolescents improve their knowledge and decision-making around drug use ( Fischer, N. R., Substance Abuse Treatment, Prevention, and Policy, Vol. 17, 2022). Teens are enthusiastic about these programs, which experts often call "Just Say Know" to contrast them with the traditional "Just Say No" approach. In one pilot study, 94% of students said a "Just Say Know" program provided helpful information and 92% said it might influence their approach to substance use ( Meredith, L. R., et al., The American Journal of Drug and Alcohol Abuse, Vol. 47, No. 1, 2021).

"Obviously, it's the healthiest thing if we remove substance use from kids' lives while their brains are developing. At the same time, my preference is that we do something that will have a positive impact on these kids' health and behaviors," said Nora Charles, PhD, an associate professor and head of the Youth Substance Use and Risky Behavior Lab at the University of Southern Mississippi. "If the way to do that is to encourage more sensible and careful engagement with illicit substances, that is still better than not addressing the problem."

One thing not to do is to overly normalize drug use or to imply that it is widespread, Weiner said. Data show that it's not accurate to say that most teens have used drugs in the past year or that drugs are "just a part of high school life." In fact, students tend to overestimate how many of their peers use substances ( Dumas, T. M., et al., Addictive Behaviors, Vol. 90, 2019; Helms, S. W., et al., Developmental Psychology, Vol. 50, No. 12, 2014).

A way to incorporate both harm reduction and traditional prevention is to customize solutions to the needs of various communities. For example, in 2022, five Alabama high school students overdosed on a substance laced with fentanyl, suggesting that harm reduction strategies could save lives in that community. Other schools with less reported substance use might benefit more from a primary prevention-style program.

At Stanford, Halpern-Felsher's Research and Education to Empower Adolescents and Young Adults to Choose Health (REACH) Lab has developed a series of free, evidence-based programs through community-based participatory research that can help populations with different needs. The REACH Lab offers activity-based prevention, intervention, and cessation programs for elementary, middle, and high school students, including curricula on alcohol, vaping, cannabis, fentanyl, and other drugs (Current Problems in Pediatric and Adolescent Health Care, Vol. 52, No. 6, 2022). They're also working on custom curricula for high-risk groups, including sexual and gender minorities.

The REACH Lab programs, including the comprehensive Safety First curriculum, incorporate honest discussion about the risks and benefits of using substances. For example: Drugs are one way to cope with stress, but exercise, sleep, and eating well can also help. Because many young people care about the environment, one lesson explores how cannabis and tobacco production causes environmental harm.

The programs also dispel myths about how many adolescents are using substances and help them practice skills, such as how to decline an offer to use drugs in a way that resonates with them. They learn about the developing brain in a positive way-whereas teens were long told they can't make good decisions, Safety First empowers them to choose to protect their brains and bodies by making healthy choices across the board.

"Teens can make good decisions," Halpern-Felsher said. "The equation is just different because they care more about certain things-peers, relationships-compared to adults."

Motivating young people

Because substance use and mental health are so intertwined, some programs can do prevention successfully with very little drug-focused content. In one of the PreVenture Program's workshops for teens, only half a page in a 35-page workbook explicitly mentions substances.

"That's what's fascinating about the evidence base for PreVenture," said clinical psychologist Patricia Conrod, PhD, a professor of psychiatry at the University of Montreal who developed the program. "You can have quite a dramatic effect on young people's substance use without even talking about it."

PreVenture offers a series of 90-minute workshops that apply cognitive behavioral insights upstream (addressing the root causes of a potential issue rather than waiting for symptoms to emerge) to help young people explore their personality traits and develop healthy coping strategies to achieve their long-term goals.

Adolescents high in impulsivity, hopelessness, thrill-seeking, or anxiety sensitivity face higher risks of mental health difficulties and substance use, so the personalized material helps them practice healthy coping based on their personality type. For example, the PreVenture workshop that targets anxiety sensitivity helps young people learn to challenge cognitive distortions that can cause stress, then ties that skill back to their own goals.

The intervention can be customized to the needs of a given community (in one trial, drag racing outstripped substance use as the most problematic thrill-seeking behavior). In several randomized controlled trials of PreVenture, adolescents who completed the program started using substances later than peers who did not receive the intervention and faced fewer alcohol-related harms ( Newton, N. C., et al., JAMA Network Open, Vol. 5, No. 11, 2022). The program has also been shown to reduce the likelihood that adolescents will experiment with illicit substances, which relates to the current overdose crisis in North America, Conrod said (Archives of General Psychiatry, Vol. 67, No. 1, 2010).

"People shouldn't shy away from a targeted approach like this," Conrod said. "Young people report that having the words and skills to manage their traits is actually helpful, and the research shows that at behavioral level, it really does protect them."

As young people leave secondary school and enter college or adult life, about 30% will binge drink, 8% will engage in heavy alcohol use, and 20% will use illicit drugs ( Alcohol and Young Adults Ages 18 to 24, National Institute on Alcohol Abuse and Alcoholism, 2023; SAMHSA announces national survey on drug use and health (NSDUH) results detailing mental illness and substance use levels in 2021). But young people are very unlikely to seek help, even if those activities cause them distress, Murphy said. For that reason, brief interventions that leverage motivational interviewing and can be delivered in a school, work, or medical setting can make a big difference.

In an intervention Murphy and his colleagues are testing, young adults complete a questionnaire about how often they drink or use drugs, how much money they spend on substances, and negative things that have happened as a result of those choices (getting into an argument or having a hangover, for example).

In an hour-long counseling session, they then have a nonjudgmental conversation about their substance use, where the counselor gently amplifies any statements the young person makes about negative outcomes or a desire to change their behavior. Participants also see charts that quantify how much money and time they spend on substances, including recovering from being intoxicated, and how that stacks up against other things they value, such as exercise, family time, and hobbies.

"For many young people, when they look at what they allocate to drinking and drug use, relative to these other things that they view as much more important, it's often very motivating," Murphy said.

A meta-analysis of brief alcohol interventions shows that they can reduce the average amount participants drink for at least 6 months ( Mun, E.Y., et al., Prevention Science, Vol. 24, No. 8, 2023). Even a small reduction in alcohol use can be life-altering, Murphy said. The fourth or fifth drink on a night out, for example, could be the one that leads to negative consequences-so reducing intake to just three drinks may make a big difference for young people.

Conrod and her colleagues have also adapted the PreVenture Program for university students; they are currently testing its efficacy in a randomized trial across multiple institutions.

Christie is also focused on the young adult population. As a policy intern with Students for Sensible Drug Policy, she created a handbook of evidence-based policies that college campuses can use to reduce harm among students but still remain compliant with federal law. For example, the Drug Free Schools and Communities Act mandates that higher education institutions formally state that illegal drug use is not allowed on campus but does not bar universities from taking an educational or harm reduction-based approach if students violate that policy.

"One low-hanging fruit is for universities to implement a Good Samaritan policy, where students can call for help during a medical emergency and won't get in trouble, even if illegal substance use is underway," she said.

Ultimately, taking a step back to keep the larger goals in focus-as well as staying dedicated to prevention and intervention approaches backed by science-is what will help keep young people healthy and safe, Weiner said.

"What everyone can agree on is that we want kids to have the best life they can," he said. "If we can start there, what tools do we have available to help?"

Further reading

Public Policy Statement on Prevention
American Society of Addiction Medicine, 2023

Listen to young people: How to implement harm reduction in the collegiate setting
Christie, N. C., 2023

Brief alcohol interventions for young adults: Strengthening effects and disentangling mechanisms to build personalized interventions for widespread uptake
Special issue of Psychology of Addictive Behaviors, 2022

Addressing adolescent substance use with a public health prevention framework: The case for harm reduction
Winer, J. M., et al., Annals of Medicine, 2022

A breath of knowledge: Overview of current adolescent e-cigarette prevention and cessation programs
Liu, J., et al., Current Addiction Reports, 2020

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More teens than ever are overdosing. Psychologists are leading new approaches to combat youth substance misuse

# data[].attributes.attachment_link.description
"Just Say No" didn't work, but experts are employing new holistic programs to help steer kids away-or at least keep them from dying-from illicit substances.

# data[].attributes.attachment_link.authors[].name
Rachel N. Lipari, Ph.D., and Struther L. Van Horn, M.A.

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Children Living with Parents Who Have a Substance Use Disorder

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This report uses data from the 2009 to 2014 National Surveys on Drug Use and Health (NSDUHs) to determine the number of children aged 17 or younger living with a parent who had an substance use disorder, an alcohol use disorder or illicit drug use disorder.

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The Role of Family Dynamics in Adolescent Substance Abuse: Investigate how different family structures, parenting styles, and family histories contribute to or mitigate the risk of drug addiction in teenagers.

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Family Dynamics May Influence an Individual’s Substance Use Abstinence Self-Efficacy

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Previous work on substance use suggests the influence of family dynamics on emotion regulation.The present study examined the role of family in substance use recovery. It is of importance to examine whether conflict with various family members influences…

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Parents, family influence adolescent substance abuse

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The study found there was a higher proportion of children from alcoholic families that used substances as adolescents compared with those from non-alcoholic families.

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Four Tiers of Sources and How to Tell the Difference – A Dam Good Argument

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Amy Guptill; Liz Delf; Rob Drummond; and Kristy Kelly

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Socioeconomic Status, Parental Education, School Connectedness and Individual Socio-Cultural Resources in Vulnerability for Drug Use among Students

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Background and Aims: Families who live in a disadvantaged socioeconomic situation frequently face substandard housing, unsafe neighborhoods, inadequate schools and more stress in their daily lives than more affluent families, with a host of psychological…

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Family-based Treatments for Adolescent Substance Use

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Adolescent substance use is a major risk factor for negative outcomes including substance dependence later in life, criminal behavior, school problems, mental health disorders, injury and death. As it stands, there are a variety of available treatment…

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"Teenagers who use cannabis, alcohol and nicotine are more likely to have underlying psychiatric symptoms, and worse symptoms, than their peers who are not regularly using substances, new research has found."

"Compared with prior generations, today’s adolescents are experiencing more mental health symptoms but a declining use of drugs and alcohol. Binge-drinking and cigarette smoking, in particular, have fallen sharply, affecting a smaller portion of the adolescent population."

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"Many parents are doing a good job in raising their children. But this year’s CASA survey uncovered problem parents who enable (some even encourage) their 12- to 17-year-olds to use tobacco, alcohol and illegal prescription drugs. By their action and inaction, and by failing to become part of the solution, these parents become part of the problem of teen alcohol and drug abuse."

"This year’s survey identified as problem parents those who:

• fail to monitor their children’s leaving their home and hanging out on school nights (Monday through Thursday),

• fail to keep away from their children their own dangerous and addictive prescription drugs, like painkillers and stimulants,

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• fail to address the problem of drugs in their children’s school,

• set a bad example."

"All parents should monitor their children on school nights, keep dangerous prescription drugs out of their children’s reach, demand that their children’s schools be drug free, and be engaged in their cld’s life."

"There are no more powerful examples of parental engagement than getting a teen involved spiritually and having family dinners. Teens who are religiously involved and who have frequent family dinners are at much lower risk of using and abusing substances."

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The annual back-to-school surveys of The National Center on Addiction and Substance Abuse at Columbia University seek to identify situations and characteristics that increase or decrease the risk that a teen will smoke, drink, get drunk, use illegal drugs or abuse prescription drugs. This year's CASA survey of teens and their parents focused on how what parents do-and don't do-influence the risk of substance abuse by their 12- to 17-year-old children.

The results are disturbing. Although virtually all mothers and fathers are concerned about the challenges of raising their kids, many do not realize how certain of their actions affect the likelihood that their children will become substance abusers. Many are not willing to take actions to prevent placing their children at higher risk of substance abuse.

Compared to the time when they were growing up, almost nine out of 10 parents surveyed (84 percent) said that in these days it is harder to keep teenagers safe, and 3 of 4 parents (72 percent) said it is harder to raise a teen "of good moral character." With this in mind, why are there so many parents who either don't appreciate the impact of their actions on their children's vulnerability to substance abuse or who don't try harder?

Teens whose parents are "hands on"-engaging themselves in their teens' day-to-day lives, relaxing with them, having frequent family dinners, supervising them, establishing standards of behavior, instilling a sense of the importance of religion in their children and setting positive examples of healthy behavior-are much less likely to smoke, drink or use drugs.

Problem Parents

Many parents are doing a good job in raising their children. But this year's CASA survey uncovered problem parents who enable (some even encourage) their 12- to 17-year-olds to use tobacco, alcohol and illegal prescription drugs. By their action and inaction, and by failing to become part of the solution, these parents become part of the problem of teen alcohol and drug abuse.

This year's survey identified as problem parents those who:

* fail to monitor their children's leaving their home and hanging out on school nights (Monday through Thursday),

* fail to keep away from their children their own dangerous and addictive prescription drugs, like painkillers and stimulants,

* fail to address the problem of drugs in their children's school,

* set a bad example.

"It's 10 p.m. Do you know where your child is?"

Some 46 percent of 12- to 17-year-olds-compared to only 14 percent of their (unknowing or disingenuous) parents-said they typically left home to hang out with friends on school nights.

Not knowing where your kid is and what your kid is up to on a school night is risky business. Why? Because the later teens are hanging out with friends on school nights, the likelier it is that drug and alcohol use will be going on among them. Half of those teens who come home after 10:00 p.m. say that is the case, as do almost a third of those who come home between 8:00 and 10:00 p.m.

Parents as Passive Pushers

Some parents become "passive pushers" by leaving around the house addictive prescription drugs like OxyContin and Vicodin, making them easily available to their children. Among kids who abuse prescription drugs to get high, 34 percent say they get them from their homes; another 31 percent say they get them from their friends. Since it's fair to assume that a third of those friends in turn get the drugs from their homes, it's likely that for almost half of kids abusing addictive prescription drugs, the pills are coming out of the family medicine cabinet.

These kids tend to think prescription drugs are safer than drugs bought from street dealers since these drugs come from a pharmacy and mom and dad use them. A few decades ago, parents used to lock their liquor cabinets; perhaps the time has come for them to lock their medicine cabinets, or at least keep track of the number of pills there.

Pessimistic and Naïve Parents

Almost all parents-including those who believe that drugs are used, kept and sold at their child's school-say it is important that their teen's school is drug-free. Yet, of the almost half of parents who say their children are in drug-infested schools, only 39 percent believe the goal of making their child's school drug free is realistic.

Not surprisingly, in view of this parental attitude, one in five middle schoolers and almost two-thirds of high schoolers attend schools where drugs are used, kept and sold. Research consistently demonstrates that compared to kids at drug-free schools, those at drug-infested schools are three times more likely to smoke marijuana and get drunk in a typical month, and twice as likely to smoke and drink. Nevertheless, one-third of parents believe that the presence of illegal drugs in their teen's school does not make it any more likely that their child will try them.

These pessimistic and naïve parents should not accept drug-infested schools as inevitable, any more than they would tolerate asbestos-infested schools as an acceptable risk for their children. State laws require that parents send their children to middle and high schools. These parents should demand that the state remove drugs from schools. No government should require parents to send their children to schools where drugs are used, kept and sold.

Prescription Drugs and Marijuana

The ready availability of illicit substances puts an extra burden on parents to stay engaged with their teens. Availability is the mother of use and, for most teens, prescription drugs and marijuana are as easy to get as candy.

Each year we ask teens which of these is easiest to buy: cigarettes, beer, marijuana or prescription drugs. For the first time in the history of CASA's survey, more teens said prescription drugs were easier to buy than beer. The proportion of teens who say prescription drugs are easiest to buy jumped by 46 percent since 2007.

Marijuana is more available than ever, with 23 percent of teens able to get the drug in an hour or less, and 42 percent of teens able to get it in a day or less. The survey reveals a 35 percent increase over last year in the number of teens who can get marijuana in an hour or less, and a 14 percent increase over last year in teens who can get the drug in a day or less.

From 2007 to 2008-in just one year-we saw an increase of 1.4 million teens who can buy marijuana in an hour or less (4.4 vs. 5.8 million), and an increase of 1.1 million teens who can buy marijuana in a day or less (9.5 vs. 10.6 million). In this same year, the population of 12- to 17-year-olds decreased by almost half a million.

More than two-thirds of 17-year-olds can get marijuana in a day or less. Half of 16- and 17-year-olds say that among teens their age, smoking marijuana is more common than smoking cigarettes.

A Mom and Pop Operation

Preventing substance abuse among teens is primarily a mom-and-pop operation. Every mother and father should ask, "Am I doing the parenting essential to help my child negotiate the difficult teen years free of tobacco, alcohol and other drugs?"

Most important are the ABC's of setting a good example: not smoking or using illegal drugs, not abusing alcohol or prescription drugs. The saddest revelation of this year's survey was that a quarter of 12- to 17-year-olds knew parents of friends or classmates who used marijuana, and 10 percent knew parents of friends or classmates who smoked pot with teens.

All parents should monitor their children on school nights, keep dangerous prescription drugs out of their children's reach, demand that their children's schools be drug free, and be engaged in their child's life.

There are no more powerful examples of parental engagement than getting a teen involved spiritually and having family dinners. Teens who are religiously involved and who have frequent family dinners are at much lower risk of using and abusing substances. Mom and pop are key here. Compared with teens who attend religious services weekly-whether Catholic, Protestant, Jewish, Muslim-those who never attend such services are three times likelier to use marijuana and twice as likely to smoke and drink. In 21st- century America, it is unlikely that teens are regularly attending religious services unless their parents are taking them.

And what a difference dinner makes! Young people who have dinner with their parents at least five times a week are far less likely to smoke, drink or use drugs than kids who have family dinners less than three times a week.

The payoff for good parenting is enormous: A child who gets to age 21 without smoking, using illegal drugs or abusing alcohol is virtually certain never to do so. In this day and age, few, if any, children are going to make it through the turbulent decade from age 11 to 21 without engaged parents. If parents are not part of the solution, they become part of the problem.
From the archives. Joseph A. Califano, Jr., on "The Myths of Drug Legalization."

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Hands-On Parenting: How parents can prevent teen drug abuse