Showing papers on "Substance abuse published in 1997"

Protecting adolescents from harm: Findings from the National Longitudinal Study on Adolescent Health.

Abstract: Context. —The main threats to adolescents' health are the risk behaviors they choose. How their social context shapes their behaviors is poorly understood. Objective. —To identify risk and protective factors at the family, school, and individual levels as they relate to 4 domains of adolescent health and morbidity: emotional health, violence, substance use, and sexuality. Design. —Cross-sectional analysis of interview data from the National Longitudinal Study of Adolescent Health. Participants. —A total of 12118 adolescents in grades 7 through 12 drawn from an initial national school survey of 90118 adolescents from 80 high schools plus their feeder middle schools. Setting. —The interview was completed in the subject's home. Main Outcome Measures. —Eight areas were assessed: emotional distress; suicidal thoughts and behaviors; violence; use of 3 substances (cigarettes, alcohol, marijuana); and 2 types of sexual behaviors (age of sexual debut and pregnancy history). Independent variables included measures of family context, school context, and individual characteristics. Results. —Parent-family connectedness and perceived school connectedness were protective against every health risk behavior measure except history of pregnancy. Conversely, ease of access to guns at home was associated with suicidality (grades 9-12: P P P P P P P P P P P P P P P Conclusions. —Family and school contexts as well as individual characteristics are associated with health and risky behaviors in adolescents. The results should assist health and social service providers, educators, and others in taking the first steps to diminish risk factors and enhance protective factors for our young people.

Drug Abuse: Hedonic Homeostatic Dysregulation

Abstract: Understanding the neurobiological mechanisms of addiction requires an integration of basic neuroscience with social psychology, experimental psychology, and psychiatry. Addiction is presented as a cycle of spiralling dysregulation of brain reward systems that progressively increases, resulting in compulsive drug use and a loss of control over drug-taking. Sensitization and counteradaptation are hypothesized to contribute to this hedonic homeostatic dysregulation, and the neurobiological mechanisms involved, such as the mesolimbic dopamine system, opioid peptidergic systems, and brain and hormonal stress systems, are beginning to be characterized. This framework provides a realistic approach to identifying the neurobiological factors that produce vulnerability to addiction and to relapse in individuals with a history of addiction.

The self-medication hypothesis of substance use disorders: a reconsideration and recent applications.

Abstract: The self-medication hypothesis of addictive disorders derives primarily from clinical observations of patients with substance use disorders. Individuals discover that the specific actions or effects of each class of drugs relieve or change a range of painful affect states. Self-medication factors occur in a context of self-regulation vulnerabilities--primarily difficulties in regulating affects, self-esteem, relationships, and self-care. Persons with substance use disorders suffer in the extreme with their feelings, either being overwhelmed with painful affects or seeming not to feel their emotions at all. Substances of abuse help such individuals to relieve painful affects or to experience or control emotions when they are absent or confusing. Diagnostic studies provide evidence that variously supports and fails to support a self-medication hypothesis of addictive disorders. The cause-consequence controversy involving psychopathology and substance use/abuse is reviewed and critiqued. In contrast, clinical observations and empirical studies that focus on painful affects and subjective states of distress more consistently suggest that such states of suffering are important psychological determinants in using, becoming dependent upon, and relapsing to addictive substances. Subjective states of distress and suffering involved in motives to self-medicate with substances of abuse are considered with respect to nicotine dependence and to schizophrenia and posttraumatic stress disorder comorbid with a substance use disorder.

Addiction is a brain disease, and it matters.

Abstract: Scientific advances over the past 20 years have shown that drug addiction is a chronic, relapsing disease that results from the prolonged effects of drugs on the brain. As with many other brain diseases, addiction has embedded behavioral and social-context aspects that are important parts of the disorder itself. Therefore, the most effective treatment approaches will include biological, behavioral, and social-context components. Recognizing addiction as a chronic, relapsing brain disorder characterized by compulsive drug seeking and use can impact society's overall health and social policy strategies and help diminish the health and social costs associated with drug abuse and addiction.

On stigma and its consequences: evidence from a longitudinal study of men with dual diagnoses of mental illness and substance abuse.

Abstract: Numerous studies have demonstrated a strong connection between the experience of stigma and the well-being of the stigmatized. But in the area of mental illness there has been controversy surrounding the magnitude and duration of the effects of labeling and stigma. One of the arguments that has been used to downplay the importance of these factors is the substantial body of evidence suggesting that labeling leads to positive effects through mental health treatment. However, as Rosenfield (1997) points out, labeling can simultaneously induce both positive consequences through treatment and negative consequences through stigma. In this study we test whether stigma has enduring effects on well-being by interviewing 84 men with dual diagnoses of mental disorder and substance abuse at two points in time--at entry into treatment, when they were addicted to drugs and had many psychiatric symptoms and then again after a year of treatment, when they were far less symptomatic and largely drug- and alcohol-free. We found a relatively strong and enduring effect of stigma on well-being. This finding indicates that stigma continues to complicate the lives of the stigmatized even as treatment improves their symptoms and functioning. It follows that if health professionals want to maximize the well-being of the people they treat, they must address stigma as a separate and important factor in its own right.

Clinical Characteristics of Women With a History of Childhood Abuse: Unhealed Wounds

Abstract: Objectives. —To determine the prevalence of childhood physical or sexual abuse in women seen in primary care practices; to identify physical and psychologic problems associated with that abuse; and to compare the effects of childhood physical vs sexual abuse and childhood vs adult abuse. Design. —Cross-sectional, self-administered, anonymous survey. Setting. —Four community-based, primary care internal medicine practices. Patients. —A total of 1931 women of varied age and marital, educational, and economic status examined from February through July 1993. Main Outcome Measures. —Prevalence of physical and sexual abuse, physical symptoms, psychological symptoms (Symptom Checklist-22), alcohol abuse (CAGE questions), and street drug use. Results. —Of the 1931 respondents, 424 (22.0%) reported childhood or adolescent physical or sexual abuse. Compared with women who reported never having experienced abuse (n=1257), women who reported abuse as children but not adults (n=204) had more physical symptoms (mean±SE, 6.2±0.2 vs 4.0±0.9;P Conclusions. —Childhood physical or sexual abuse is associated with adult health problems including physical symptoms, psychological problems, and substance abuse; for many variables, this association is as strong as for patients experiencing current abuse.

Psychiatric and Substance Use Comorbidity Among Treatment-Seeking Opioid Abusers

Abstract: Background: Major studies of psychiatric comorbidity in opioid abusers reported rates of comorbidity that far exceeded general population estimates. These studies were published more than a decade ago and reported on few women and few substance use diagnoses. Methods: Psychiatric and substance use comorbidity was assessed in 716 opioid abusers seeking methadone maintenance. Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition diagnostic assessment was conducted 1 month after admission. Rates of psychiatric and substance use disorder were compared by gender, and associations were assessed between psychiatric comorbidity and dimensional indexes of substance use severity, psychosocial impairment, and personality traits. Results: Psychiatric comorbidity was documented in 47% of the sample (47% women and 48% men). Antisocial personality disorder (25.1%) and major depression (15.8%) were the most common diagnoses. Patients had at least 2 substance use diagnoses, most often opioid and cocaine dependence. Demographics, substance use history, and personality variables discriminated between patients with vs without comorbidity. Psychiatric comorbidity also was associated with a more severe substance use disorder. Conclusions: Psychiatric comorbidity, especially personality and mood disorder, was common in men and women. The positive associations between psychiatric comorbidity and severity of substance use and other psychosocial problems were most consistent among those with antisocial personality.

A 2-year longitudinal analysis of the relationships between violent assault and substance use in women.

Abstract: Women experience alarming levels of physical and sexual assault, which may lead to escalation of substance use Reciprocally, evidence from cross-sectional studies indicates that substance use may increase risk of assault To date, directionality of this relationship remains unclear This issue is addressed by the present 3-wave longitudinal study in which a national probability sample of 3,006 women were followed for 2 years Dependent measures were obtained at each wave of the study and included questions about lifetime and new assault status, alcohol abuse, and drug use Wave 1 use of drugs, but not abuse of alcohol, increased odds of new assault in the subsequent 2 years Reciprocally, after a new assault, odds of both alcohol abuse and drug use were significantly increased, even among women with no previous use or assault history For illicit drug use, findings support a vicious cycle relationship in which substance use increases risk of future assault and assault increases risk of subsequent substance use

Outcome, attrition, and family-couples treatment for drug abuse: a meta-analysis and review of the controlled, comparative studies.

Abstract: This review synthesizes drug abuse outcome studies that included a family-couples therapy treatment condition. The meta-analytic evidence, across 1,571 cases involving an estimated 3,500 patients and family members, favors family therapy over (a) individual counseling or therapy, (b) peer group therapy, and (c) family psychoeducation. Family therapy is as effective for adults as for adolescents and appears to be a cost-effective adjunct to methadone maintenance. Because family therapy frequently had higher treatment retention rates than did nonfamily therapy modalities, it was modestly penalized in studies that excluded treatment dropouts from their analyses, as family therapy apparently had retained a higher proportion of poorer prognosis cases. Re-analysis, with dropouts regarded as failures, generally offset this artifact. Two statistical effect size measures to contend with attrition (dropout d and total attrition d) are offered for future researchers and policy makers.

National Survey Results on Drug Use from the Monitoring the Future Study, 1975-1995. Volume II: College Students and Young Adults.

Abstract: AUTHOR Johnston, Lloyd D.; O'Malley, Patrick M.; Bachman, Jerald G. TITLE National Survey Results on Drug Use from the Monitoring the Future Study, 1975-1995. Volume 1, Secondary School Students. INSTITUTION Michigan Univ., Ann Arbor. Inst. for Social Research. SPONS AGENCY National Inst. on Drug Abuse (DHHS/PHS), Rockville, MD. REPORT NO NIH-96-4139 PUB DATE 1996-00-00 NOTE 496p.; For volume II, see CG 028 238. CONTRACT 3R01DA01411 PUB TYPE Numerical/Quantitative Data (110) Reports Research

Childhood sexual abuse and women's substance abuse : National survey findings

Abstract: Objective: Clinical studies have found elevated rates of childhood sexual abuse (CSA) in women seeking treatment for alcohol or drug abuse, and elevated rates of alcohol and drug disorders among female psychiatric patients with histories of CSA. The present study examines the relationship of CSA to women's use of alcohol and other drugs in a large, nationally representative sample of U.S. women. Method: As part of a national survey of women's drinking, 1,099 women were asked about sexual experiences occurring before age 18. Women who reported sexual experiences classified as abusive were compared to women without histories of CSA on nine measures of substance use, self-perception of anxiousness, the occurrence of one or more lifetime depressive episodes, five measures of sexual dysfunction, and early onset of masturbation and consensual sexual intercourse. Results: Results of logit analyses, controlling for age, ethnicity and parental education, indicated that women with histories of CSA were significantl...

Is ADHD a risk factor for psychoactive substance use disorders : Findings from a four-year prospective follow-up study

Abstract: Objective To evaluate whether attention-deficit hyperactivity disorder (ADHD) is a risk factor for psychoactive substance use disorders (PSUD), attending to issues of psychiatric comorbidity, family history, and adversity. Method Using assessments from multiple domains, the authors examined 140 ADHD and 120 normal control subjects at baseline and 4 years later. Drug and alcohol abuse and dependence were operationally defined. Results No differences were detected in the rates of alcohol or drug abuse or dependence or in the rates of abuse of individual substances between the groups; both ADHD and control probands had a 15% rate of PSUD. Conduct and bipolar disorders predicted PSUD, independently of ADHD status. Family history of substance dependence and antisocial disorders was associated with PSUD in controls but less clearly so in ADHD probands. Family history of ADHD was not associated with risk for PSUD. ADHD probands had a significantly shorter time period between the onsets of abuse and dependence compared with controls (1.2 years versus 3 years, p Conclusions Adolescents with and without ADHD had a similar risk for PSUD that was mediated by conduct and bipolar disorder. Since the risk for PSUD has been shown to be elevated in adults with ADHD when compared with controls, a sharp increase in PSUD is to be expected in grown-up ADHD children during the transition from adolescence to adulthood.

The Link Between Substance Abuse and Posttraumatic Stress Disorder in Women: A Research Review

Abstract: Research has documented a high incidence of comorbid post-traumatic stress disorder (PTSD) and substance abuse. Women substance abusers, in particular, show high rates of this dual diagnosis (30% to 59%), most commonly deriving from a history of repetitive childhood physical and/or sexual assault. Rates for men are two to three times lower and typically stem from combat or crime trauma. Patients with both disorders are characterized by high severity on a multitude of psychological and treatment variables and use of the most severe drugs (cocaine and opioids). Treatment research on women is limited but suggests the possibility of retaining patients and achieving positive outcomes.

Religion, Psychopathology, and Substance Use and Abuse: A Multimeasure, Genetic-Epidemiologic Study

Abstract: Objective: The authors sought to 1) understand the sources of familial resemblance for religiosity, 2) clarify the relationship between religiosity and current psychiatric symptoms, current substance use, lifetime psychiatric disorders, and lifetime substance dependence, and 3) explore the stress-buffering properties of religiosity. Method: Data were obtained by personal interview of 1,902 twins from female-female pairs in the population-based Virginia Twin Registry. Measures included 1) 10 items reflecting a range of religious behavior and beliefs, 2) a scale of institutional conservatism of current religious affiliation, 3) previous history of stressful life events, 4) current psychiatric symptoms and substance use, and 5) lifetime psychiatric disorders and substance dependence. Statistical methods used included factor analyses, Cox and linear regression, and twin modeling. Results: Personal devotion and personal and institutional conservatism were all strongly familial, and model fitting suggested that this familial resemblance was due largely to the effect of environmental factors. None of the dimensions of religiosity was strongly associated with lifetime psychopathology or current symptoms, but low levels of depressive symptoms were related to high levels of personal devotion. By contrast, personal devotion and personal and institutional conservatism were significantly and inversely associated with current levels of drinking and smoking as well as lifetime risk for alcoholism and nicotine dependence. Personal devotion, but not personal or institutional conservatism, buffered the depressogenic effects of stressful life events. Conclusions: The dimensions of religiosity, are not strongly related to risk for psychiatric symptoms and disorders. However, religiosity may be one of the more important familial-environmental factors that affect the risk for substance use and dependence. Religious devotion but not conservatism assists in coping with stress.

Specific major mental disorders and criminality: a 26-year prospective study of the 1966 northern Finland birth cohort.

Abstract: Objective: The purpose of the study was to examine the quantitative risk of criminal behavior associated with specific mental disorders. Method: An unselected 1966 birth cohort (N=12,058) in Northern Finland was prospectively studied until the end of 1992. The investigation started during the mothers’ pregnancy, and the data on the subjects’ family characteristics, mental and physical development, living habits, psychiatric morbidity, and criminal records were gathered at various times. Results: The prevalence of offenses was the highest among males with alcohol-induced psychoses and male schizophrenic subjects with coexisting alcohol abuse, and more than half of the schizophrenic offenders also had problems with alcohol. Eleven (7%) of the 165 subjects who committed violent crimes were diagnosed as psychotic. Male schizophrenic subjects had a moderately high risk for violent offenses, but the risk for other types of crimes was not elevated significantly. Odds ratios for criminal behavior were adjusted according to the socioeconomic status of the childhood family and were the same as or slightly lower than the crude odds ratios for all disorders except schizophrenia and mood disorders with psychotic features. Conclusions: The results indicate that the risk of criminal behavior was significantly higher among subjects with psychotic disorders, even though the socioeconomic status of the childhood family was controlled. The higher risk for violent behavior was associated especially with alcohol-induced psychoses and with schizophrenia with coexisting substance abuse. The results suggest that schizophrenia without substance abuse may also be associated with a higher risk of offenses, but this finding is tentative and requires further investigation. (Am J Psychiatry 1997; 154:840‐845)

Eating Disorders in Males: A Report on 135 Patients

Abstract: Objective: The goal of this study was to better understand the etiology, clinical characteristics, and prognosis of eating disorders in males. Method: All males with eating disorders who had been treated at Massachusetts General Hospital from Jan. 1, 1980, to Dec. 31, 1994, were identified. Hospital charts and psychiatric departmental records were reviewed to verify that the eating disorders met DSM-IV criteria and to abstract demographic and clinical data. Results: One hundred thirty-five males with eating disorders were identified, of whom 62 (46%) were bulimic, 30 (22%) were anorexic, and 43 (32%) met criteria for an eating disorder not otherwise specified. There were marked differences in sexual orientation by diagnostic group; 42% of the male bulimic patients were identified as either homosexual or bisexual, and 58% of the anorexic patients were identified as asexual. Comorbid psychiatric disorders were common, particularly major depressive disorder (54% of all patients), substance abuse (37%), and personality disorder (26%). Many patients had a family history of affective disorder (29%) or alcoholism (37%). Conclusions: While most characteristics of males and females with eating disorders are similar, homosexuality/bisexuality appears to be a specific risk factor for males, especially for those who develop bulimia nervosa. Future research on the link between sexual orientation and eating disorders would help guide prevention and treatment strategies. (Am J Psychiatry 1997; 154:1127‐1132)

Correspondence Between Adolescent Report and Parent Report of Psychiatric Diagnostic Data

Abstract: Objective To examine the degree of agreement between parent and adolescent report of major psychiatric disorders in the adolescent (14 to 18 years of age) Method A total of 281 parent-adolescent pairs were interviewed separately regarding psychopathology in the adolescent Results The k values for parent-adolescent agreement on the disorders ranged from 19 for alcohol abuse/dependence to 79 for conduct disorder, with an average k of 42 Excellent agreement was found for conduct disorder and the core symptom of anorexia; good agreement was found for separation anxiety disorders, attention-deficit/hyperactivity disorder, oppositional defiant disorder, substance abuse/dependence, and the core symptom for bulimia; poor agreement was found for major depression, dysthymia, anxiety disorders other than separation anxiety, alcohol abuse/dependence, and the infrequent core symptoms of bipolar and obsessive-compulsive disorders Parent-adolescent agreement was not influenced by gender, current adolescent age, parental education level, disorder onset age, or severity of disorder Conclusions For detecting cases of adolescent psychopathology, there are clear advantages to the current consensus position that combines adolescent and parent report, especially for externalizing disorders However, if forced to choose one informant, assessing the adolescent will result in the detection of more diagnosed cases J Am Acad Child Adolesc Psychiatry, 1997, 36(5):610–619

The familial aggregation of common psychiatric and substance use disorders in the National Comorbidity Survey: A family history study

Abstract: BACKGROUND Most family studies of psychiatric disorders examine one syndrome at a time, and identify probands in clinical rather than epidemiological settings. METHOD In the National Comorbidity Survey, 5877 respondents were asked about the history of five psychiatric disorders in their parents: major depression (MD), generalised anxiety disorder (GAD), antisocial personality disorder (ASP), alcohol abuse/dependence (AAD) and drug abuse/dependence (DAD). RESULTS Significant familial aggregation was seen for all disorders. Controlling for other disorders produced only modest reductions in the odds ratios for MD, GAD and AAD and larger reductions for ASP and DAD. The familial transmission of these disorders can be explained by underlying vulnerabilities to internalising and to externalising disorders transmitted across generations with moderate fidelity. CONCLUSIONS Familial aggregation of common psychiatric and substance use disorders is substantial in epidemiologic samples. The examined environmental adversities account for little of the observed parent-offspring transmission of these conditions.

Physical and Sexual Assault History in Women With Serious Mental Illness: Prevalence, Correlates, Treatment, and Future Research Directions

Abstract: An emerging body of research on the physical and sexual abuse of seriously mentally ill (SMI) women documents a high incidence and prevalence of victimization within this population. While causal links are not well understood, there is convergent evidence that victimization of SMI women is associated with increased symptom levels, HIV-related risk behaviors, and such comorbid conditions as homelessness and substance abuse. These abuse correlates may influence chronicity, service utilization patterns, and treatment alliance. This article reviews the research literature on the prevalence, symptomatic and behavioral correlates, and treatment of abuse among SMI women, particularly women with schizophrenia. Within each topic, we discuss relevant research findings, limitations of available studies, and key questions that remain unanswered. We also discuss mechanisms that may underlie the relationship between trauma and schizophrenia-spectrum disorders. We conclude by outlining directions for future research in this area.

Early Victimization, Drug Use, and Criminality: A Comparison of Male and Female Prisoners

Abstract: Comparative analysis of the relative victimization of 1,030 adult male prisoners and 500 adult female prisoners in Texas reveals significant gender differences in childhood and adult maltreatment and subsequent substance use and criminality. Female inmates report significantly more maltreatment as children than do male inmates. Moreover, the maltreatment of women increases when they become adults, whereas the maltreatment of men drops sharply. The study found childhood maltreatment to be more strongly associated with adult depression and substance dependence among women than among men. The severity of substance misuse and problems associated with it are stronger predictors of female rates of criminal activity than male rates. Recent literature from the social sciences is presented to account for the findings. A female empowerment treatment model to help women attain control over their lives is suggested. Language: en

Diseases among men 20 years after exposure to severe stress: implications for clinical research and medical care.

Abstract: OBJECTIVE Epidemiologic studies have linked exposure to severe environmental stress, such as natural disasters and combat operations, to the onset of specific psychiatric disorders. Some research also suggests that these exposures may be associated with the onset of chronic diseases as well. However, these chronic disease outcome studies often have been obscured by bias and confounding. METHOD The medical histories of 1399 male Vietnam veterans approximately 20 years after combat exposure (mean years = 17) were analyzed by lifetime posttraumatic stress disorder (PTSD) status (lifetime PTSD = 332 cases). These men were included in a national, random in-person study of United States Army veterans of the Vietnam War (study completion rate = 65%). RESULTS After controlling for preservice, in-service, and postservice factors (including intelligence, race, region of birth, enlistment status, volunteer status, Army marital status, Army medical profile, hypochondriasis, age, smoking history, substance abuse, education, and income), associations were found for reported circulatory [odds ratio (OR) = 1.62, p = .007], digestive (OR = 1.47, p = .036), musculoskeletal (OR = 1.78, p = .008), endocrine-nutritional-metabolic (OR = 1.58, p = .10), nervous system (OR = 2.47, p < .001), respiratory (OR = 1.54, p = .042), and nonsexually transmitted infectious diseases (OR = 2.14, p < .004) after military service. CONCLUSION Although this study has some limitations, it suggests that there is a direct link between severe stress exposures and a broad spectrum of human diseases. In the future, medical researchers and clinicians should focus more on the medical consequences of exposure to severe environmental stress and seek to better integrate psychobiologic models of disease pathogenesis.

The science of prevention: methodological advances from alcohol and substance abuse research.

Abstract: The goal of The Science of Prevention: Methodological Advances From Alcohol and Substance Abuse Research is to promote critical thinking among new and established investigators about how to design research and analyze research findings. Although the substantive focus of many chapters is on applications to the prevention of alcohol and substance abuse, nearly all of the methodological principles and statistical models are general and have potential application to the full range of areas in which prevention research takes place. The contributors to this book share their knowledge from an informed, applied perspective. Most are active researchers in the field of substance abuse prevention who are also methodological experts. They have a firsthand knowledge not only of the methodological, statistical, and measurement issues but also of the substantive issues of their field. [publisher description]

Characteristics of 36 subjects reporting compulsive sexual behavior.

Abstract: Objective: The authors describe the sociodemographic features, phenomenology, and psychiatric comorbidity of 36 subjects reporting compulsive sexual behavior. Method: Twentyeight men and eight women who responded to advertisements for “persons . . . who have a problem with compulsive sexual behavior” completed structured and semistructured assessments, including the Diagnostic Interview Schedule for DSM-III-R disorders (axis I) and the Structured Interview for DSM-III-R Personality Disorders, Revised (axis II). Results: The typical subject was a 27-year-old man who reported experiencing compulsive sexual behavior for nearly 9 years. Sexual behavior was described as excessive and poorly controlled and was associated with either subjective distress or impairment in interpersonal or occupational functioning or as overly time-consuming. Fourteen subjects (39%) reported a history of major depression or dysthymia, 15 (42%) a history of phobic disorder, and 23 (64%) a history of substance use disorder. Personality disorders were quite frequent, particularly the paranoid, histrionic, obsessive-compulsive, and passive-aggressive subtypes. The compulsive sexual behavior was quite varied and included both paraphilic (e.g., cross-dressing) and nonparaphilic (e.g., compulsive masturbation) types. Conclusions: Compulsive sexual behavior may be a clinically useful concept, but it describes a heterogeneous group of individuals with substantial psychiatric comorbidity and diverse behavioral problems. (Am J Psychiatry 1997; 154:243‐249)

Preventing Drug Use among Children and Adolescents: A Research-Based Guide.

Abstract: This In Brief edition provides highlights from the Preventing Drug Use among Children and Adolescents: A Research-Based Guide for Parents Educators and Community Leaders Second Edition. It presents the updated prevention principles an overview of program planning and critical first steps for those learning about prevention. Thus this shortened edition can serve as an introduction to research-based prevention for those new to the field of drug abuse prevention. Selected resources and references are also provided. This publication and the complete second edition can be ordered or printed from NIDAs Web site www.drugabuse.gov. NIDA hopes that research can continue to provide effective appropriate and practical approaches for communities working on the challenges of preventing drug abuse among children and adolescents nationwide. (excerpt)