Journal of Human Behavior in the Social Environment

ISSN: 1091-1359 (Print) 1540-3556 (Online) Journal homepage: http://www.tandfonline.com/loi/whum20

Predictors and Protective Factors in the Prevention

and Treatment of Adolescent Substance Use
Disorders

Ozietta D. Taylor

To cite this article: Ozietta D. Taylor (2010) Predictors and Protective Factors in the Prevention
and Treatment of Adolescent Substance Use Disorders, Journal of Human Behavior in the
Social Environment, 20:5, 601-617, DOI: 10.1080/10911351003673369

To link to this article: http://dx.doi.org/10.1080/10911351003673369

Published online: 09 Aug 2010.

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 Journal of Human Behavior in the Social Environment, 20:601–617, 2010
Copyright © Taylor & Francis Group, LLC
ISSN: 1091-1359 print/1540-3556 online
DOI: 10.1080/10911351003673369

Predictors and Protective Factors in the

Prevention and Treatment of Adolescent
Substance Use Disorders

OZIETTA D. TAYLOR
Department of Applied Psychology and Rehabilitation Counseling,
Coppin State University, Baltimore, Maryland
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Contemporary adolescents are at a higher risk for developing a

substance use disorder. Risk factors serve as predictors for identi-
fying youths at the greatest risk for developing these disorders. Pro-
tective factors serve to protect adolescents from developing the sub-
stance use disorders. First-time drug use can be prevented through
the ‘‘model program’’ modalities implemented through prevention
research. However, when youths fall through the cracks and de-
velop a substance dependency on alcohol or other substances,
treatment strategies promise hope for adolescents who are expe-
riencing the onset of substance dependency.

KEYWORDS Adolescents, substance use disorders, prevention, treat-

ment

INTRODUCTION

Adolescent substance abuse and dependency continue to be devastating

and disheartening issues in the United States. Researchers have noted that
the gateway drugs—alcohol, marijuana, and tobacco—were the substances
most used by adolescents in the United States. Burrow-Sanchez, (2006), upon
his investigation into the Monitoring the Future Study (MTF, 2002) found that
alcohol is the primary substance of use by adolescents; with a high percent-
age of adolescents using the substance experimentally and a low percentage
of adolescents using the substance on a regular basis (Burrow-Sanchez).
Contrarily, a recent investigation into the MTF indicates that adolescents are
still misusing, abusing, and becoming dependent on alcohol and other drugs

Address correspondence to Ozietta D. Taylor, Department of Applied Psychology and

Rehabilitation Counseling, Coppin State University, 2500 W. North Avenue, Baltimore, MD
21216, USA. E-mail: otaylor@coppin.edu

601
 602 O. D. Taylor

at record rates; however, alcohol is not the primary drug of choice anymore.
Ecstasy is now the primary drug of choice (MFT, 2007).
The MTF study, consisting of a sample of more than 48,000 adolescents
in 403 secondary schools in the eighth, tenth, and twelfth grades indicated
that although marijuana, amphetamines, Ritalin, methamphetamine, crystal
methamphetamine, alcohol, and cigarettes use is decreasing gradually in
one grade cohort (eighth grade), ecstasy use is on the increase in adolescent
cohorts in the tenth and twelfth grades. Though the decrease in marijuana
and other substance use appears promising, because it was once viewed as
a gateway drug, practitioners cannot take the statistics lightly. For example,
in 2007, the annual prevalence of marijuana use fell by a significant 1.4
percentage points among eighth graders to 10.3% and by a non-significant
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0.6 percentage points among tenth graders to 24.6%, and annual marijuana
use among twelfth graders leveled at 31.7% (MTF, 2007).
Conversely, the other substances falling within a variety of drug classi-
fications showed little-to-no change in usage during 2007. These substances
included hallucinogens (i.e., LSD); cocaine and crack; heroin (and its deriva-
tives such as OxyContin and Vicodin); sedatives; tranquilizers; the ‘‘club
drugs’’ (i.e., Ketamine, Rohypnol, and GHB); and steroids. Conversely, though
the study did not focus on alcohol abuse, if included in the study the statistics
would soar. Furthermore, it has been reported in the MTF study that slightly
fewer than half of American secondary school students have tried alcohol
or other drugs (AOD) by the time they near high school graduation (MTF,
2007). Therefore, whether adolescents are experimenting with AOD or using
these substances on a regular basis, it is imperative that therapists gain an
understanding of the severity of adolescent substance abuse and dependence
to prevent or treat the onset of the substance use disorders. Thus, this article
seeks to educate readers of the predictors (i.e., risk factors), prosocial factors
(i.e., family bonding), and current paradigms in substance abuse prevention.
Further, the current treatment modalities (i.e., cognitive-behavioral therapy)
that are being utilized in treating substance-abusing or substance-dependent
adolescents will be identified.

RISK FACTORS IN ADOLESCENT SUBSTANCE ABUSE

AND SUBSTANCE DEPENDENCY:
HOW FAR HAVE WE COME?

The Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition

(DSM-IV-TR, 2000) differentiates the essential features of substance abuse
and substance abuse dependence. It describes substance abuse as, ‘‘a mal-
adaptive pattern of substance use that is manifested by recurrent and sig-
nificant consequences that are related to the repeated use of substances.’’
So that someone may be given the diagnostic label for substance abuse,
 Predictors and Protective Factors 603

various diagnostic criteria must be met. For example, an individual must

manifest a repeated failure to fulfill major role obligations, manifest repeated
substance use in situations that are physically hazardous, and be involved in
multiple legal problems. Further, there must be problems in the interpersonal
and social areas. These problems must occur recurrently during the same
12-month period. Unlike the criteria for substance dependence, the criteria
for substance abuse do not include tolerance, withdrawal, or a pattern of
compulsive use. Retrospectively, it includes only the harmful consequences
of repeated use. The diagnosis of substance abuse is more likely to occur
in individuals who recently started taking a substance. The category of
substance abuse does not apply to caffeine or nicotine.
A person diagnosed within this classification may repeatedly demon-
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strate intoxication or other substance-related symptoms when expected to

fulfill major role obligations at work, school, or home. There may be repeated
absences or work performance related to recurrent hangovers. Furthermore,
a student may have substance-related absences, suspensions, or expulsions
from school. Conversely, the diagnostic criteria for substance dependence are
more complex. The DSM-IV-TR describes substance dependence as ‘‘a clus-
ter of cognitive, behavioral and physiological symptoms indicating that the
individual continues use of substances despite significant substance-related
problems.’’ There is a pattern of repeated self-administration that usually
results in tolerance, withdrawal, and compulsive drug-taking behavior. A di-
agnosis of substance dependence can be applied to every class of substances
except caffeine. The symptoms of dependence are similar across the various
categories of substances; however, for certain classes, some symptoms are
less salient. In a few instances, not all symptoms apply (e.g., withdrawal
symptoms are not specified for hallucinogen dependence). Although not
specifically listed as a criterion item, ‘‘cravings’’ (a strong subjective drive to
use a substance) is likely to be experience by most (if not all) individuals
with substance dependence. Dependence is defined as a cluster of three or
more of the symptoms occurring at any time in the same 12-month period.
These symptoms include tolerance, withdrawal, and a pattern of compulsive
drug use.
Tolerance is the need for increasingly larger amounts of a substance to
achieve intoxication (or the desired effect) or a markedly diminished effect
with the continued use of the same amount of the substance. The degree
to which tolerance develops varies greatly across substances. For example,
individuals who maintain heavy opioid and stimulant use can develop a sub-
stantial level of tolerance—often to a dosage that would be lethal to nonusers.
Second, withdrawal is a maladaptive behavioral change, with physiolog-
ical and cognitive concomitants, that occurs when blood or tissue concentra-
tions of a substance decline in an individual who had maintained prolonged
heavy use of the substance. After developing unpleasant withdrawal symp-
toms, the person is likely to take the substance to relieve the symptoms
 604 O. D. Taylor

or avoid the symptoms. Withdrawal symptoms will vary with the type of
substance taken. Physiological signs of withdrawal are common with alcohol,
opioids, sedatives, hypnotics, and anxiolytics. Further, withdrawal symptoms
are less apparent with amphetamines, cocaine, and hallucinogens.
Finally, the DSM-IV-TR describes the following as the compulsive pattern
of substance taking behavior (that is, behavior characteristic of substance
dependence):

1. The individual may take the substance in larger amounts or over a longer
period of time than was intended.
2. The individual may express a persistent desire to cut down or regulate
substance use.
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3. The individual may spend a great deal of time obtaining the substance,
using the substance, or recovering from its effects.
4. The individual’s activities revolve around the use of the substance.
5. The individual may withdraw from family activities and hobbies to use the
substance in private or to spend more time with substance using friends.

In retrospect, an adolescent is likely to use AOD on an experimental basis

in the beginning. Therefore, he or she would be diagnosed as a substance
abuser. However, the diagnosis of substance dependence can be given to
an adolescent with a long history of substance-abusing behaviors, especially
those which meet the criteria for substance dependence as defined in the
DSM-IV-TR.
Several variables (i.e., peer pressure, low self-esteem, drug availability)
leading to the onset of the substance use disorders (e.g., substance abuse
and substance dependence) and their related problems serve as predictors
in identifying youths who are at risk for abusing or becoming dependent
on AOD. Risk factors can be defined as the variables that increase the
probability that someone will begin to use alcohol and other substances
(Hogan, Gabrielsen, Luna, & Grothaus, 2003; Burrow-Sanchez, 2006). A study
completed by Crowley & Riggs (1995) found that certain traits are associated
with early, heavy, and more problematic substance use.
In an attempt to trace the trajectory of research identifying the risk factors
associated with substance abuse, a retrospective review was completed by
the author. As early as the 1970s, researchers had begun to discover the risk
factors that serve to identify youths at risk for substance-abusing behaviors.
Jessor & Jessor (1977) developed problem behavior therapy as an important
conceptual model for understanding many aspects of the substance-using
behaviors of adolescents. In this theory, the Jessors maintain problem be-
havior is a contributing factor to problem drinking, illicit drug use, rebellious
attitudes, and delinquency behaviors (Newcomb & Bentler, 1988, p. 230).
Other risk factors identified included peer drug use, school suspensions, law
infringements, truancy, conflict with parents, smoking (Swadi, 1992; Crowley
 Predictors and Protective Factors 605

& Riggs, 1995), lower school motivation, school failures, emotional distress,
life dissatisfaction, depression, impulsiveness, restlessness, and little-to-no
church attendance (Adlaf & Smart, 1985; Crowley & Riggs, 1995).
Twenty-one years later, Lysaught and Wodarski (1996) found that the
early initiation of substance abuse include parental alcoholism, risk-taking
behaviors, peer group influence, deviant personality traits, low self-esteem,
and childhood or adolescent depression.
Almost 30 years after the study conducted by the Jessors, the National In-
stitute on Drug Abuse (NIDA, 2002) avowed that substance use is precipitated
by a chaotic home environment, parents who use or abuse substances, par-
ents with mental illnesses, ineffective parenting skills, children with difficult
temperaments, oppositional deviance or conduct disorders, lack of mutual
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attachments and nurturing, inappropriately shy or aggressive behavior in the

classroom, poor school performance, poor social coping skills, affiliations
with deviant peers, and approval of drug-using behaviors in the family,
work, school, peer, and community environments (NIDA, 2002). Moreover,
victimized girls experiencing sexual abuse during adolescence is a major
indicator for AOD use in women (Brady & Ashley, 2005).
Burrow-Sanchez (2006) concludes the more risk factors that affect an
adolescent’s life, the higher the threat is that the adolescent will develop a
substance use disorder. Thus, in administering an assessment to an adoles-
cent, therapists should pay particular attention to these indicators that serve
as predictors to the onset of substance use disorders.

Protective Factors in the Prevention of Adolescent

Substance Abuse
Protective factors, also called prosocial factors, are those variables that serve
to protect the adolescent from present and future substance use. The protec-
tive factors have been classified into three categories: individual characteris-
tics, positive family and community bonding, and healthy beliefs and clear
standards (Hogan et al., 2003). Individual characteristics include resiliency
factors (e.g., a strong personal constitution against substance use), positive
social skills, and the appropriate use of cognitive processes. Positive family
and community bonding have been shown to decrease the incidence of
substance use among adolescents who are attached to positive families,
friends, schools, and communities. These youths, although they may live
in low socioeconomic communities, thrive because they bond with positive
caregivers or role models. Research further indicates when clear rules and
standards are set to deter substance use, youths are more likely to follow
these standards (Hogan et al.).
In addition, the NIDA (2002) concurs that protective factors can prevent
the onset of substance abuse. These factors include strong and positive bonds
within a prosocial family; parental monitoring; clear rules of conduct that are
 606 O. D. Taylor

consistently enforced within the family; involvement of parents in the lives

of their children; success in school performance; strong bonds with other
prosocial peers and institutions, such as school and religious organizations;
and the adoption of conventional norms about drug use (NIDA, 2002).
Conversely, when the risk factors are greater than the protective factors,
adolescents are more likely to abuse substances and possibly develop a
substance dependency disorder.

Behavioral Profile of a Substance-Abusing Adolescent

Adolescents in need of substance abuse or substance dependency treatment
display a host of behavior problems, which include school truancy, delin-
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quency, associating with negative peer groups, problems at home and in the
school setting, violent or aggressive behavior, oppositional deviance disorder
and conduct disorder, and engaging in risky sexual behavior (NIDA, 2003).
According to the NIDA (2003), families play a major role in their chil-
dren’s behavioral problems and their drug use patterns. Bronfenbrenner
(1977, 1979, 1986, 1988) recognized that a child develops within the context
of a variety of social systems. These social systems include the family, peers,
institutions, communities, and government. Although other systems influence
the lives of these youths, the family is the most important system in which
an adolescent learns and develops (Perrino, Gonzales-Soldevilla, Pantin, &
Szapoocznik, 2000; Szapocznik & Coatsworth, 1999).
Families of substance-abusing adolescents exhibit high degrees of neg-
ativity (Robbin, Szapocznik, Alexander, & Miller, 1998). Negativity is usu-
ally heightened when family members fight and blame one another for
an adolescent’s behavior. Communication between family members and the
adolescent is often emotionally charged and bitter, leading to a host of other
behavior issues. Some behaviors are linked to the poor quality of parent-
adolescent communication; the lack of clear rules and consequences or the
inconsistent application of rules and consequences for an adolescent’s be-
havior; inadequate monitoring and management of the adolescent activities
with peers; lack of adult supervision of the adolescent’s activities with peers;
poor adolescent bonding to family; and poor family cohesiveness (NIDA,
2003). Moreover, parents engaging in substance-using practices can have a
negative influence on adolescents living within the family system. Thus, the
substance-abusing behaviors manifested by some youths are learned through
the family system or their peer groups.

Parental Substance Use in the Development of the

Substance Use Disorders
The Substance Abuse and Mental Health Services Administration, NSDUH
Report (2009) revealed between 2002–2007, 8.3 million children under 18
 Predictors and Protective Factors 607

years of age (11.9%) lived with at least one parent who was dependent on
or abused alcohol or an illicit drug during the past year. Of the 8.3 million
children living with a substance abusing parent, 10.3% lived with a parent
who was dependent on or abused alcohol, and about 3% lived with a parent
who was dependent on or abused illicit drugs. Furthermore, approximately,
5.4 million children under 18 years of age lived with a father who met the
criteria for past year substance dependence or abuse, and 3.4 million lived
with a mother who met the criteria (USDUH). Extensive research has been
completed on the genetic factors in alcoholism (Duncan et al., 2006; NIAAA,
1992; Heath, 1994; Schuckit, 1995; Miles, 1995; Cotton, 1979). Though the
research focuses mainly on the genetic predisposition of alcoholism, it is
assumed that the results are applicable to the other drugs of abuse (McNeece
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& DiNitto, 2005).

Studies focused on the familial relationship between alcoholism and
heredity. Twin studies have resulted in the theoretical position that genetics
play a significant role in alcoholism (Haskin, Hatzenbuehler, & Waxman,
2006). These studies show a comparison of the degree of similarity for alco-
holism in identical twins, who are 100% identical in their genetic blueprints.
Monozygotic, or one-egg twins, are compared with dizygotic twins (two-
egg twins) to understand how genetics influence alcoholism. A classic study
completed by Kaij (1960), which studied 174 male twin pairs, reported a
54% concordance (similarity) for alcoholism in monozygotic twins versus a
28% concordance for alcoholism in dizygotic twins (Estes and Heinemann,
1986). Subsequent research completed by other researchers indicates that
alcoholism tends to run in families (Obrien, 2001; Cloninger, 1999; Thomas &
Schandler, 1996; Caudill et al., 1994; Schuckit, 1994; Windle, 1994; Goodwin
& Warnock, 1991).
In addition, empirical studies provide strong support for the association
between parental substance abuse and adolescent substance abusing behav-
iors. Dishon et al. (1988) demonstrated that parental drug use is related to
early adolescent drug experimentation. Further, Barnes et al. (1986) found
that parents who are heavy drinkers are more likely to have adolescents who
are heavy drinkers. Greene (1991) reported a positive association between
parental drinking and adolescent drinking for female progeny as opposed
to male offspring. Furthermore, parental drug use may provide more access
to substances and opportunities for AOD use in the home setting.

CURRENT PARADIGMS IN SUBSTANCE

ABUSE PREVENTION

The clinical implementation of prevention research seeks to deter first-time

substance use among adolescents. Across the United States, programs are
being developed, implemented, and evaluated for effectiveness in preventing
 608 O. D. Taylor

adolescent substance use. Based on effectiveness, from the least effective

to the most effective, three program classifications have emerged: promis-
ing approaches, best practices, and model programs. Promising approaches
consist of programs that are in their infancy, that have not been vigorously
evaluated but still have merit for their existence. Best-practices programs are
effective and are known to delay substance use. The model programs are the
most valuable because of their demonstrated ability to produce unsurpassed
outcomes. Youths who are engaged in model programs are more likely not
to be involved in substance use (Hogan et al., 2003).

Treatment for Substance-Abusing or

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Substance-Dependent Adolescents
Substance addiction and alcoholism form a progressive, chronic, complex but
treatable disease. It is characterized by compulsive drug craving, seeking, and
use persisting even in the face of severe adverse consequences. For many
people, substance addiction is chronic, with relapses possible even after
long periods of abstinence. In fact, relapse to substance abuse occurs at rates
similar to other chronic medical illnesses such as diabetes, hypertension, and
asthma (Fisher & Harrison, 2005). As with other chronic, recurring illnesses,
addiction is characterized by relapse and may require repeated treatments.
Through treatment, people with substance addiction can lead productive
lives.
The ultimate goal of substance-addiction treatment is to enable an indi-
vidual to achieve lasting abstinence, but the immediate goals are to reduce
substance abuse, improve a patient’s ability to function, and minimize the
medical and social complications of substance abuse and addiction. Like
people with diabetes or heart disease, people in treatment for substance
addiction will have to change their behavior to adopt a healthy lifestyle
(NIDA, 2002).
Several treatment approaches are utilized by treatment professionals in
helping adolescents with substance use disorders. These treatment modalities
include but are not limited to (1) Twelve Step Programs, (2) family therapy,
(3) cognitive-behavioral therapy, (4) psychopharmacology, and (5) relapse
prevention.

TWELVE STEP PROGRAMS

The various modalities in substance abuse treatment are discussed to gain

an understanding of the current theoretical framework in treating adolescent
substance abusers. The most widely used approach to the treatment of
adolescent substance abuse and dependency is based on the principles
of Alcoholics Anonymous (AA) and Narcotics Anonymous (NA; Wheeler
& Malmquist, 1987). Some programs that are based on the principles of
 Predictors and Protective Factors 609

AA and NA have been alternatively called the Minnesota Model or self-

help programs (Substance Abuse and Mental Health Services Administration
[SAMSHA], 1999; Cook, 1988).
The premise guiding the AA and NA tradition is that abusers can change
the behaviors associated with addiction if they first recognizes that the dis-
ease exists. Once they have arrested the disease, abusers must learn to adapt
to it by working on the behaviors associated with the disease. Spiritual guid-
ance is sought, and personal growth is paramount to the recovery process.
Substance abusers are asked to take responsibility for their behaviors by
changing what needs to be changed to live a healthier lifestyle. Substance-
abusing or -dependent individuals are supported in fellowship and are taught
to look toward the self for the fortitude to change. Small-scale evaluation of
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12 Step Programs show that abstinence rates for adolescents are at about
50% to 60% (SAMSHA, 1999).

FAMILY THERAPY

The multigenerational transmission of substance abuse disorders occurs with-

in families. A biopsychosocial assessment of substance-abusing or -depen-
dent individuals and their families is important to determine factors in-
fluencing their addiction. The opportunity to observe the entire family is
valuable in the diagnostic process (Doweiko, 2006; Kaufman & Kaufman,
1992; Technical Assistance Publication Series 11, 1994). There are three
parts of the family system: the person’s family of origin, the nuclear, and
the extended family. The dysfunctional patterns manifested by families may
include denial, scapegoating, negative communication, and lack of consistent
limit setting by parents.
Treatment priorities include persuading the family to instigate the detoxi-
fication process for a substance dependent person. It is also important to help
the family to initiate and support the person’s involvement in appropriate
treatment modalities (e.g., Twelve Steps, therapeutic community, methadone
maintenance). Family members may need to be coached by a therapist to
confront the dependent person with care and concern. The family may
need to be educated about the deadly consequences of substance abuse
or substance dependency.
Behavior techniques may be used to teach family members how to
avoid triggering a relapse. Communication therapy may be needed to teach
family members how to state messages clearly to avoid discrepancies in com-
munication among family members (Kaufman, 1992; Technical Assistance
Publication Series 11, 1994). Both educational and counseling interventions
are useful in improving coping and parenting skills (Technical Assistance
Publication Series 11, 1994).
One approach to family therapy is brief strategic family therapy (BSFT).
BSFT is a brief intervention model used to treat adolescent substance use
 610 O. D. Taylor

that occurs simultaneously with other problem behaviors. These behaviors

include conduct problems at home and at school, oppositional behavior,
delinquency, associating with antisocial peers, aggressive and violent be-
havior, and risky sexual behavior ( Jessor and Jessor, 1977; Newcomb and
Bentler, 1989; Perrino et al., 2000). The therapy is based on three basic
principles. The first is that BSFT is a family-systems approach taking under
consideration that what affects one family member affects other members
(NIDA, 2003). Second, this therapeutic approach operates under the premise
that family interaction influences the behavior of each member of the fam-
ily (NIDA, 2003). Third, another guiding principle is that interventions are
prescribed to change patterns of family interactions. A therapist’s role is to
change maladaptive interactions that are related to adolescent substance use
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or to solidify positive interactions occurring amongst the family members

(NIDA, 2003).
Outcome studies on the effectiveness of family therapy were found to
be more effective than other treatment approaches in retaining adolescents
in treatment and reducing their drug abuse (Liddle & Dakof, 1995; McNeece
& DiNitto, 2005).

COGNITIVE-BEHAVIORAL THERAPY

Cognitive-behavioral therapy is another approach used by therapists in the

treatment of adolescents with substance abuse problems. This approach tar-
gets the substance abuse behaviors while working to eliminate a multitude of
associated behavioral and emotional problems. It focuses on identifying and
changing negative thinking patterns while working to change the patient’s
behavior (NIDA, 1998). Cognitive-behavioral therapy approaches consist of
social skills training, problem-solving skills, anger management, cognitive
therapy, relapse prevention, and aversion therapy. These methods, used in
conjunction with 12 Step Programs, offer a more integrated approach to
treatment (Bukstein, 1995).

PSYCHOPHARMACOLOGY
Psychopharmacology is the use of medication to treat substance use dis-
orders, in particular the substance dependence disorder. Pharmacological
agents are used in the detoxification, treatment, and withdrawal symptoms
of substance dependency. Disulfiram (Antabuse) is prescribed to deter al-
coholics from alcohol use. It causes an aversive, toxic reaction if alcohol is
ingested. The physical reaction of ingesting alcohol when Antabuse is taken
is very unpleasant. Hallucinations many occur in patients who ingest high
doses of Antabuse (i.e., more than 500 mg/day) (SAMHSA, 2005). Some of the
adverse effects resulting from Antabuse ingestion are drowsiness, depression,
disorientation, headache, restlessness, excitation, optic neuritis, periphereal
 Predictors and Protective Factors 611

neuropathy, skin eruptions, impotence, and psychosis (Bezchlibnyk-Butler

et al., 1999).
Methadone is a synthetic opioid used in the treatment of heroin addic-
tion. A disproportionate number of people who had been addicted to heroin
have been rehabilitated and regained a more quality lifestyle. Methadone
is also medically used in the management of specific types of pain. It has
been used in the United States for the treatment of opioid addiction since the
1960s. When taken in the appropriate doses, methadone stops the craving for
heroin, but the patient using these substances does not experience euphoria,
sedation, or an analgesic effect (SAMHSA, 2005).
Naltrexone is prescribed to block the effects of opioids. This medica-
tion is also used to reduce the craving for alcohol. It has been shown to
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decrease alcohol craving and relapse potential. Further, this medication has
the ability to interfere with the management of pain when opioids are taken
(SAMHSA, 2005). Case studies report efficacy in mitigating hallucinogen-
related flashbacks. Side effects resulting from naltrexone use are abdom-
inal cramps, nausea, vomiting, weight loss, headache, insomnia, anxiety,
dysphoria, depression, confusion, nervousness, and joint and muscle pain
(Bezchlibnyk-Butler et al., 1999).
Buprenorphine, approved in 2002, is a prescription medication used to
treat opioid addiction. It has the dual purpose of treating opioid withdrawal
symptoms and long-term maintenance. Physicians can prescribe buprenor-
phine from their medical offices. The action of this medication is comparable
to methadone at low doses; however, it causes narcotic withdrawal at higher
doses (SAMHSA, 2005).
Bromocriptine and amantadine, medications used in the treatment of co-
caine, have been utilized to decrease cravings and dysphoria during cocaine
withdrawal (Giannini, Baumgartel, & DiMarzio, 1987; Tennant & Sagerian,
1987).

RELAPSE PREVENTION THERAPY

Terence Gorski developed the Cenaps model of relapse prevention. Treat-

ment professionals implementing this model operate under the assumption
that substance dependency is a disease. The principles of Alcoholics Anony-
mous and the Minnesota Model of Addiction are utilized to treat people with
a substance use disorder (Fisher & Harrison, 2005). Clients are taught relapse
prevention skills to be well equipped if confronted with a high-risk situation.
The first step in relapse prevention must be to determine the specific
situations for each client that may lead to a slip or a lapse. The type of situ-
ations that are risky vary from client to client, although Cummings, Gordon,
and Marlatt (1980) found that 75% of the relapses by alcoholics, smokers,
and heroin users were due to negative emotions, interpersonal conflict, and
social pressure.
 612 O. D. Taylor

The therapist’s role is to help clients identify high-risk situations. Once

the high-risk situations have been identified, it is necessary for the clients
to have strategies to deal with these situations effectively. Education about
relapse prevention strategies is very helpful in assisting clients to avoid po-
tential lapses. Relapsers need accurate information about the triggers that can
lead to relapse and what strategies to employ to prevent this from occurring.
Relapse prevention strategies should teach recovering clients to learn to
cope with daily life without the use of alcohol and/or other drugs. Further
teachings should include problem-solving and decision-making strategies.
Moreover, clients should be taught to identify environmental cues that can
lead to relapse (Fisher & Harrison, 2005).
Retrospectively, in relapse therapy, patients learn to enhance self-control
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skills by recognizing and correcting problem behavior. Specific techniques

include weighing the positive and negative consequences of continued drug
use, identifying triggers and learning to cope with craving, self-monitoring to
identify high-risk situations for use, and developing methods used for coping
with or avoiding those situations (Partnership for a Drug Free America, 2006).
Finally, a comprehensive treatment approach is needed in treating ado-
lescents with a substance use disorder. The eclectic approach consists of
a combination of the treatment modalities to ensure that adolescents re-
ceive the most superior treatment available. Thus, an excellent treatment
approach in service provision would consider traditional paradigms (AA/NA)
to confront denial and motivate adolescents for treatment while teaching
the 12 steps and traditions. Further, family therapy offers the opportunity to
improve communication between family members while providing structure,
limits, and supervision for substance-abusing adolescents. Cognitive therapy
helps change negative distortions and negative self-talk. In addition, medica-
tion, if needed, targets the affective states (i.e., mood, anxiety, etc.; Bukstein,
1995).

SUMMARY

In summary, research indicates such variables as parental drug use, peer

pressure, low self-esteem, curiosity, and drug availability can lead to the
onset of the substance use disorders and its related effects. Risk factors serve
as predictors in identifying youths who are at risk for abusing or becoming
dependent on AOD. Clinicians who are savvy in identifying the risk factors
to the substance use disorders are in the position to educate their patients
in the prevention of first-time drug use.
Protective factors, such as individual characteristics, positive family and
community bonding, and healthy beliefs and clear standards serve to protect
adolescents from initiating substance use. Resiliency factors (e.g., a strong
personal constitution against substance use), positive social skills, and the
 Predictors and Protective Factors 613

appropriate use of cognitive processes aid in protecting youths from the

negative influences found in their immediate environments. Positive family
and community bonding have been shown to decrease the incidence of
substance use among adolescents who are attached to positive families,
friends, schools, and communities. Healthy beliefs, clear standards, and clear
rules, when consistently reinforced, also protect the adolescent from first time
drug use (Hogan et al., 2003).

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