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This chapter presents the first-year results of a two-year study exploring whether a multiattribute utility (MAU) model that includes a new momentary salience parameter can predict smoking and alcohol use among an ethnically diverse Southern California sample of 2,789 seventh graders. The model allowed detailed investigation of the role that perceptions regarding ten anticipated consequences of substance use (e.g., being more popular, feeling more relaxed, contracting a devastating illness in the future) played in the decision to initiate substance use. An important finding of this study was that MAU for tobacco users was on average higher than those for non-users. This result is especially striking because the participants did not articulate their MAUs. Rather, the predictor was obtained by calculations that employed parameters reported by the participants. This success illustrates the power of the “divide and conquer” strategy extolled by Edwards.

This chapter continues the topic of ODD and CD, emphasizing its presentation and treatment in adolescence. It also focuses on substance use disorders given the shared risk factors for both ODD/CD and substance use disorders, and the fact that the disorders are often co-morbid. The chapter reviews the evidence basis for the treatment of these disorders in adolescence. Cognitive-behavioral individual approaches and multi-dimensional family theoretical approaches predominate in this literature. These interventions are evaluated against how well they address risk factors for the development of these disruptive behavior disorders and adjustment for afflicted youth. Recommendations for practice and research are explored.

Chapter 8 provides a description of the major theories of the etiology of substance abuse which guide treatment programs. Risk and protective factors for substance abuse disorders are outlined and the relationship between substance abuse and childhood maltreatment is discussed. Two of the cases described in earlier chapters provide illustration. Research on substance abuse disorders and co-occurring disorders is summarized, and the nature and effects of substances of abuse are discussed. The chapter includes sections on assessment, treatment research, and treatment model, including 12-Step models, Motivational Interviewing, cognitive behavioural therapy, and integrated treatment models. Aftercare and the therapeutic relationship are discussed and key treatment principles provided.

Many people who have a co-occurring substance use disorder (dual diagnosis) are found ineligible for employment services because of substance use. This chapter includes an illustration of a person with a co-occurring substance use disorder who becomes interested in working. The illustration highlights benefits of working for people with dual disorders, such as structuring time and providing a motivation to reduce substance use. Motivational counseling strategies are used to help clients clarify goals. The employment specialist, treatment team, and client work together to identify a good job match that supports sobriety. The employment specialists and the team help clients develop a money management plan because money is often a cue for people with dual diagnosis to buy alcohol and drugs. The team provides ongoing support even when the client relapses.

Many adolescents with substance-use disorder (SUD) have a history of trauma and symptoms of post-traumatic stress disorder (PTSD). Integrated cognitive behavior therapy (CBT) for co-occurring PTSD and SUD in adolescents is a phased intervention approach in which the same clinician or team of clinicians provides treatment for both disorders at the same time. This chapter discusses psychosocial conceptual models of the etiology of PTSD and the role of substance abuse, theory of change, target population, and CBT intervention parameters for integrated PTSD and SUD treatment programs.

This chapter reviews the deleterious effects of addictive drugs on brain development and what is known about ways to reverse these effects. It shows that adolescence is a vulnerable period for initiating substance abuse. Progression from use to abuse to addiction is influenced by multiple, simultaneous variables categorized in the medical model as agent, host, and environment. However, the majority of adolescents who experiment with drugs do not progress to addiction, although they could experience harm or fatalities from acute effects and accidents. Those beginning at a younger age have the highest risk of developing an addiction and the poorest results when they later seek treatment as adults.

This chapter discusses common but challenging situations that have been encountered in providing group treatment for domestic violence offenders. It focuses on the special characteristics of the domestic violence group and how to deal with difficult situations that might arise. It addresses the issue of the non-voluntary client and how to use non-confrontational questions to help clients focus on what they want. The issue of aggressive clients is discussed and the difficult challenge of substance abusers and group members who have DSM:IV diagnoses. The chapter also addresses issues working with clients from diverse ethno-racial backgrounds, and discusses how language and literacy barriers could be overcome. Finally, it offers tangible solutions to working with difficult clients.

This chapter describes how to apply the strengths- and skills-building model to substance use disorders after building a rationale for the use of the model with this problem area. Specifically, motivational enhancement strategies help increase client commitment to changing substance abusing behaviors, solution-focused interviewing focuses on strengths-finding, and cognitive-behavioral therapy targets skills-building. Clients are seen as agents of change, and practitioners use language that implies and encourages change. A rationale is also provided for the use of art therapy in this particular chapter as it is consistent with a strengths orientation. Art therapy uses a non-confrontational, collaborative approach and validates the client's construction of the problem. The strengths- and skills-building model is applied, along with art therapy techniques, to a case example in a short-term inpatient substance abuse treatment facility.

This chapter covers a type of treatment for substance use that targets partners of the problem drinker. Variations of this type of treatment are categorized together as “reinforcement training,” which revolve around operant behavioral theory and the central importance of reinforcement for increasing desirable behavior (sobriety in the case of substance use). Also central is the concept of antecedent conditions that cue certain behaviors to occur. Applied to substance abuse, partners are trained to pay more positive attention to their partners when they are not drinking and to create opportunities for sobriety. Skills training in communication and conflict resolution are also offered as part of a behavioral approach. Before presenting the application of the model, its empirical evidence will be briefly described, followed by a discussion of when it is appropriate to use reinforcement training as an option for treatment.

This chapter provides a thorough review of the evidence regarding disparities that differentially affect the health of African American, Latino, and Asian/Pacific Islander gay, bisexual, and other men who have sex with men. These disparities are based in multiple forms of social discrimination including homophobia, racism, and gender nonconformity. Particular attention is given to the unique experiences of African American, Latino, and Asian/Pacific Islander gay men that affect their mental health, substance use and abuse, and HIV risk. The chapter concludes by identifying gaps in prior research and suggesting future research and prevention efforts.

Evidence shows that well-being increases during the period between late adolescence and early adulthood, but questions remain about how widespread this increase may be and why it occurs and, more generally, how the course of well-being relates to the various diverse pathways out of high school. Substance use also tends to increase during this period, reaching its lifetime peak during the early twenties, depending on the given cohort and substance. Well-being and substance use, while not necessarily sharing a common etiology or developmental course across the life span, may increase among young adults during transition in part because of the new roles and contexts that provide more freedom and selection of opportunities. Using data from four waves of nationally representative U.S. panel data spanning ages eighteen to twenty-four, this chapter investigates early adult transitions and their relation to well-being and substance use. It analyzes the timing, sequencing, and covariation of social role transitions related to school and work, romantic involvement (specifically marriage), parenthood, and independence in the form of leaving the parental home.

This chapter presents a model of parental socialization that summarizes the interrelations among parental modeling of substance use, parent approval, parental monitoring and control, parent–child relationship quality, child cognitions, friends’ substance use, and child/adolescent substance use. Parental alcohol consumption, smoking, and drug use are significant predictors of child and adolescent drinking, smoking, and marijuana use. Parental substance use is associated with lower quality parenting and family management practices and lower quality relationships with offspring, both of which are associated with greater offspring substance use. Parental substance use, parental approval, parenting practices, and relationship quality are associated with adolescents’ affiliation with substance-using friends. Parental non-use, effective parenting practices, and good-quality parent–child relationships buffer the relation between friends’ modeling of substance use and adolescent offspring substance use. The model should facilitate the development of targeted tests of its utility for generating new research on the socialization of adolescent substance use.

This chapter considers whether substance-use-prevention programs targeted at adolescents can influence the probability of experiencing poverty as an adult. Because we are not aware of any studies that have directly addressed this question, we draw conclusions from two different literatures: (1) the literature on the effectiveness of programs intended to prevent substance use among adolescents and (2) the literature on the effect of substance use on educational attainment and labor market outcomes. A discussion on the etiology of substance use that helps the reader understand why the timing of substance use initiation and escalation complicates studies attempting to assess the causal effect of this use on later life outcomes is presented. The chapter discusses the effectiveness of substance-use prevention and the effect of substance use on education, employment, and earnings. Although there is a fair amount of evidence suggesting that prevention programs for adolescents have short-term effects on consumption, there is very little evidence to suggest that these effects remain through high school.

This chapter describes characteristics of a developmental perspective on substance use regarding age curves; heterogeneity in course; embeddedness within all else that is changing developmentally and historically; and a life course emphasis on distal upstream predictors and downstream consequences as well as more proximal developmental mechanisms and consequences, including transitions, turning points, and developmental disturbances. The chapter then describes the developmental and historical context of adolescence and the transition to adulthood, followed by a consideration of key conceptual issues related to developmental continuity, discontinuity, and transitions. Next, it examines implications for understanding risk and protective factors for, and consequences of, substance use during adolescence and the transition to adulthood. it concludes with a discussion of opportunities and challenges for future research.

Risky substance use and risky gambling describe behaviour that has the potential for, but does not actually result in, harm to the individual engaging in the behaviour, their friends, and family, or wider society. Drawing together evidence from 12 disciplines working in the field of substance use and gambling, this chapter presents determinants of the transition from no use or low-risk use to risky substance use or risky gambling, operating across three levels of analysis: the social, economic, and political environment; the individual; and the cellular and molecular. Determinants within each level of analysis are clustered into domains, such as social and economic marginalization, gender and sexuality, personality traits, and neuroadaptations. There is much interaction between factors operating across the three levels of analysis. A key finding is that the social, economic, and political environment is particularly important for understanding transitions to risky behaviour.

Harmful substance use and harmful gambling describe behaviour that is related to material harms of social, mental, or physical nature for either the user or those around them—harm that would not have occurred in the absence of the substance use or gambling. This chapter presents a broad range of determinants of harmful substance use and harmful gambling, clustered into domains such as marginalization, marketing, economic cycles, intra-individual factors, and biological vulnerabilities. There is much interaction between determinants operating within different domains. In comparison to the determinants of transitions to risky substance use and gambling, where the balance of evidence was stronger for factors at the level of the social, economic, and political environment, the balance of evidence for determinants of transitions to harmful substance use and gambling is predominantly at the individual and cellular and molecular levels of analysis.

Understanding the factors that influence the transition from harmful to low-risk substance use and gambling or abstinence is important for reducing the societal burden of harm attributable to these behaviours. Following the same methodology used in Chapters 3 and 4, this chapter presents determinants within domains including social identity and social networks, economic and cultural changes, emotional and cognitive factors, life circumstances, and neurocircuitry. Analyses are limited to transitions without formal help like treatment (often named as ‘self-change’, ‘spontaneous remission’, or ‘natural recovery’), as such transitions are understudied, even though this is the most frequent pathway to full or partial remission. There is a particular lack of evidence on relevant factors for the transition from harmful to low-risk gambling or abstinence. As with psychoactive substances, most people change their problem gambling behaviour without formal interventions, but the underlying processes are not well understood.

The life course approach to substance use has potential to enhance our understanding of the development and persistence of substance use behaviours. The life course approach as applied to substance use is summarized. A critical review is made of published research on the life course of substance use in the areas of timing of substance use onset, early life determinants, trajectories, broader contexts, and historical periods. Notable contributions of this research include: characterization of lifelong patterns of substance use; identification of the broader context as important in shaping early use patterns with an increasing role of biology for the progression to abuse or dependence; and identification of intergenerational and early life effects on substance use patterns. The challenges in the field are assessed with respect to data and measurement and future directions are recommended that include extension of methods and application of the full life-course framework.

The positive emotions that individuals derive from substance use likely promote continued recreational use. However, key neurobiological changes account for the development and maintenance of substance use disorders. Because individuals with substance use disorders are hyporesponsive to non-drug-related rewards, chronic deficits in positive emotions may be an important component of a larger pattern of cyclic emotional dysregulation that maintains addiction. Consequently, the capacity of individuals to experience positive emotions could represent a source of resilience that sensitizes individuals to non-drug-related rewards and buffers against deleterious effects of negative emotions on relapse. Lending support to this hypothesis, the limited clinical research conducted to date indicates that elevated positive emotions may predict better substance abuse treatment outcomes. In order to inform future clinical research, this chapter concludes by delineating theory-based pathways that may account for the effects of positive emotions on recovery from substance use disorders.

This chapter provides a systematic review of the experiences of gay and bisexual adolescents and youth in the United States that affect physical and mental health. It begins by addressing methodological issues in research. The bulk of the chapter provides a thorough overview of the causes, epidemiology, and disparities associated with common problems experienced by young gay and bisexual men including school problems, running away, homelessness, prostitution, substance abuse, suicide risk, eating disorders, and other risk behaviors and threats affecting health. The chapter then reviews what is known about promising responses to resolving the health disparities experienced by gay and bisexual adolescent boys and young men. It concludes by providing a vision for future that has direct implications for research, programs, and policy.