Table Of Content

— cm CaoveriiiKcaS Fabiicafios.s H hi -mi J>6I — ' .iy'l ^ o — ^ ^1 ARF CHeaanlatdhaand Welfare SCaanntaedaet Bien-etre social ARFdoedusinecdataritcoihnon dsFuoernldalaartteiocoxhniecrocmhaenie P)ar>tnlerlsiln Canada's drug strategy Digitized by the Internet Archive 2017 with funding from in University of Toronto https://archive.org/details/drugusebyadolescOOanni DRUG USE BY ADOLESCENTS: IDENTIFICATION, ASSESSMENT AND INTERVENTION Edited by Helen M. Annis and Christine S. Davis BOOK OF READINGS The views expressedandpositions taken in this bookare thoseofthecontributors anddo notnecessarily represent theviews orpositions oftheAddictionResearchFoundation orHealth and Welfare Canada. — No part of this book may be reproduced in a—ny form except for a brief quotation (not to exceed 1,(XX) words) in areview orprofessional work withoutpermission in writing from thepublisher. Canadian Cataloguingin Publication Data Main entry under title: Drug use by adolescents At head oftitle: Youth and drugs. Includes bibliographical references and index. ISBN 0-88868-189-5 1. Youth -Drug Use. 2. Youth - Adolescence. I. Annis, Helen M. II. Davis, Christine Susan IE. Ontario. Addiction Research Foundation. IV. Title: Youth and Drugs. HV5824.Y68D78 1991 362.29’0835 C90-095878-2 ® Minister ofSupply and Services, Canada 1991 ® Addiction Research Foundation, Canada 1991 Alcoholism and Drug Addiction Research Foundation 33 Russell Street, Toronto, Ontario, Canada MSS 2S1 All rights reserved. Printed in Canada. Contributors Helen M. Annis, Addiction Research Foundation, Toronto, Ontario, Canada Christine S. Davis, Psychology Department, Sunnybrook Health Science Centre, Toronto, Ontario, Canada Margo S. George, Addiction Research Foundation, Toronto, Ontario, Canada Vivian A. Jansen, Addiction Research Foundation, Toronto, Ontario, Canada Richard Jessor, Institute ofBehavioral Science, University ofColorado, Boulder, Colorado, U.S.A. Harvey Joanning, Department ofHuman Development and Family Studies, Texas Tech University, Lub bock, Texas, U.S.A. Bruce P. Kuehl, Department ofHuman Development and Family Studies, Texas Tech University, Lub bock, Texas, U.S.A. GarthW. Martin, Addiction Research Foundation, Toronto, Ontario, Canada William H. Quinn, Department of Child and Family Development, University ofGeorgia, Athens, Geor- gia, U.S.A. Harvey A. Skinner, Addiction Research Foundation, Toronto, Ontario, Canada Reginald G. Smart, Addiction Research Foundation, Toronto, Ontario, Canada Robert M. Solomon, Faculty ofLaw, University ofWestern Ontario, London, Ontario, Canada Frank N. Thomas, Department ofHuman Development and Family Studies, Texas Tech University, Lubbock, Texas, U.S.A. Sydney J. Usprich, Faculty ofLaw, University ofWestern Ontario, London, Ontario, Canada D. Adrian Wilkinson, Addiction Research Foundation, Toronto, Ontario, Canada PREFACE This book was developed as part ofan initiative by the Addiction Research Foundation ofOntario to provide front-line professionals with an overview ofcurrent research landings and clinical practices in the field of — youth and drugs. Many professionals physicians, nurses, psychologists, social workers, police and correctional officers, clergy, teachers, school guidance counsellors and other youth workers - are in routine contactwithyouthwhoarebeginningtoexperimentwithorusedrugsregularly. Bybringingtogetherreview papers by leading researchers in the field ofyouth and drugs, this book is intended to provide front-line professionals with an overview ofcurrent findings in adolescent development, drug use, assessment and intervention strategies. Chapters 1 and2address basic background issues and research findings in the areas ofadolescent development and youth substanceabuse. InChapter 1 onAdolescentDevelopmentandBehavioral Health, Richardlessor presents evidence linking health risk in adolescence (including risk ofdrug use) to personality, environmental and behavioral factors and suggests the relevance ofthese factors to the design ofinterventions to reduce riskandenhancehealth. Chapter2byReginald SmartandVivianJansenonYouthSubstanceAbuseprovides a review ofthe nature and extent ofdrug use in young people (age 9 to 19 the characteristics ofusers, and ), the physical, psychological, family and social problems that may result from such use. Legal issues in the assessment and treatment ofyoung people with alcohol and drug problems is explored in depth in Chapter 3 by Robert Solomon and Sydney Usprich. Areas covered include principles ofconsent to treatment, the concepts ofconfidentiaUty and privilege, a healthcare professional’s disclosure, reporting and recordkeeping obligations, and finally the potential criminal liability concerns for professionals that may arise in the course oftreating drug users. Chapters 4, 5 and 6 provide overviews ofidentification and assessment methods with young drug users and interventionstrategiesincluding familycounselling. InChapter4, MargoGeorgeandHarveySkinnerreview critical issues in the assessment ofadolescent drug use, and examine the evidence for two recently proposed comprehensive assessment models together with various clinically-derived guidelines for treatment-related decisions. It is noted that these are underdeveloped areas in need ofresearch. The empirical literature on treatment ofyouth with problems ofsubstance abuse is reviewed by Adrian Wilkinson and Garth Martin in Chapter 5. In addition to evaluating the evidence on the effectiveness ofvarious treatment approaches and the predictors ofoutcome, other important issues are addressed in this chapter including factors the counsellor should consider in the choice oftreatment goals and treatment approach with drug dependent youth. Finally, in Chapter 6 by William Quinn, Bruce Kuehl, Frank Thomas and Harvey Joanning, interventions are described that address an adolescent’s drug abuseusing the family as the unit oftreatment. Treatment steps recommended in this approach are illustrated with vignettes from actual therapy transcripts offamilies in treatment. We would like to acknowledge the contribution ofmany individuals to the preparation ofthis book. Of course, we are most indebted to the authors for the fine chapters they have contributed. We also extend our thanks to members ofthe Steering Committee established by the Addiction Research Foundation to oversee the production ofeducational materials for front-line professionals working with youth; these members are Peter Bohm, Dick Boudreau, Grant Lowery, Donald Morgan, James Rankin, Judi Stevenson, Elsbeth Tupker and Graham Turrall. Invaluable editorial, design and production assistance were received from Catherine Cragg, Marg Yco, and Dennis Poff. Finally, we wish to thank the Addiction Research Foundation and the Education and Training Group of Canada’s Drug Strategy, Health and Welfare Canada for contributing the support and resources needed tobring this project topublication. Helen M. Annis Christine S. Davis TABLE OF CONTENTS CHAPTER 1 ADOLESCENT DEVELOPMENT AND BEHAVIORAL HEALTH Richard Jessor 1 Introduction 5 Adolescence in the life span 5 Adolescence and change 7 Adolescence as a relatively high-risk stage ofhfe 8 The interrelatedness ofhealth riskbehaviors in adolescence 11 The psychological meanings ofhealth risk behaviors in adolescence 13 A theoretical frame\vork for health risk behaviors in adolescence 14 Problem-behavior theory and adolescent development 17 The continuity ofhealth risk between adolescence and young adulthood 19 Some implications for health promotion and risk reduction in adolescence 21 CHAPTER 2 YOUTH SUBSTANCE ABUSE Reginald G. Smart & Vivian A. Jansen 25 Introduction 29 Alcohol 29 Cannabis 32 Cocaine 35 Other illicit drugs: heroin, inhalants, hallucinogens, and speed 37 Prescription drugs: tranquillizers, barbiturates and stimulants 43 Multiple drug use 45 Conclusion 46 CHAPTER 3 PROVIDING TREATMENT TO YOUNG ALCOHOL AND DRUG USERS: A REVIEW OF THE LEGAL ISSUES R. Solomon & S. Usprich 53 Introduction 57 Consent to treatment 57 Confidentiality, disclosure, and recordkeeping 64 Culpability for drug offences 72 Conclusion 74 Appendix 1: Child abuse reporting obligations 75 CHAPTER 4 ASSESSMENT Margo S. George & Harvey A. Skinner 85 Introduction 89 Critical issues in adolescent assessment 89 Assessment models in adolescent drug use 92 Clinically based criteria for making treatment decisions 101 Conclusion 105 CHAPTER 5 INTERVENTION METHODS FOR YOUTH WITH PROBLEMS OF SUBSTANCE ABUSE D. Adrian Wilkinson & Garth W. Martin 109 Introduction 113 Defining substance abuse among youth 113 Characteristics ofyouth receiving treatment for drug dependence 115 Assessment ofyouth with problems ofdrug dependence 116 Varieties of treatment approaches 116 Assessments of the effectiveness oftreatment 119 Predictors ofoutcome, and matching to treatment 121 The goals oftreatment 122 Research needs on treatment ofyouth 123 Ethical issues in research and treatment 124 CHAPTER 6 FAMILIES OF ADOLESCENT DRUG ABUSERS: SYSTEMIC INTERVENTIONS TO ATTAIN DRUG-FREE BEHAVIOR William H. Quinn, Bruce P. Kuehl, Frank N. Thomas & Harvey Joanning 131 Introduction 135 A conceptual overview 135 Countering adolescent sabotage 144 Conclusion 145 AUTHOR INDEX 149 SUBJECT INDEX 153 CHAPTER 1: ADOLESCENT DEVELOPMENT AND BEHAVIORAL HEALTH Richard Jessor ReprintedwithpermissionfromJ.D. Matarazzo, J.A. Herd, N.E. Miller, andS.M. Weiss, (Eds), Behavioral Health: A Handbook ofHealth Enhancement andDisease Prevention. (New York: Wiley, 1984).