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Life Course, Stages of Development & Substance Abuse (EE)
This initial or rough draft of a summary (formatted in an encyclopedia entry format) has been started by the International School Health Network from a previous Canadian project. Visitors to and members of this wiki-based web site are welcome to edit the draft (using the Easy Edit" tool found at the top of the page or to comment on the draft by using the "thread" tool found at the bottom of the page. (All previous versions of this page are automatically saved by the system, so don't hesitate to edit this page). Eventually, when time and resources permit, this initial draft will be formatted in accordance with the outline for encyclopedia entries used in this knowledge exchange program for health,safety, educational and social development interventions.
This page begins a discussion of a problem associated with school-based health and human development programs; short-term expectations from decision-makers and program developers that often fail to recognize that changes in behaviours, beliefs and attitudes requires several years. (Use the "Thread" tool at the bottom of the page) and/or to suggest research, resources, experts, examples and other information related to this point (Use the Easy Edit at the top of the page to add suggestions directly on the page).
1.4 Programs should be based on a recognition that health and social behaviours occur and develop over the life course.
Application to school substance abuse prevention
(Contributors are invited to add statements of good practice or to identify implications related to the point being made on this page.)
Match programs to age/stage and transitions
This page discusses how programs should be matched with the developmental stages in the lives of young people as well as the key transitions such as elementary school to high school, moving to a new neighbourhood, changes in their families etc.
Protective and risk factors are best seen within a developmental pathways perspective that reflects the dynamic relationship between various factors, as perceived by the individual.[i] Viewing factors according to a developmental pathways perspective suggests
The balance of the number of risk factors in relation to the number of protective factors is important in determining the likelihood of problem behaviours; individuals experiencing a disproportionate number of risk factors are generally viewed as being at heightened risk for various academic and social problems.
How does heightened risk manifest itself in terms of substance use? As has been noted, alcohol, cannabis and tobacco use are common among Canadian adolescents, as is binge drinking – and harms do arise from this use. It isn’t possible to predict with certainty how even a minimal-use pattern will proceed. It may pass without incident or evolve into a hazardous lifestyle. Moreover, as has been noted, even “low-risk” youth experience risk factors that shouldn’t be ignored. But young people living with an accumulation of risk factors tend to engage in heavier and more frequent use of these substances and are more likely to use other illegal substances.[ii] They are also more likely to begin using at an earlier age. As Toumbourou (2004, p 5) observes, “early use of legal substances and harmful use of illicit substances (frequent cannabis use and other illicit drug use) may be particularly influenced by the cumulative exposure to early risk factors and their interaction with early school adjustment pathways, which may in turn be more prevalent within disadvantaged and lower SES families”.
Paglia-Boak and Adlaf contend that special attention be given to early use (i.e. before age 13 or 14) of substances in adolescence.[iii] It is clear from research that early substance use is linked to several significant harms with life-long consequences. Early use:
A U.S. analysis of a longitudinal study found that the likelihood of alcohol dependence decreased by 14% with each additional year of delayed initiation.[iv] Consequently, efforts by schools and parents to delay or prevent substance use are important and some drug education programs have this as a specific aim. However, it is important to see that early use of substances likely arises from experiences in earlier years that are more effectively addressed at an earlier point.[v]
Although the various problem behaviours (e.g. problematic substance use, mental health problems, teen pregnancy, violence and criminal activity) appear to share many root factors, there is much to learn about the complex relationships, pathways and mechanisms by which the various factors operate and lead to problems.[vi] The science behind the identification of risk factors is not completely helpful because it can have the effect of removing the person from their context, and does not reflect the complex and dynamic manner in which factors play out in people’s lives. It can contribute to an overemphasis on individual human deficit while de-emphasizing other environmental or structural factors, such as marketing and cultural norms, that are not so easily understood through typical experimental research.[vii] However a developmental pathways approach shows promise in explaining how the various factors operate in the lives of individuals and in identifying common bases of concern among those working to prevent substance use and other problems such as mental health, violence and crime.
Conclusion
All young people can be seen as “at risk” by virtue of their developmental needs and the various cultural messages to which they are exposed. While many Canadian students choose not to use any substances, many others do so, often in hazardous ways. These students would benefit from school-based opportunities to discern the strength of the various influences in their lives, develop personal and social skills to effectively cope with these influences and to learn how to avoid harming themselves or others when they choose to use a substance. The classroom and the broader school environments (particularly social but also physical) can offer important protection for learning, and help reduce substance use and other problem behaviours.
For children and young people experiencing many more risk than protective factors, interventions early in problem pathways are advocated. Prevention experiences early in school are very important but it is also important to focus on later transition points (e.g. moving from junior high or middle school to high school). Preventive effect may be gained from a positive overall school environment but it may also be necessary to select these students for particular programming. In pre and early adolescence the aim of the programming needs to focus on delaying use of alcohol, tobacco and other substances, while later programming would more appropriately aim to reduce hazardous use (e.g. frequent, heavy use or use in hazardous contexts) of alcohol, cannabis and, possibly, other drugs.
This page begins a discussion of a problem associated with school-based health and human development programs; short-term expectations from decision-makers and program developers that often fail to recognize that changes in behaviours, beliefs and attitudes requires several years. (Use the "Thread" tool at the bottom of the page) and/or to suggest research, resources, experts, examples and other information related to this point (Use the Easy Edit at the top of the page to add suggestions directly on the page).
1.4 Programs should be based on a recognition that health and social behaviours occur and develop over the life course.
Application to school substance abuse prevention
(Contributors are invited to add statements of good practice or to identify implications related to the point being made on this page.)
- Good/promising practice 4: recognize that the many factors that either increase risk or provide protection for substance use harms present themselves at different points in the life of a child and call for different responses during each developmental phase. (Canadian Association for School Health, p.25) Go to Match programs to age/stage & transitions for a discussion of this practice.
- Good/promising practice 2: schools need to make preventing or delaying the early use (i.e. age 12/13 or earlier) of tobacco, alcohol and cannabis a priority. Because early use of these and other substances often results from factors evident in earlier childhood, universal and targeted programming prior to middle school is important.(Canadian Association for School Health, p.10) Go to Universal programs to prevent early use for a discussion of this practice.
- Go to Comprehensive elementary programs to address multiple behaviours Also go to Middle/junior high programs to discuss this practice of age-appropriate strategies and programs.
Match programs to age/stage and transitions
This page discusses how programs should be matched with the developmental stages in the lives of young people as well as the key transitions such as elementary school to high school, moving to a new neighbourhood, changes in their families etc.
Protective and risk factors are best seen within a developmental pathways perspective that reflects the dynamic relationship between various factors, as perceived by the individual.[i] Viewing factors according to a developmental pathways perspective suggests
- there is no single risk factor that is directly related to developmental problems such as substance misuse; rather, risk factors vary through the life course and often affect development through their cumulative impact over time
- a combination of factors at a particular life stage can, on the other hand, combine to place a person at particular risk (e.g. a student whose parents have just separated and is now going to a new school)
- risk factor exposure early in life can have a snowball effect, altering the subsequent course of development; that is, upcoming risk factors tend to stick and accumulate (e.g. weak child-parent attachment at infancy contributes to behaviour problems, which affect school performance and engagement with peers)
The balance of the number of risk factors in relation to the number of protective factors is important in determining the likelihood of problem behaviours; individuals experiencing a disproportionate number of risk factors are generally viewed as being at heightened risk for various academic and social problems.
How does heightened risk manifest itself in terms of substance use? As has been noted, alcohol, cannabis and tobacco use are common among Canadian adolescents, as is binge drinking – and harms do arise from this use. It isn’t possible to predict with certainty how even a minimal-use pattern will proceed. It may pass without incident or evolve into a hazardous lifestyle. Moreover, as has been noted, even “low-risk” youth experience risk factors that shouldn’t be ignored. But young people living with an accumulation of risk factors tend to engage in heavier and more frequent use of these substances and are more likely to use other illegal substances.[ii] They are also more likely to begin using at an earlier age. As Toumbourou (2004, p 5) observes, “early use of legal substances and harmful use of illicit substances (frequent cannabis use and other illicit drug use) may be particularly influenced by the cumulative exposure to early risk factors and their interaction with early school adjustment pathways, which may in turn be more prevalent within disadvantaged and lower SES families”.
Paglia-Boak and Adlaf contend that special attention be given to early use (i.e. before age 13 or 14) of substances in adolescence.[iii] It is clear from research that early substance use is linked to several significant harms with life-long consequences. Early use:
- increases the likelihood of regular heavy use, use of various substances, legal problems, violence, injuries, mental health problems and dependence in early adulthood;
- hampers the young person’s ability to make expected transitions from adolescence into adulthood—for example, attaining higher education and finding success in marriage.
A U.S. analysis of a longitudinal study found that the likelihood of alcohol dependence decreased by 14% with each additional year of delayed initiation.[iv] Consequently, efforts by schools and parents to delay or prevent substance use are important and some drug education programs have this as a specific aim. However, it is important to see that early use of substances likely arises from experiences in earlier years that are more effectively addressed at an earlier point.[v]
Although the various problem behaviours (e.g. problematic substance use, mental health problems, teen pregnancy, violence and criminal activity) appear to share many root factors, there is much to learn about the complex relationships, pathways and mechanisms by which the various factors operate and lead to problems.[vi] The science behind the identification of risk factors is not completely helpful because it can have the effect of removing the person from their context, and does not reflect the complex and dynamic manner in which factors play out in people’s lives. It can contribute to an overemphasis on individual human deficit while de-emphasizing other environmental or structural factors, such as marketing and cultural norms, that are not so easily understood through typical experimental research.[vii] However a developmental pathways approach shows promise in explaining how the various factors operate in the lives of individuals and in identifying common bases of concern among those working to prevent substance use and other problems such as mental health, violence and crime.
Conclusion
All young people can be seen as “at risk” by virtue of their developmental needs and the various cultural messages to which they are exposed. While many Canadian students choose not to use any substances, many others do so, often in hazardous ways. These students would benefit from school-based opportunities to discern the strength of the various influences in their lives, develop personal and social skills to effectively cope with these influences and to learn how to avoid harming themselves or others when they choose to use a substance. The classroom and the broader school environments (particularly social but also physical) can offer important protection for learning, and help reduce substance use and other problem behaviours.
For children and young people experiencing many more risk than protective factors, interventions early in problem pathways are advocated. Prevention experiences early in school are very important but it is also important to focus on later transition points (e.g. moving from junior high or middle school to high school). Preventive effect may be gained from a positive overall school environment but it may also be necessary to select these students for particular programming. In pre and early adolescence the aim of the programming needs to focus on delaying use of alcohol, tobacco and other substances, while later programming would more appropriately aim to reduce hazardous use (e.g. frequent, heavy use or use in hazardous contexts) of alcohol, cannabis and, possibly, other drugs.
[i] France, A., & Homel, R. (2006). Societal access routes and developmental pathways. Putting social structure and young people’s voice into the analysis of pathways into and out of crime. Australian and New Zealand Journal of Criminology, 39(3).
[ii] Stockwell, T., Toumbourou, J.W., Letcher, P., Smart, D., Sanson, A., & Bond, L. (2004). Risk and protection factors for different intensities of adolescent substance use: When does the prevention paradox apply? Drug and Alcohol Review, 23(1), 67-77.
[iii] Paglia-Boak, A., & Adlaf, E. (2007). Substance use and harm in the general youth population. In Canadian Centre on Substance Abuse (Ed). (2007). Substance Abuse in Canada: Youth in Focus. Retrieved September 30, 2007, from http://www.ccsa.ca/NR/rdonlyres/5D418288-5147-4CAC-A6E4-6D09EC6CBE13/0/ccsa0115212007e.pdf
[iv] Grant, B.F., & Dawson, D.A. (1997). Age of onset of alcohol use and its association with DSM-IV alcohol abuse and dependence: Results from the national longitudinal alcohol epidemiological survey. Journal of Substance Abuse, 9.
[v] Toumbourou, J.W., Rowland, B., Jefferies, A., Butler, H., & Bond, L. (2004). Preventing drug-related harm through school re-organisation and behavior management [Prevention research evaluation report]. Melbourne, Australia: Australia Drug Foundation. Retrieved September 30, 2007, from http://www.druginfo.adf.org.au/downloads/Prevention_Research_Quarterly/PRQ_04Nov_Early_intervention_in_schools.pdf
[vi] Spooner, C., & Heatherington, K. (2004). Social determinants of drug use [Tech. Rep. No. 228]. Retrieved September 30, 2007, from http://ndarc.med.unsw.edu.au/ndarcweb.nsf/website/Publications.reports.TR228
[vii] Borrell, J., & Boulet, J. (2005). A theoretical exploration of culture and community health: Implications for prevention, research, and problem gambling. Journal of Gambling Issues, 13.
Comprehensive elementary programs to address multiple behaviours
Middle/junior high programs to address multiple issues
Universal programs to prevent early use This page discusses the use of universal programs in primary and middle schools that should be aimed at preventing early use of substances.
While a significant proportion of middle school students do not use any substance (See Canadian prevalence data), the use of alcohol becomes normative in the high school years and cannabis and tobacco use becomes common. Students in Grades 7 and 8 may be more accurately termed “not-yet-users” rather than “non-users”, particularly in relation to alcohol. With increasing age, the rate of hazardous patterns of use also increases, and use of tobacco is a marker for these patterns. Addressing early use of tobacco, alcohol and cannabis needs to be a priority for school prevention programs. Because significant numbers of older students use these and other substances in hazardous ways, and given the significant immediate harms that can arise from these patterns, prevention that explicitly aims to prevent hazardous use and possible harms needs to considered for the high school prevention agenda.
Comprehensive elementary programs to address multiple behaviours
This page discusses comprehensive elementary programs that address substance abuse among several issues related to this stage of child development.
A growing body of research that includes a number of controlled studies suggests that interventions focusing on improving primary school environments can contribute to better learning outcomes while also reducing pathways to harmful substance use.[i] Below are two elementary level programs that aimed to build school bonding among students as a route to promoting academic success and preventing later behavioural problems.
The Seattle Social Development Project, developed by Hawkins and colleagues, is a universal intervention for students in Grades 1-6 that combines parent training with modified teaching practices. The intervention was conducted in 18 Seattle elementary schools, with students randomly assigned to experimental or control classrooms. The teachers were trained in proactive classroom management (i.e. providing clear expectations for behaviour, recognizing and rewarding compliance, use of encouragement and praise), interactive teaching, and cooperative learning. The parent training component consisted of optional parent classes offered in first through third grades, covering child behaviour management, academic support through improved communication, and prevention of antisocial behaviour.[ii]
The 6-year follow-up compared results for three groups of students: those who had received a “full intervention” (grades 1 through 6), those who had received a “late intervention” (grades 5 and 6 only), and a no-intervention control group. The late intervention group showed little long-term effect while the full intervention group scored significantly higher than the control group on measures of school commitment and attachment, school achievement, misbehaviour, lifetime violence and sexual activity by age 18. At the end of high school, heavy drinking was reported by fewer of the students who had received the full intervention (15.4 per cent) relative to those in the control schools (25.6 per cent).
The researchers speculate that the program’s emphasis on school bonding and achievement may set children on a developmental path toward school completion and success that is naturally reinforced both by teachers responsive to motivated students and by the students’ own commitment to schooling.
The Child Development Project developed by Battistich and colleagues was intended to transform schools into “caring communities of learners”. Components include school staff training in the use of cooperative learning and a language arts model that fostered cooperative learning, buddy activities, and classroom decision-making. School-wide community-building activities were used to promote school bonding and parent involvement activities, such as interactive homework. This program was evaluated in a quasi-experimental study with 4,500 third to sixth grade students (average age 11 years) in 24 schools. Intervention and control schools were well matched. Results showed improvements in interpersonal and problem solving skills and in substance use and anti-social behaviour. When a sample of students was followed up in middle school, a number of positive effects were maintained, however effects on alcohol and cannabis use were no longer evident.[iii]
A growing body of research that includes a number of controlled studies suggests that interventions focusing on improving primary school environments can contribute to better learning outcomes while also reducing pathways to harmful substance use.[i] Below are two elementary level programs that aimed to build school bonding among students as a route to promoting academic success and preventing later behavioural problems.
The Seattle Social Development Project, developed by Hawkins and colleagues, is a universal intervention for students in Grades 1-6 that combines parent training with modified teaching practices. The intervention was conducted in 18 Seattle elementary schools, with students randomly assigned to experimental or control classrooms. The teachers were trained in proactive classroom management (i.e. providing clear expectations for behaviour, recognizing and rewarding compliance, use of encouragement and praise), interactive teaching, and cooperative learning. The parent training component consisted of optional parent classes offered in first through third grades, covering child behaviour management, academic support through improved communication, and prevention of antisocial behaviour.[ii]
The 6-year follow-up compared results for three groups of students: those who had received a “full intervention” (grades 1 through 6), those who had received a “late intervention” (grades 5 and 6 only), and a no-intervention control group. The late intervention group showed little long-term effect while the full intervention group scored significantly higher than the control group on measures of school commitment and attachment, school achievement, misbehaviour, lifetime violence and sexual activity by age 18. At the end of high school, heavy drinking was reported by fewer of the students who had received the full intervention (15.4 per cent) relative to those in the control schools (25.6 per cent).
The researchers speculate that the program’s emphasis on school bonding and achievement may set children on a developmental path toward school completion and success that is naturally reinforced both by teachers responsive to motivated students and by the students’ own commitment to schooling.
The Child Development Project developed by Battistich and colleagues was intended to transform schools into “caring communities of learners”. Components include school staff training in the use of cooperative learning and a language arts model that fostered cooperative learning, buddy activities, and classroom decision-making. School-wide community-building activities were used to promote school bonding and parent involvement activities, such as interactive homework. This program was evaluated in a quasi-experimental study with 4,500 third to sixth grade students (average age 11 years) in 24 schools. Intervention and control schools were well matched. Results showed improvements in interpersonal and problem solving skills and in substance use and anti-social behaviour. When a sample of students was followed up in middle school, a number of positive effects were maintained, however effects on alcohol and cannabis use were no longer evident.[iii]
[i] Toumbourou, J.W., Stockwell, T., Neighbors, C., Marlatt, G.A., Sturge, J., & Rehm, J. (2007). Interventions to reduce harm associated with adolescent substance use: An international review. Lancet, 369, 1391-1401.
[ii] Toumbourou, J.W., Rowland, B., Jefferies, A., Butler, H., & Bond, L. (2004). Preventing drug-related harm through school re-organisation and behavior management [Prevention research evaluation report No. 12]. Melbourne, Australia: Australia Drug Foundation. Retrieved September 30, 2007, from http://www.druginfo.adf.org.au/downloads/Prevention_Research_Quarterly/PRQ_04Nov_Early_intervention_in_schools.pdf
[iii] Battistich, V., Schaps, E., & Wilson, N. (2004). Effects of an elementary school intervention on students’ “connectedness” to school and social adjustment during middle school. The Journal of Primary Prevention, 24(3).
Middle/junior high programs to address multiple issues
This page discusses effective comprehensive programs at the middle school and junior high school level that should address substance use witrhin the contect of several related health and social issues and behaviours.
Less research has been conducted on the effectiveness of social environments at the middle and high school level. The available research is inconclusive, but does suggest that secondary school re-organization and behaviour management practices may influence young people’s drug use.[i] Dewit and colleagues (2002) reviewed this literature and identified several fundamental ingredients or components of school bonding or connectedness interventions that must be present to increase the likelihood of positive change in student learning and behavioural outcomes:[ii]
Less research has been conducted on the effectiveness of social environments at the middle and high school level. The available research is inconclusive, but does suggest that secondary school re-organization and behaviour management practices may influence young people’s drug use.[i] Dewit and colleagues (2002) reviewed this literature and identified several fundamental ingredients or components of school bonding or connectedness interventions that must be present to increase the likelihood of positive change in student learning and behavioural outcomes:[ii]
- Efforts to change the social environment of schools should be guided by an overarching set of principles that when implemented help to organize and guide the selection of programs and strategies (e.g. social development, or schools as community models). Incorporating these principles into the fabric of whole school programs allows the activities associated with one program component to reinforce and complement the activities of another and hence improve the likelihood of positive student outcomes.
- School reforms aimed at improving sense of school connections and other student outcomes need to recognize that children’s educational experiences occur within several imbedded contexts, starting at the classroom level and extending outwards to broader contextual influences. Programs that focus on just one of these areas at the exclusion of the others are less likely to succeed.
- Programs that target school connectedness need to be sensitive to the developmental needs of students. For example, secondary students need to provide opportunities for decision-making at the classroom level at a time when there is a growing need for autonomy and independence.
- Sustainable committees or networks consisting of students, teachers, administrators, parents, and members of the community operating according to a specified framework for action are needed.
- Finally, whole-school programs may be effective in preventing the escalation of some behavioural problems but are unlikely to address the specific needs of individuals with severe problems. For this reason, school-connectedness programs should be supplemented with specialized in-school services such as student assistance programs that provide referrals, service recommendations, and follow-up support programs for students in greatest need of help.
- feedback from a student survey about students’ sense of personal safety, communication with teachers, and participation in broader school life;
- recruitment of staff in each school to a coordinating action team;
- an average of 40 hours of consultation and training for staff on specific curriculum or whole school strategies.
- the individual-focused curriculum: an average of 15 hours of instruction in English, Health, or Personal Development classes that aimed to enhance understanding and skills for dealing with difficult situations and emotions;
- the environment focus: using whole-school strategies to address particular risk and protective factors in the school environment identified in the review of the current situation.
[i] Toumbourou, J.W., Stockwell, T., Neighbors, C., Marlatt, G.A., Sturge, J., & Rehm, J. (2007). Interventions to reduce harm associated with adolescent substance use: An international review. Lancet, 369, 1391-1401.
[ii] DeWit, D.J., Akst, L., Braun, K., Jelley, J., Lefebvre, L., & McKee, C. (2002). Sense of school membership: A mediating mechanism linking student perceptions of school culture with academic and behavioural functioning. Toronto, Canada: Centre for Addiction and Mental Health.
[iii] Patton, G., Bond, L., Carlin, J., Thomas, L., & Butler, H., et al. (2006). Promoting social inclusion in schools: A group-randomized trial of effects on student health risk behavior and well-being. American Journal of Public Health, 96(9).
[iv] University of Calgary, Population health intervention research centre. (n.d.). Feeling alienated at school: how risky health behaviours start. Retrieved August 31, 2007, from http://www.ucalgary.ca/PHIRC/snapshots.html
Universal programs to prevent early use
This page discusses the use of universal programs in primary and middle schools that should be aimed at preventing early use of substances.While a significant proportion of middle school students do not use any substance (See Canadian prevalence data), the use of alcohol becomes normative in the high school years and cannabis and tobacco use becomes common. Students in Grades 7 and 8 may be more accurately termed “not-yet-users” rather than “non-users”, particularly in relation to alcohol. With increasing age, the rate of hazardous patterns of use also increases, and use of tobacco is a marker for these patterns. Addressing early use of tobacco, alcohol and cannabis needs to be a priority for school prevention programs. Because significant numbers of older students use these and other substances in hazardous ways, and given the significant immediate harms that can arise from these patterns, prevention that explicitly aims to prevent hazardous use and possible harms needs to considered for the high school prevention agenda.
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, Jan 26 2010, 10:19 AM EST
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