Elizabeth B. Robertson

Review of the evidence base for treatment of childhood psychopathology: Externalizing disorders.

This article reviews controlled research on treatments for childhood externalizing behavior disorders. The review is organized around 2 subsets of such disorders: disruptive behavior disorders (i.e., conduct disorder, oppositional defiant disorder) and attention-deficit/hyperactivity disorder (ADHD). The review was based on a literature review of nonresidential treatments for youths ages 6-12. The pool of studies for this age group was limited, but results suggest positive outcomes for a variety of interventions (particularly parent training and community-based interventions for disruptive behavior disorders and medication for ADHD). The review also highlights the need for additional research examining effectiveness of treatments for this age range and strategies to enhance the implementation of effective practices.

Illegal Drug Use among Rural Adults: Mental Health Consequences and Treatment Utilization

This study uses the National Household Survey on Drug Abuse to examine mental health consequences and treatment utilization among nonmetropolitan and rural adults. The study employs an ecological system perspective, dividing the study population into three groups: nonmetropolitan-rural, nonmetropolitan-urban, and metropolitan-rural. Logistic regression analysis is used to examine four sets of factors related to self-report of mental health problems among drug-using adults, including community level features, family characteristics, personal characteristics, and stress factors. Perceived ease of purchasing cocaine, number of moves in last five years, employment in blue-collar occupations, number of jobs in last five years, and residence in neighborhoods with a low rate (< 10%) of minority households were significantly related to self-report problems. Results of the analysis are discussed in terms of barriers to utilization of treatment and rehabilitation services among nonmetropolitan and rural adults, such as availability and access to facilities and professional services, social stigma, ability to afford services, and the difficulty for rural communities to support inhospital and outpatient services.

Blending Prevention Research and Practice in Schools: Critical Issues and Suggestions

Drug abuse often starts during childhood and adolescence; therefore, prevention strategies need to target these early stages of development. Given this target, the primary venue for delivery of prevention services has been the school system. Both the National Institute on Drug Abuse (NIDA) through its research portfolio, and the Substance Abuse and Mental Health Services Administration (SAMHSA) through its community prevention programs at the Center for Substance Abuse Prevention (CSAP) are working together to help improve school-based prevention efforts. In particular, increasing demands on schools to focus their efforts on the “basics” has led to what is perceived to be decreased access to schools for prevention research and to diminished interest by schools in investing time and money in science-based prevention interventions. To gain a better understanding of the accuracy of these perceptions, NIDA convened a conference of experts to discuss issues from a variety of viewpoints. The conference titled “What Do Schools Really Think About Prevention Research? Blending Research and Reality” held in the spring of 2003 was an important component of the shared NIDA/CSAP goal of improving school-based prevention efforts. At the conference, the two major topical areas discussed were the challenges inherent in conducting school-based substance abuse prevention research, and implementing research-based prevention programs in schools. Meeting participants included

Patterns of Drug use among nonmetropolitan and rural adults

This article examines illegal drug use among adults living in nonmetropolitan and rural areas of the United States using data from the National Household Survey on Drug Abuse. Subjects were classified into three categories by residence: nonmetropolitan-urban, metropolitan-rural, and nonmetropolitan-rural. Respondents indicate about 10% of adults were current users of marijuana or other illegal drugs. Discriminant analysis was used to examine differences among groups of individuals classified as current users, past users, and nonusers. For both marijuana and other illegal drugs, the variables that accounted most for group differences were age, marital, status, employment status, occupation, and income. Only minor differences in drug use were exhibited across the three residential categories. It is recommended that future research on the rural and nonmetropolitan adult population incorporate both structural level measures of socioeconomic and demographic characteristics of localities, and individual level measures of peer influence, work stress, family factors, and psychosocial characteristics.

A transdisciplinary focus on drug abuse prevention: an introduction.

This article introduces the scope of the Special Issue. A variety of scientific disciplines are brought together to establish theoretical integration of the arenas of drug use, misuse, “abuse,” and drug misuse prevention. Transdisciplinary scientific collaboration (TDSC) is utilized as a process of integration. Introductory comments regarding the strengths and limitations of TDSC are presented. Then, the relevance of genetics to substance misuse and substance misuse prevention is presented. Next, the relevance of cognition for prevention is discussed. Specifically, neurologically plausible distinctions in cognition and implicit cognition and their relevance for prevention are discussed. At a relatively molar social-level of analysis, social network theory, systems dynamic models, geographic information systems models, cultural psychology, and political science approaches to drug misuse and its prevention are introduced. The uses of both quantitative and qualitative statistical approaches to prevention are mentioned next. Finally, targeted prevention, bridging the efficacy-effectiveness gap, and a statement on overcoming disbalance round out the Special Issue. The bridges created will serve to propel drug misuse “prevention science” forward in the years to come. Advances in understanding etiological issues, translation to programs, and ecological fit of programming are desired results.

Does Early Intervention Prevent Health-Risking Sexual Behaviors Related to HIV/AIDS?

Adolescence and young adulthood are developmental stages full of social and economic opportunities and challenges, as young people learn about themselves and experiment with adult behaviors and roles. Unfortunately for many in these age groups, involvement with drugs and associated health-risking sexual behaviors (HRSB) becomes part of these important life transitions, interrupting the course of healthy development. For decades, families, schools, and communities have struggled to find the best ways to raise adolescents and support young adults toward happy, healthy, and productive lives. The National Institutes of Health (NIH) has also attended to this important public health issue through funding research dedicated to understanding the role of malleable risk and protective factors for drug use, abuse, and co-occurring mental, emotional, and behavioral (MEB) disorders and using that knowledge for research devoted to the testing of associated prevention intervention strategies. The results of these latter efforts have demonstrated that theory- and etiologically based interventions delivered in childhood can delay or prevent the onset of MEB disorders, including drug abuse and associated HRSB, among adolescents and young adults (National Research Council and Institute of Medicine 2009). NIH funding has benefited the field of prevention science leading to tremendous gains in biopsychosocial behavioral research over the past 30 years. This Supplemental Issue of Prevention Science presents research supported through the Prevention Research Branch (PRB) at the National Institute on Drug Abuse (NIDA) from its portfolio of theory-based, developmentally grounded prevention interventions. This portfolio covers the lifespan from the prenatal period through adulthood with interventions for universal, selective, and indicated levels of risk. The testing and replication of early childhood mental health and drug abuse prevention interventions have led to a growing body of long-term follow-up studies that examines differences in life-course outcomes of intervention and control group participants over time, some into late adolescence and adulthood. Evidence from this body of work indicates that (1) it is possible to intervene early in development on proximal risk and protective factors to have an impact on a broad array of distal outcomes; (2) interventions can have effects, some of which are unanticipated positive effects on outcomes not specifically targeted by the intervention; and (3) those at greatest risk can benefit the most from prevention interventions.

Physical Activity for the Prevention of Child and Adolescent Drug Abuse

Data on the relationship between physical activity and the use of alcohol, tobacco, and other drugs warrant a closer look before automatically presuming that physical activity has the potential to reduce risk for drug abuse. For example, recent analyses from the Monitoring the Future Study (MTF) between substance use and physical activity (either exercise in general or athletic team participation specifically) among US middle and high school youth from 1992 to 2009 indicates varying patterns of use by type of physical activity (Terry-McElrath, O’Malley, & Johnson, 2011). Exercise in general (reported level of participation in sports, athletics, or exercising) was associated with lower prevalence of middle and high school alcohol use, binge drinking, cigarette use, smokeless tobacco use, marijuana use, and steroid use; in contrast, athletic team participation (extent of participating in school athletic teams) was associated with lower rates of marijuana and cigarette use in middle school and higher rates of alcohol use, binge drinking, and steroid use in high school. Clearly, based on this information from the MTF data, physical activity is not the “silver bullet” of drug abuse prevention. However, there are many possible explanations for these relationships, and those explanations could lead to different approaches to prevention. While the MTF measurement questions around physical activity specify some distinctions in type of physical activity, those questions leave out many of the important dimensions and nuances described in Chap. 1 of this volume, which is focused on definitions of physical activity. Thus, assuming the relationships found in the MTF study relate solely to organized sports participation, without looking at the specifics such as characteristics of the sport itself and the motivation of the individual for participating, may lead to erroneous conclusions about causality and misguided direction for prevention. A more holistic view of physical activity offers the potential of elucidating multiple etiologic pathways and more targeted approaches for drug abuse prevention interventions.

Partnerships in drug abuse prevention services research: perspectives from the National Institute on Drug Abuse.

The mission of the National Institute on Drug Abuse (NIDA) is to lead the nation in bringing the power of science to bear on drug abuse and addiction. Within NIDA, the Prevention Research Branch (PRB) supports a developmentally grounded program of research on the prevention of initiation of drug use, progression to abuse and dependence, and transmission of drug-related HIV infection. This research involves the use of rigorous scientific methods to test theoretically derived hypotheses to advance our understanding of the science of prevention within diverse populations and settings. Studies that support this purpose include: investigations of cognitive, behavioral, and social processes as they relate to the development of novel prevention approaches; tests of the efficacy and effectiveness of newly developed and/or modified (adapted) prevention programs; studies of services research questions on the processes associated with the selection, adoption, adaptation, implementation, sustainability, and cost-effectiveness of science-based interventions; and the development of methodologies appropriate for studying complex aspects of prevention science. These programs of research are intended to provide pathways toward the discovery of population-level approaches for the prevention of drug abuse and dependence, drug-related problems (such as mental health, interpersonal violence, criminal involvement, and lost productivity), and drug-related diseases and disorders (e.g. HIV/AIDS, hepatitis B, and C, or comorbid drug and psychiatric disorders) across the life course. The services research component of the PRB portfolio has its origins in the 1992 legislation that authorized the creation of NIDA as one of the NIH research institutes. That authorization mandated a budget set aside for the conduct of preventionand treatment-services research. Initially, the majority of services research focused on treatment. However, the development and testing of efficacious and effective drug abuse interventions using randomized controlled trials led to discussions of how to promote the wide-scale implementation and dissemination of prevention interventions. Early prevention-services research questions addressed the barriers and enhancers to wide-scale dissemination through existing and created service systems. Over time, this portfolio has become both larger and more sophisticated, partly through requests for application (RFA) initiatives to promote an understanding of programmatic-level questions and systemsor implementation-level questions related to moving evidencebased interventions (EBIs) into wide-scale implementation. There also was a growing understanding that for largescale implementation and dissemination to occur, a thorough grasp of what works in specific contexts and locales and the processes that contribute to decision-making, selection, adoption, adaption, implementation, evaluation, financing and sustainability of EBIs was needed. Moreover, partnerships between researchers and community stakeholders/practitioners were seen as an integral part of the research process from conceptualization of a project through to completion. The approach taken by the PRB has been validated in the findings of a recent review of prevention science: the National Research Council and Institute of Medicine report titled ‘‘Preventing Mental Emotional and Behavioral E. B. Robertson (&) Prevention Research Branch (PRB), Division of Epidemiology Services and Prevention Research (DESPR), National Institute on Drug Abuse (NIDA), 6001 Executive Boulevard, Bethesda, MD 20892, USA e-mail: er52h@nih.gov

THE COMMUNITY EPIDEMIOLOGY WORK GROUP APPROACH

“Drug abuse” provides many unique challenges to the research community. Some of these involve fundamental epidemiologic issues, such as measuring the extent of the problem, identifying and assessing changes in patterns and trends, detecting emerging “drugs of abuse”, characterizing vulnerable populations and determining health and social consequences. A number of research methods are employed to address these issues. This paper describes one of these—a model in which ongoing surveillance of “drug abuse” is maintained through a network of community-based researchers, local officials, academics, and other interested and qualified members of the community. Timely, accurate, and cost-effective data can be generated through systematic collection and analysis of indirect indicators of “drug abuse” that are often routinely produced by a variety of community sources. This information, in turn, can be used to make informed public health policy decisions. The community-based network model has been implemented at the city, state, national, regional, and international levels, and a case is made that this type of program could be useful, as well, in understanding the dynamics of “drug abuse” in rural areas of the country. [Translations are provided in the International Abstracts Section of this issue.]