Steve Sussman

Depression, Suicidal Ideation, and Substance Use Among Continuation High School Students

This study examines the structural relationships among depression, suicidal ideation, “gateway” substance use (including cigarettes, alcohol, and marijuana), and “hard” substance use (including cocaine, stimulants, and inhalants) in a sample of continuation high school students at high risk for drug abuse. When the model was examined separately by ethnic group (Latino and Caucasian) and gender, significant differences among the factor correlations emerged. Compared to Latinos and females, Caucasians and males, respectively, demonstrated a greater number of significant relationships among the factors. For Latinos and females, only the depression and suicidal ideation factors were significantly correlated with each other, as were the gateway and hard substance use factors. For Caucasians and males, four of the six factors were significantly intercorrelated. One implication is that mood enhancement may be a particularly important reason for hard substance use among Caucasian and male adolescents.

Drug Abuse: Concepts of Drugs, Drug Use, Misuse, and Abuse

First the man took a drink, then the drink took a drink, then the drink took the man. – Recovery movement proverb This first chapter provides a discussion and clarification of various concepts relevant to drug abuse. Although we attempt clarification of many terms and concepts, it is important to note that there are different substantive distinctions and “fuzzy” boundaries between the concepts. For example, distinctions between drug misuse and abuse, and terms such as street drugs or hard or soft drugs are somewhat ambiguous and perhaps dependent on sociocultural contexts. The chapter begins by providing an overview of a definition of a drug, drug use, and drug action and then distinguishes drug use from misuse and provides terms used to refer to drugs that might be misused. What Is a Drug and Drug Use? A drug is a substance that can be taken into the human body and, once taken, alters some processes within the body. Drugs can be used in the diagnosis, prevention, or treatment of a disease. Some drugs are used to kill bacteria and help the body recover from infections. Some drugs assist in terminating headaches. Some drugs cross the blood–brain barrier and affect neurotransmitter function. The varieties of drugs that produce a direct or indirect effect on neurotransmitter function in the brain are of primary interest in this book. Drugs are processed by the body in four steps, and these drugs also may have various effects on each other when used together.

Drug Abuse: Social Interaction and Social Groups

This chapter examines small group-level effects on individuals that may facilitate drug use. Small group interactions involve verbal (word content and intonation) and nonverbal (body language) behavioral exchanges. Each member of the group interprets the meaning of the interactions that transpire, and these perceptions of interactions that occur may differ across group members. Therefore, a distinction between perceived or egocentric social phenomena and observed, group-level social phenomena is generally recognized (e.g., as in smoking; Hoffman, Sussman, Unger, & Valente, 2006). The topics presented in this chapter include possible egocentric and group-level effects on drug use. The topics presented include the family unit and parenting, peer social influence, social learning, social support, social networks, deviant subcultures, and group identification. The Family Unit and Parenting Youth begin or do not begin to have drug-related experiences through parental and older sibling discussions of use and modeling of use (Flay et al., 1994). In addition, family interactions may serve to facilitate later drug use or protect against later use. Youth from single-parent homes, or those who spend relatively less time with parents or guardians (latch-key children), are relatively likely to use drugs later on (Dwyer et al., 1990; Griffin et al., 2000; Richardson et al., 1989). These findings are remarkable and require careful consideration, given the increasing number of single-parent homes in the United States (and several other countries), as well as households where it is necessary for all adults in the home to work.

Drug Abuse: Concepts of Prevention

This chapter defines and discusses key concepts and program methods that have evolved with increased understanding of the complexity of substance use behavior and its prevention. In an effort to improve program effectiveness, and as a result of findings from evidence-based prevention programs, prevention interventions are now often designed for use in a particular setting or settings and tailored to address the needs of specific groups. Moreover, different prevention programs target persons across the life span (young children, elementary school youth, teens, emerging adults, adults). The use of interactive techniques (e.g., role-play, peer discussions) has been found to increase involvement in the learning process while reinforcing skills training and may be a sin quo non for prevention efficacy (see Botvin et al. 1995; Sussman et al., 1995; Sussman, Rohrbach, Patel, & Holiday, 2003; Tobler et al., 2000). This chapter also provides a discussion of the importance of reinforcing prevention goals with repeated interventions or booster programs, long-term follow-up, and worldwide reach of prevention efforts. Prevention Definitions and Classifications Historically, public health researchers and practitioners have divided the field of prevention programming into three levels. These levels are primary prevention (before the problem behavior starts), secondary prevention (before the disease starts), and tertiary prevention (before death is likely). However, new terms are now being used to further differentiate various levels of prevention programming.