Various intervention programs have been proposed and implemented in the educational institutions of the United States to curb underage drinking. Some of them have met with success and some others not quite so. It is generally learnt that programs that cater to the specific demands of a particular risk-group have performed better than the rest. A review of literature on the subject has also thrown light on areas of deficiency with these programs and possible remedial measures. Only a comprehensive program design that is based on a scientific and sociological understanding of the underage drinking problem can produce better results.
Education – Adolescent Alcoholism:
Introduction:
There are approximately 26.8 million Children of Alcoholics in America. When compared to other risk groups, these children are the most vulnerable to fall into underage drinking habits. Of this group, those aged 18 or younger comprise nearly 50%. Almost inevitably, these children face negative outcomes as a result of their parental misdemeanor (Emshoff, 1999).
Another intervention model that is forwarded recently “suggests that building competence through increasing coping skills will reduce the incidence of psychopathology. Thus, appropriate goals for primary prevention for Children of Alcoholics would include the reduction of stress and the development of self-esteem, social competence, and a strong social support system (Emshoff, 1999).
In a survey conducted by Jacqueline Miller and her team of researchers, some startling facts were revealed about the prevalence of alcohol consumption among school going students. 45% of high school going students had admitted to drinking alcohol during the past month. 29% of the respondents reported drinking in excess as well. The students who reported to drink or binge-drink also displayed “poor school performance and involvement in other health risk behaviors such as riding with a driver who had been drinking, being currently sexually active, smoking cigarettes or cigars, being a victim of dating violence, attempting suicide, and using illicit drugs” (Miller, et. al., .2007)
In light of such bleak consequences of teenage drinking, it is critical that educational institutions across the United States draw up intervention programs to address this pandemic facing the next generation. The necessity for early intervention had been identified quite some time back and many proposals were forwarded in remedying the situation. Different programs have met with different levels of success. The following passages give a review of these programs and their efficacy/drawbacks (Miller, et. al., 2007).
A high proportion of buy attempts by underage youth are successful, and more than of high school students say that alcohol is easy to obtain. On top of these, most alcohol advertisements are placed in media outlets where the audiences are usually from the younger age groups. In light of this, it is imperative that authorities from educational institutions device intervention measures to nip the problem in its nascence. Some of those intervention programs are discussed below (Palfrey, 2005).
Literature Review:
Student Assistance Programs (SAPs)
These programs were designed after the success of Employee Assistance Programs. The aim of a SAP is to provide extensive “prevention and early intervention services” to youth that are especially vulnerable. The programs were implemented across all levels of schooling in America. Although the programs pay special attention to Children of Alcoholics, all high-risk children come under their purview. The programs are adapted to meet the specific requirements of a group while taking into consideration the availability of resources. Student counselors who have had prior experience are employed to provide their services at the school premises or community centers. Intervention steps are proposed to the students based on their particular inter-personal, socio-economic and substance abuse problem. The SAP ropes in school staff as well, so as to aid the counselors from outside with necessary input and to also help them coordinate the program better. Students can volunteer to attend the program or can be referred by parents or teachers (Bailey, et. al, 2004).
The SAPs have achieved remarkable success right since their initiation. Three reasons were cited for its success:
Firstly, the program’s “structure and process of identifying students” already into alcoholism and drug abuse and those vulnerable to it is a time-tested one. Secondly, the SAPs involve the community in all its programs. Thirdly, the aftercare support offered by the programs help the students reintegrate into society in a streamlined fashion.
Stress Management and Alcohol Awareness Program
Another equally successful program implemented by the American educational institutions. The program is a short-termed one lasting for 2 months based on early intervention. In the words of
“The framework is a person-centered, competency-building intervention that uses various psycho-educational techniques to strengthen children’s competence. These include the enhancement of self-esteem, provision of alcohol-related information, and emotion and problem-focused coping strategies. The process includes showing a film depicting experiences of alcohol addicted students to all students in the targeted grades, holding an informational follow-up meeting to discuss the film and explain the program, and finally extending an invitation to all children who are interested in participating.” (Emshoff, 1999).
Of late, the program incorporates lectures for students to help them gain coping skills. The personalized attention provided by the program is another reason for its success, as each student can apply prevention techniques that are applicable to his/her particular case. The following table, taken from (Emshoff, 1999) reveals the seriousness of the issue.
TABLE 2 Prevalence of Binge Drinking Among US High School Students Who
Report Drinking Alcohol According to Gender, 2003
Characteristic Boys (n = 3273), Girls (n = 3230),
% (95% Cl) % (95% Cl)
All respondents 67.4(65.0-69.8) 61.1(58.2-64.0)
Age
12-14 y 48.9(41 8-56.0) 60.5(50.5-70.4)
15 17 y 67.8(65.3-70.3) 60.9(57.8-64.0)
[greater than or equal to] 74.0(69.5-78.3) 62.4(57.8-67.1)
18 y
Grade
9th 57.2(50.6-63.9) 54.6(47.2-61.9)
10th 66.8(62.1-73.5) 61.6(56.1-67.1)
11th 72.4(68.5-76.2) 64.1(59.9-68.4)
12th 71.9(68.3-75.6) 63.4(57.9-68.9)
Race/ethnicity
White 71.6(69.1-74.0) 66.3(63.8-68.8)
Black or African American 48.7(41.7-55.7) 34.7(28.2-41.2)
Hispanic or Latino 65.7(60.0-71.5) 62.6(58.4-66.8)
Other (a) 63.1(49.5-76.6) 53.5(40.8-66.1)
Characteristic Total (n = 6543),
% (95% CI)
All respondents 64.2(61.8-66.6)
Age
12-14 y 55.6(49.2-62.0)
15 17y 64.3(61.7-66.9)
[greater than or equal to] 68.7(65.5-71.9)
18 y
Grade
9th 55.8(50.5-61.1)
10th 64.1(60.2-68.0)
11th 68.3(65.0-71.6)
12th 67.7(64.9-70.4)
Race/ethnicity
White 68.9(67.0-70.9)
Black or African American 41 5(36.6-46.4)
Hispanic or Latino 64.1(60.0-68.1)
Other (a) 58.7(50.6-66.7)
Binge drinking is defined as having drank [greater than or equal to]
drinks of alcohol in a row on [greater than or equal to] 1 day during
the past 30 days.
"Drinking alcohol" is defined as having drank at least 1 drink of
alcohol on [greater than or equal to] 1 day during the past 30 days
(a) Includes American Indian, Alaskan Native, Asian, Native Hawaiian,
Pacific Islander, and multiracial.
Students Together and Resourceful (STR)
This is another innovative program whose success was due to strong community participation. Students are educated about the ill effects of alcohol consumption both to themselves and their family. The psychological aspects of alcohol consumption as well as its etiology are elucidated to the participating students. This program is different from the ones discussed above in that it lays special focus on helping students improve their peer relations by intervening at appropriate stages. In addition,
“Group exercises were designed to facilitate the identification, acceptance, and expression of feelings. A related goal was that of improving the social network of participants. Specific skills such as problem-solving, decision-making, stress management and refusal skills were emphasized. In short, the intervention was designed to do what parents normally do: help children learn to live with themselves in their environments, establish good relationships, and make constructive decisions and follow them through.” (Bailey, et. al, 2004)
Cambridge and Somerville Program for Alcoholism Rehabilitation:
The Cambridge and Somerville Program for Alcoholism Rehabilitation is a program specifically aimed at children of Alcoholics. All student age groups are included in this program. Adolescents susceptible to behavioral problems and substance abuse are educated about remedies and precautionary measures. Similar to the SAP and STR programs discussed above, teachers are actively involved in the program. And so are the members of the community (Palfrey, 2005).
Children of Drug Abusers and Alcoholics
This program again has many features common with the programs discussed above. This three month programs focuses on children between 4 and 10 years of age. Group activities are central to the program which tries to incorporate elements of art and play in its therapeutic procedures. An evaluation of the program on the basis of the Child Behavior Checklist shows that it has been successful in improving participants’ “competence and behavior” (Palfrey, 2005).
Discussion:
The young adolescents who participated in the SMAAPs and SAPs demonstrated better understanding of the potential risks of alcohol addiction. They were also found to report social support and emotion based coping behavior. These programs were effective in reducing the stress these students were going through as a result of their own alcohol consumption or that of their parents. (Bailey, et. al, 2004)
Research conducted on STR program outcomes shows that it has been effective in intervening and mitigating alcohol related issues for the participating adolescents. The participants were found to exhibit more confidence during their social interactions as well as better self-esteem. This had translated into a broader circle of friends, healthy peer interaction and a positive regard for their community. Not surprisingly, the incidences of depression and anxiety disorders among the participating teenagers were lesser than the control group (Bailey, et. al, 2004).
The following table, taken from the March 2002 issue of Pediatrics gives us some interesting insights:
TABLE 1. Estimates of the Effects of Intervention Based on a
Logistic Regression Analysis with Adjustment for Child and
Family Baseline Characteristics and Clinic Pair
Alcohol/Tobacco Outcomes Adjusted * OR for Alcohol
and Tobacco Arm to
Safety Arm
Outcome 12 Months OR P Value
(95% CI)
Alcohol
Child ever drinker
Among all subjects 1.17 (0.92, 1.48) .20
Tobacco
Child ever smoked
Among all subjects 1.05 (0.80, 1.39) .71
Child ever used smokeless tobacco
Among all subjects 1.00 (0.39, 2.54) .99
Child and Parent Telephone Interviews
Intervention Arm Alcohol and Safety
Telephone Topics Tobacco
Parent Child Parent Child
Continued prevention communication
within family 97% 75% 77% 67%
Family policy with consequences in
place 50% 32% 46% 46%
Recent visit to pediatric practice 85% 83% 83% 85%
The project helps our family talk
about risks 89% 80% 85% 90%
The project has impact on me 66% 82% 76% 82%
TABLE 3. Baseline Demographic Characteristics
of Participating Children and Parents
Recommendations:
In light of the gravity of the prevailing situation, effective intervention strategies need to be implemented. Some of them include – “a legal imposition of minimum drinking age, screening and brief intervention, and increasing alcohol taxes” in order to discourage underage alcohol consumption and adverse health and social outcomes resulting from this it (Miller, et. al., .2007).
In addition to the above discussed school programs, the National Minimum Legal Drinking Age Act alongside the zero-tolerance laws have gone a long way in bringing down automobile accidents caused by teenagers. However, only a few more such intervention efforts have been implemented. Given that the few existing programs lack proper financial backing and wholehearted community involvement, a comprehensive plan of remedy is called for (Miller, et. al., .2007).
In all the existing programs, the role of Physicians and child-care professionals has been ignored. So, bringing them into the scheme of things would help achieve better results. For example,
“Some studies have shown that screening and brief intervention in medical settings may be helpful for youth who screen positive for alcohol problems. The American Academy of Pediatrics encourages clinicians to ask adolescents about their alcohol use, refer those adolescents with suspected drinking problems or other psychosocial problems for age-appropriate treatment, include guidance for substance abuse prevention in routine and episodic office visits, and encourage parental and community efforts to prevent underage drinking.” (Jones, 2001)
Conclusions:
Hence it could be concluded that the early intervention programs are generally quite successful and responsive. This should give pediatricians more confidence in referring dysfunctional families for the intervention services. However, more research and local evaluation efforts are called for to arrive at strategies that provide all families with timely and suitable preventative measures (Bailey, 2004).
Teenage alcoholism is also recognized as a significant public health problem across the United States. It is also a leading cause for youth violence, irresponsible social behavior, poor academic performance, suicidal tendencies and high-risk sexual behavior. Adolescents who indulge in drinking are also prone to substance abuse and attitude problems. If left unattended, they can grow to develop anti-social personalities and face psychological problems as adults.
Pediatricians need to review scrupulously the health promotion actions proposed nationally in light of limited funding. As projects that had appeal to families and clinicians both did not result in major improvements in safety and drug use behaviors when put to rigorous analysis. Prevention endeavors may be better if physicians rather combine their work with others members of the community to bring about coherent change to patients and families in varied settings (Jones, 2001).
References:
Emshoff, J G, & Price, A W (May 1999). Prevention and Intervention Strategies With Children of Alcoholics. Pediatrics, 103, 5. p.1112(1).
Miller, J W, Naimi, T S, Brewer, R D, & Jones, S. E. (Jan 2007). Binge drinking and associated health risk behaviors among high school students., Pediatrics, 119, 1. p.76(10)
Beich, A., Gannik, D., & Malterud, K. (Oct 19, 2002). Screening and brief intervention for excessive alcohol use: qualitative interview study of the experiences of general practitioners. (Primary care)., British Medical Journal, 325, 7369. p.870(3).
Palfrey, J S, Hauser-Cram, P., Bronson, M B, Warfield, M. E., Sirin, S., & Chan, E. (July 2005)., The Brookline Early Education Project: a 25-year follow-up study of a family-centered early health and development intervention. Pediatrics, 116, 1. p.144(9).
Bailey, D B, Hebbeler, K., Scarborough, A., Spiker, D., & Mallik, S. (April 2004). First experiences with early intervention: a national perspective. Pediatrics, 113, 4. p.887(10).
Stevens, M M, Olson, A L, Gaffney, C A, Tosteson, T D, Mott, L A, & Starr, P. (March 2002)., A pediatric, practice-based, randomized trial of drinking and smoking prevention and bicycle helmet, gun, and seatbelt safety promotion, Pediatrics, 109, 3. p.490(8).
Jones, J. (March 17, 2001)., New alcohol strategy being developed for England., British Medical Journal, 322, 7287. p.636.