Issue Editors’ Notes

The use of psychoactive substances, such as cigarettes, alcohol, or cannabis, is a widespread phenomenon in adolescence around the globe (and in particular in the westernized world). Based on data of the World Health Organization (Health Behavior in School-aged Children Survey) on adolescent substance use within various European countries, Canada, and the United States, among fifteen-year-olds, about 30 percent reported first smoking at age 13 or younger.1 In addition, 20 percent smoke at least once a week. With regard to alcohol use, 26 percent of fifteen-year-olds drink alcohol at least once a week. About 15 percent (in the same age group) reported first drunkenness at age 13 or younger and 33 percent have been drunk at least twice. Regarding cannabis use, this study showed that about 18 percent of fifteen-year-olds have ever consumed cannabis in their lifetime, with a recent prevalence of 6 percent (during the past thirty days). Longitudinal studies demonstrate that prevalence, frequency, and amount of substance use increase across adolescence and early adulthood.2 Thus, although there are differences in prevalence rates and consumption habits between countries, the use of psychoactive substances, it seems, is initiated in adolescence, when consumption habits develop.3 In addition, substance use seems to represent a rather normative behavior in adolescent girls and boys. Because in particular the use of legal substances (alcohol and cigarettes) is often culturally accepted, a clear demarcation between use, misuse, and abuse is needed. However, such differentiation is difficult to establish during adolescence, because clinical classification systems (such as ICD-10 or DSM-V) are more focused in their diagnosis on adults (that is, symptoms such as tolerance development are difficult to apply to youth).4 In addition, adolescents have a reduced ability to make the right decisions in situations that have a high affective loading and they are more risk-prone due to age-typical restructuring of the brain.5 Applying a developmental perspective, problematic use or misuse of psychoactive substances can be defined as early and high substance use, characterized by physical dependence and an increase in dosage. Such usage patterns cause impaired life circumstances and are linked to emerging compromises to deal successfully with environmental challenges (such as school or interpersonal stress).6 They also relate to negative short- and long-term consequences for various aspects of individual psychosocial adaptation in adolescence and adulthood. In addition, problematic use or misuse is associated with high costs for the individual, the community, and (inter)national economy. The WHO, for instance, identified alcohol as the third and cigarette use as the seventh highest risk for premature death and loss of life quality.7 Consequently, scientists, politicians, school communities, and the public are alert to the issue of youth substance abuse, so that there is a high interest in generating new insights into the developmental history of adolescent substance use, and the development and implementation of effective prevention measures. The field of prevention science is a relatively young research area that has gained in importance during the last three decades. Ferrer-Wreder and colleagues state that recently prevention work with adolescents reached an unexpected level of scientific activity.8 Prevention science has played a role in health care and hygiene systems for several centuries. Today, prevention is understood based on the ecological model that interprets the development of problems and illness as a product of a dynamic interaction of the person with various interwoven levels of the environment such as family, peer group, or school.9 In this person–environment interaction, adolescents take on an active role in order to promote their own development.10 Furthermore, the development of problem behavior is considered to be influenced by multiple factors (that is, risk and protective factors as targets of interventions).11 Prevention science today aims at generating knowledge and measures to work against the development of problem behavior, such as early and high adolescent substance use, by developing programs based on a strong theoretical basis and evaluated based on rigorous research design. In this volume, we aim to bring together international experts in the areas of prevention, health, and developmental science, all relating to adolescent substance use. In the first section, theories and models explaining adolescent substance misuse will be summarized and their relevance for prevention will be discussed (Chapters 1–3). In the second section, examples of excellent theory-based and effective programs that were evaluated by applying state-of-the-art methods in the United States and Europe are introduced, along with descriptions of programs and findings (including results on mediators and moderators of effectiveness; Chapters 4–7). In the final section of this volume, selected topics such as economic aspects (Chapter 9) and issues of dissemination of interventions into practice (Chapter 8) are discussed. The focus of this volume lies explicitly on intervention attempts within schools, reflecting one of the most important development contexts of adolescents, where they spend many hours per day with same-aged peers and (optimally) under the influence of positive adult role models. In addition, trained teachers might be particularly effective program facilitators, and (because of compulsory school attendance) entire cohorts of adolescents can be reached. Programs delivered to all youth in a school have been shown to be an effective model of universal, primary prevention of substance use. Chapter 1, by Marloes Kleinjan and Rutger C. M. E. Engels, provides an overview of health consequences, determinants of adolescent substance use, and a short summary of the effectiveness of prevention attempts, thereby demonstrating that, for instance, risky peer associations and low bonding to normative instances are important risk factors promoting adolescent substance use, which can be targeted within preventions attempts in school. In Chapter 2, by Nathaniel R. Riggs, David S. Black, and Anamara Ritt-Olson, a neurodevelopmental theory is applied to school-based substance use prevention. The authors discuss the specifics of brain development during adolescence and its relation to emotional regulation, decision making, and risk behavior, and apply these results to intervention issues. They discuss the usefulness of modern neurocognitive models in prevention attempts in schools (for example, by promoting mindfulness through strengthening directed attention and awareness). Chapter 3, by Steve Sussman and Adam Leventhal, focuses on a particular risk factor, namely anhedonia (that is, the inability to experience pleasure in positive life events). Anhedonia is related to certain central nervous system particularities and is a risk factor for drug addiction. Sussman and Leventhal apply these findings in the development of school-based intervention efforts to permit individuals to tolerate low levels of pleasure without resorting to drug use or to counteract anhedonia by enhancing the individual's capacity to experience pleasure (for instance by behavioral activation). Chapter 4, written by Gilbert J. Botvin and Kenneth W. Griffin, introduces the school-based Life Skills Training for preventing substance misuse by enhancing individual and social competence. In this chapter, the theoretical foundations and development of the Life Skills Training are described, and associated findings from the evaluation studies are summarized. This program is one of the most successful preventive attempts against early and problematic substance use in youth in the United States and, as is shown, it exerts long-term effects and produces costs savings of as much as $38 for every dollar invested. Chapter 5, by Federica D. Vigna-Taglianti, Maria Rosaria Galanti, Gregor Burkhart, Maria Paola Caria, Serena Vadrucci, and Fabrizio Faggiano, reports on a European school-based program for substance use prevention (“Unplugged”). This program is based on the social influence approach and addresses social and personal skills knowledge and normative beliefs. The program has been implemented and evaluated across various countries within Europe. Based on the analysis, an impressive cross-national sample, the authors demonstrate that the Unplugged program is effective in the short term, with the possible exception of differential findings with regard to gender and SES. Chapter 6, by Karina Weichold, reports on the German life skills program IPSY (Information + Psychosocial Competence = Protection). IPSY is based on the WHO's life skills approach aiming at the promotion of generic intra- and interpersonal life skills, substance-specific skills, school bonding, knowledge, and the prevention of substance misuse with a focus on alcohol and cigarettes. Guided by models of translational research dealing with the conditions of a successful translation of ideological findings into evidence-based prevention programs, this chapter summarizes the development and evaluation of the IPSY program with regard to long-term general effects, mediators and moderators of program effectiveness, and cross-cultural transferability. Chapter 7, by Phyllis L. Ellickson, reviews findings of the positively evaluated project ALERT and discusses what follows after one has shown that a drug prevention program is effective. The author lists ways to enhance the attractiveness of a prevention program to potential users (for instance, school authorities or teachers), not only through training and technical assistance but also through continuous support of the implementing teachers, including the dissemination of user-friendly materials. Chapter 8, by Metin Özdemir and Fabrizia Giannotta, takes an even broader perspective on the dissemination of evidence-based programs, focusing on researcher–practitioner collaboration. The authors suggest developing a holistic assessment system to evaluate risk for substance use problems and readiness for change processes (that is, implementing programs against it) in a given institution. In addition, they call for models to improve implementation quality and to stimulate new research foci within prevention (that is, identify mediators of program effects in order to select and distribute the most effective program components). Chapter 9 of this volume, by Tina M. Olsson, Laura Ferrer-Wreder, and Lilianne Eninger, applies economic analysis to the evaluation of school-based intervention against youth substance use. The authors demonstrate that economic analyses of school-based prevention efforts are often undertaken only as secondary research, thus they suffer from various restraints (for instance, measures on costs and benefits). Accordingly, prevention scientists should be trained in economic evaluation as part of their regular education so they can integrate key economic evaluation markers into existing standards of intervention trial reporting. In summary, this volume combines basic research with its application in the area of adolescent substance use with a focus on the school context, applying an international and interdisciplinary approach. The content of this volume is relevant not only for scientists but also for people working in schools who are engaged in the promotion of positive health outcomes in youth. In this volume, we offer new insights into the etiology of adolescent substance use, with the overarching aim to bring effective evidence-based well-evaluated prevention programs into widespread practice. Karina Weichold is an interim professor and the current head of the Department of Developmental Psychology, and a scientific member of the Center for Applied Developmental Science of the University of Jena, Germany. Fabrizia Giannotta is a researcher at the Center for Developmental Research at the Örebro University, Sweden.

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