Substance Abuse Prevention and Education

Abstract

In the United States, substance abuse permeates society with tremendous intensity. This article introduces alcohol as a phenomenon that seeps into common, everyday functions (such as the US workforce) with remarkable acceptance. However, once the invisible line into dependency is crossed and alcohol usage becomes an addiction, insobriety is no longer condoned. Drug use is more concretely refuted due to its illegal status, although there has been heated disagreement on whether marijuana should be legalized. Drug and alcohol abuse patterns in the United States and the United Kingdom are presented, followed by social implications, such as violence, criminal activity, and incarceration. Based on "risky" behavior that accompanies substance abuse, preventative strategies are discussed, which include intervention through Boys & Girls Club involvement, Fetal Alcohol Syndrome prevention, and school-based initiatives that target children of alcoholics. Finally, "Amethyst Initiative" is highlighted, a controversial proposal set forth by several university presidents who would like the drinking age to be lowered to curb binge drinking among college students.

Overview

The Nature of Substance Abuse. In the United States, society transmits mixed messages about alcohol that simultaneously reward and admonish alcohol use. Alcohol is a legally sanctioned substance that commonly serves as a social lubricant to ease personal anxieties, promote uninhibited expressions of lighthearted conviviality, or temporarily reduce the edginess of life's harsh realities. Alcohol is a binding force that can unite people in communal celebration. For example, it is not uncommon for many corporate organizations to host regular happy-hour functions, during which employees intermingle to instill a relational alliance that might not organically flow within the confines of their departmental workspaces. In the absence of such pre-planned gatherings, staff members might initiate casual outings with their colleagues to unwind after a long and stressful day over cocktails and office talk, by rehashing the frustrations and scandals of their work lives. Additionally, annual holiday parties are frequently sponsored by company headquarters, in which good cheer and spirit are channeled through gala events that are elaborately furnished and sufficiently stocked with a variety of intoxicating refreshments.

Despite all the reinforcing alcohol-related references that correspond with corporate America, an implicit expectation mandates that employees refrain from crossing the obscured line into the realm of dependency. Workers who are deemed "heavy drinkers," or those who drink alcohol with frequent and overzealous fervor, constituted 9 percent of the full-time workforce as of early 2022 (Dryden, 2022). According to data from the Substance Abuse and Mental Health Services Administration (SAMHSA)'s National Survey on Drug Use and Health, about 45.1 percent of people aged twelve and older working full time had used alcohol heavily within the past month at the time of the survey in 2021 ("Highlights for the 2021," 2022). When their levels of productivity quantitatively or qualitatively decline, communication with coworkers and clientele becomes strained, or when they are habitually late or absent from work, they might find themselves subjected to on-site alcohol testing or referred to peer and/or employee assistance programs (EAPs) to mend faulty drinking patterns (American Addiction Centers, 2023; Elliott & Shelley, 2005; Greenwood, DeWeese, & Inscoe, 2005). Likewise, employers might commission punitive consequences such as withholding pay and other job-related privileges, or termination.

On an additional work-related note, there may be some connection between alcoholism and certain occupations, and Smith (2003) suggests that lawyers are more prone to falling into alcohol's titillating grip. Whereas 10 percent of the general population suffers from alcohol dependency, this rate skyrockets to 15 to 18 percent among attorneys, even up to 26 percent in select regions (e.g., Florida). The American Addiction Centers reported in 2022 that the rate of heavy drinking among lawyers to be more than double the national rate ("Alcoholism & treatment statistics," 2023). This is perhaps due to the demanding pressures that correspond with an attorney's characteristics, lifestyle, and work demands, in that the traits that make them successful in their field such as an argumentative deportment, workaholic tendencies, and a heightened ego, simultaneously prevent them from pursuing rehabilitative measures once their drinking patterns escalate to an unmanageable extent. Other industries with heightened rates of alcohol abuse include mining, healthcare, construction, hospitality, and the arts ("Alcoholism & treatment statistics," 2023).

The ramifications of drug abuse are just as daunting, although the illegal status of narcotics automatically thrusts illicit chemical dependency into a definitively unacceptable standing. Society demonstrates its defamation of drug usage by the harsh penalties that are placed upon offenders (Stephen, 2004), as well as political movements that indicate its reckless and unscrupulous eminence—such as Nancy Reagan's "Just Say No" campaign that saturated the 1980s ("Reagan, GOP," 1995). An exception to this statute is marijuana usage, which some people consider benign ("Legalizing Marijuana," 2002), which led to the decriminalization of the drug in several states, beginning in Colorado in 2012. According to Kirk Muse (2005),

"If marijuana were sold in licensed business establishments where it could be regulated, controlled, and taxed, the bootleg 'grow operations' would disappear in a heartbeat—just as our bathtub gin operations disappeared in a heartbeat when alcohol was relegalized" (p. 8).

The Case of Marijuana. Advocates of this process feel that court cases targeting marijuana offenders congest the legal system and assert that marijuana usage achieves certain medicinal purposes (McKinley, 2007). Contingent usage was supported by politicians in the early 2000s, such as former Washington DC mayor Marion Barry ("Barry endorses," 1997) and former US Representatives Barney Frank ("Medical-Marijuana," 2005) and Dennis Kucinich (Hardison, 2004). Critics of marijuana legalization pointed to health risks that accompanied its use, including stressful emotional withdrawal and cognitive impairment such as short-term memory loss and marred physical coordination that may interfere with driving (Joffe & Yancy, 2004). Furthermore, smoking marijuana damages lungs akin to long-term tobacco usage. In endorsing the legitimization of marijuana, many people pointed to the fact that marijuana has less perilous societal consequences than alcohol and is not as physically harmful or addictive as either alcohol or tobacco, rendering its slanderous reputation undeserved. However, Alain Joffe and W. Samuel Yancy pointed out that legal recognition of marijuana would not eradicate the ill effects of alcohol and tobacco. Quite the contrary, it would cause more collective health-related damage.

Regardless of the arguments for either side, as of 2016, as Schwadel and Ellison (2017) reported, at least twenty-five states and the District of Columbia had passed laws allowing the use of marijuana for medical purposes and another four (Colorado, Washington, Oregon, and Alaska) had legalized the use of the drug for recreational use. The authors also pointed out that polling services such as Gallup and Pew were finding that most Americans were in favor of the legalization of marijuana. While the exact reasons for such a change in attitude are unknown, by early 2023, thirty-seven states had legalized the use of medical cannabis. According to a Pew research study in 2021, 91 percent of Americans believed cannabis should be legalized to, at least, some degree, and 16 percent of Americans reported using the drug regularly (Avery, 2023).

In the twenty-first century, gender differences among substance abuse issues have come to light. In a nationwide poll examining substance abuse patterns among thirty-five-year-old Americans, a significant gender configuration emerged—men outnumbered women on heavy alcohol consumption (32 percent for men, 13 percent for women) and illicit drug use, including marijuana (13 percent to 7 percent) and cocaine (6 percent to 3 percent). However, women reported a slightly higher dependency (8 percent) toward prescription drugs compared to their male counterparts, whose reliance rate was 7 percent (Prevalence of Alcohol, 2004). Overall, 11.5 percent of men over 12 were reported to have a substance use disorder, compared to 6.4 percent of women. Differences in susceptibility, recovery, and risk of relapse were outlined by the Addiction center. Men are more likely to become addicts in general and are more likely to abuse substances because of peer pressure, and women are more likely to self-medicate and transition from substance abuse to dependence, than addiction. Men typically experience more intense withdrawal symptoms, but women are more likely to overdose or suffer side effects such as liver damage. Once in recovery, women are more likely to crave their drug of choice and relapse, while men experience longer periods of sobriety, on average. (Bezrutczyk, 2023).

Substance abuse patterns among adolescents in the United States slightly dropped between the 1990s and the early 2000s, although a considerable amount of youth still used drugs and alcohol. According to the 2011 Youth Risk Behavior Survey, 39 percent of high school students reported drinking within the past thirty days, and 40 percent had smoked marijuana at least on one occasion during their lives. By the time of the 2016 report, 63.2 percent of students responded that they had at least one drink of alcohol on at least one day during their lives and 38.6 percent reported that they had used marijuana at least once during their lives (Centers for Disease Control and Prevention, 2016). In 2021, 30 percent of female students drank alcohol in the thirty days prior to the survey, but the overall percentage of high school students who reported actively using alcohol decreased to 23 percent.

In a study conducted by Alastair Roy, Chris Wibberley, and Jon Lamb (2005) that took place over five years (1997–2001), students between the ages of fifteen and sixteen years old and enrolled in several Manchester schools were examined on both the prevalence of their current substance use, as well as their views surrounding such matters. During this five-year timeframe, there were several notable pattern shifts, particularly regarding an increase in cannabis usage, while alcohol consumption remained consistently high throughout the course of the study. For example, in 1997 the student body was polled, and 45.8 percent indicated that they had, at some point in their lives, experimented with cannabis, a figure that rose to 53.5 percent in 2001. During this same span of time almost all students had consumed alcohol at least once, including 97.4 percent in 1997 and 96.5 percent in 2001. Furthermore, there was an increase in ecstasy experimentation (3.2 to 8.3 percent), and a decline in amphetamine usage (23.1 to 8.3 percent). When asked if they agreed with the following statements about a hypothetical friend dabbling with cannabis, results changed significantly throughout the study's five-year duration. Statements included: "It wouldn't bother me, because I don't see anything wrong with it" -- with which student agreement increased from 47.7 to 58 percent over the five-year period, and "It wouldn't bother me, it's their choice, nothing to do with me"—which also grew substantially (60.6 to 76.7 percent). At the same time, results to the following statements decreased: "I would be worried and I'd talk to them, to try to stop them using it," (46 to 32.1 percent) and "I would be worried if they brought it into school" (67.6 to 54.8 percent) (Roy, Wibberley & Lamb, 2005, p. 310, Table III). While student attitudes toward substance abuse were not collected in the Youth Risk Behavior Survey, the data clearly indicated a decrease in the use of marijuana, illicit drugs, prescription opioids, and alcohol from 2011 to 2021 (Centers for Disease Control and Prevention, 2023).

Further Insights

Substance Abuse & Violence. Approximately 80 percent of domestic violence incidents involve the use of drugs (Juergens, 2023). Substance abuse and acts of violence have a significant correlation. In one study, researchers examined the relationship between these two phenomena ("Substance Abuse a Significant," 1997). Specifically, in Memphis, Tennessee, investigators examined a variety of demographics surrounding domestic abuse allegations. Upon reporting abuse to officials, both the perpetrators and victims were surveyed on significant information to elucidate the nature of their claims, including the types of substances in their blood systems at the time of the offense. The majority of these cases included a man attacking a woman with whom he was romantically/sexually involved. Two-thirds of the perpetrators had weapons, and 92 percent were under the influence of a mind-altering substance (i.e., alcohol and cocaine), or some combination thereof; 14 percent had used cocaine that day, while 86 percent had consumed alcohol. Conversely, the victims reported alcohol consumption at a 42 percent rate, and cocaine use at a 15 percent rate. Indeed, the Center for Substance Abuse Treatment (CSAT) corroborated the merge between domestic violence and substance abuse (Rose, 1998), indicating that anywhere between 25 to 50 percent of men charged with domestic violence also have a chemical dependency. As such, Rose recommends mental health professionals merge the two realms in terms of prevention and treatment, as opposed to approaching the two domains as though they were distinct entities.

For example, clinicians specializing in domestic violence should be aware of the diagnostic criteria involved in substance abuse, and substance abuse therapists should have a firm understanding of the red flags associated with behavior executed by both abusers and their victims. An essential statistic of which experts should be mindful is that a staggering 30 percent of women hospitalized for severe body trauma not accounted for by traffic accidents are victims of domestic violence. Rose indicates that while substance and domestic abuse are both serious issues, matters that relate to a person's imminent safety are of utmost importance and should be subsequently followed by substance-related inquiries and intervention.

Logically, an increased tendency toward violence predisposes substance abusers to engage in augmented levels of criminal behavior, and various research findings support this premise (Copur, Turkcan, & Erdogmus, 2005). For example, an estimated 25 percent of the violent crimes that take place in Sweden are instigated by those with alcohol and drug dependency ("Substance Abuse Linked," 2004). Likewise, 54 percent of Canadian inmates were under the influence at the time of their arrest, 38 percent of them were addicted to alcohol and drugs together, and it is estimated that this chemically dependent population engages in the highest frequency of weekly criminal activity (7.1 violations). The following table offers a more precise interaction between drugs, alcohol, and crime ("Canadian Study," 2002, p. 3):

According to Steven Belenko and Jordan Peugh (1998), 47 percent of Americans are under the influence of drugs or alcohol at the time of their arrest, which can be explicated from various angles. Being intoxicated can provide an inborn alibi to their wrongdoings (e.g., "it wasn't me, it was the alcohol"). Moreover, alcohol lowers inhibitions while neurologically altering brain chemicals that heighten aggressive tendencies, and drug and alcohol use blurs social cues that contribute toward misconstruing other people's behavior and motivations. Alcohol tempers frontal lobe functioning, which, under normal circumstances, enables people to adequately interact with unforeseen circumstances. Belenko and Peugh surmise that 80 percent of prisoners have substance abuse problems, while only one in six inmates receive sufficient care during their incarcerated terms, causing escalated recidivism rates. They suggest that it would behoove correctional facilities to invest $6,500 on psychological, educational, treatment-based, and aftercare programs for each inmate; in the long run this would save $68,800 per person that the government would otherwise extend toward ongoing litigious matters. Furthermore, they calculate that if only 10 percent of the prison population successfully enacted this plan, it would prove to be financially prudent. Of particular concern is their approximation of the exponential growth of prison populations. They hypothesize that if incarceration rates continue to incline in accordance with its current pace, 20 percent of Americans that were born in 1997 will be imprisoned at some point in their lives.

Preventative Strategies. Alcohol and drugs allow people who would otherwise be categorized as law-abiding citizens to engage in "risky" behavior, and teenagers seem particularly vulnerable to sacrificing sensible behavior under such circumstances (Rashad & Kaestner, 2004). According to research by Kaiser Permanent, five million young adults engaged in unprotected sex while they were intoxicated ("Substance Abuse," 2002). Also, according to research by Laura Kann and her colleagues (2000), 33 percent of teenagers reported that they had been passengers in vehicles driven by an inebriated driver, and 13 percent had gotten behind the wheel themselves after drinking or drugging. According to the CDC survey in 2016, 20 percent of high school students reported riding in a vehicle at least once with a driver who had been consuming alcohol and 7.8 percent of those who had driven a car in the previous month reported that they had driven at least once when they had been drinking (CDC, 2016). As such, many preventative strides have been undertaken by researchers and clinicians to pinpoint demographic characteristics that make certain populations vulnerable to the lure of substance abuse and to mitigate prospective involvement in the drug and alcohol underground.

Tena L. St. Pierre and colleagues (2001) conducted a substance abuse prevention study in which they targeted second- and third-grade students who came from low-income neighborhoods, since this population typically has higher rates of risk factors that predispose a person toward substance use. The students in the study were no exception, in that their social-skill set, communication, and decision-making proficiencies were laden with aggressive or disruptive undertones, and both they and their parents lacked involvement in the educational process. Further, parent-child bonds tended to be severed, parenting skills and discipline tactics initiated by parents were less than desirable, and the neighborhoods in which families resided were riddled with drug use and sales.

The SMART Framework. To combat the unpropitious environmental forces with which these students continually contend, they were enlisted to participate in the Boys & Girls Club to examine situational factors that might absolve their desolate situations. To impart that which was deficient in these children's lives, a trifold SMART framework was used as the primary source of intervention. The three components of the SMART model included a SMART kids faction that focused on pro-social enrichment and supplemental educational services (e.g., tutoring), and SMART teachers who served to monitor student progress and mediate between the school and home. Finally, SMART parents concentrated on establishing a positive sense of kinship toward families who otherwise sat on the outskirts of community affairs, while instilling proactive parenting skills. After two years of such involvement, the program proved to enhance children's ability to distance their involvement in behavioral wrongdoings, refine decision-making skills, improve respectful interactions with authority figures, ameliorate their overall ethical demeanor, and even demonstrate certain academic advancements. These developmental strides were primarily conveyed through both the SMART kids and teachers' components, although parental involvement was less consistent based on the busy schedules of both the program coordinators and the parents themselves (St. Pierre, Mark, Kaltreider, & Campbell, 2001).

Fetal Alcohol Syndrome. Fetal Alcohol Syndrome (FAS) is a physical condition that develops in utero, during which time the fetus is exposed to harmful alcoholic properties. It is one syndrome in the group of disorders called fetal alcohol spectrum disorders (FASD), in which a child experiences "issues with growth, central nervous system problems, facial feature differences, and problems with attention span, learning, vision, and hearing." In 2018, FASDs—Fetal Alcohol Syndrome, Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure, Alcohol-Related Birth Defects, and Alcohol-Related Neurodevelopmental Disorder—were estimated to impact 3 to 5 percent of infants born in the United States (Wisner, 2023). There are distinct physical characteristics that children who suffer FAS tend to possess, including a smaller physique, cranial abnormalities, and intellectual disabilities, as well as central nervous system damage that manifests through infant irritability, hyperactivity, and seizures. The time at which the mother drinks alcohol depends on the type of FAS symptoms that will abound. For example, the first trimester of a baby's development equates with the formation of the skull, and mothers who drink alcohol during this period increase the risk that their child will have a smaller head and abnormal facial features. Brain development takes place during the second and third trimesters, and women who drink during this time frame expose their unborn children to potential cognitive deficiencies. Long-term behavioral problems associated with FAS include school-related complications and increased interpersonal difficulties (Elliott, Payne, Morris, et al, 2008; Niccols, 2007; Sigelman & Rider, 2012; Wacha & Obrzut, 2007).

Society shoulders the responsibility of creating programs to enhance the lives of FAS children through various social service initiatives. According to Burgess (1994), schools should apply preventative educational techniques toward children who struggle with FAS. FAS kids who score within the normal range of intellectual functioning still struggle to stay afloat academically, due to the neurological damage that affects their decision-making and judgment skills; the discrepancy between average test scores and low performance generates labels such as "lazy" and "unmotivated." Moreover, FAS children tend not to appropriately correlate causal connections between behavior and punishment and to repeat mistakes and social errors, leading adults to classify them as spitefully errant. Burgess suggests that school officials should recognize this population's specific needs, encourage their progression toward independence, and create programs and curricula to reiterate skills that come naturally to mainstream students, such as cause-and-effect sequences.

Additionally, researchers have studied the preventative attempts to curb or eliminate the occurrence of FAS through a wide range of strategies. Hankin (1994) studied protective mechanisms that inhibit pregnant women from drinking, including the 1989 mandate that the US Surgeon General brandish warning labels on beer, wine, and liquor bottles regarding the harmful health effects that are imparted onto unborn children. Incidentally, these precautionary measures effectively dissuaded "non-risk" drinkers from alcohol consumption; unfortunately, "high-risk" drinkers were not discouraged from ingesting such toxic beverages. Hankin also compiled a list of several successful FAS outreach programs including a training program for helping professionals on the ways they can deter drinking among pregnant women, including non-disparaging counseling techniques that served to enhance women's self-esteem and cognitive-behavioral techniques extended to women who had already given birth to a FAS child in an attempt to restrain them from drinking during future pregnancies.

Educational Approaches. Boulter (2007) organized a FAS prevention research project geared toward seventh- and ninth-grade students that was disseminated by older high school students who were working under a college faculty mentor. Participants underwent an informative presentation highlighting the damage a mother transmits to her unborn fetus when she consumes alcohol. Visual demonstrations included dropping a raw egg, which presenters likened to a developing brain, into a cup of alcohol so that students could witness its dissolution. Students were then tested on their knowledge surrounding FAS facts, provided with life-sized dolls that visually depicted the physical deformities FAS children bear, and engaged in a question-answer forum. Six weeks later, students were given a follow-up post-test that measured their long-term retention on such matters, which revealed significant improvements, particularly among older female students. Results overall were quite favorable, and students summoned the following information from the presentation:

"… more students knew that no amount of alcohol is safe, more than half of women in the early weeks of pregnancy are consuming alcohol, the debilitating physical, cognitive and behavioral effects of FAS and FAE, the purpose of liquor store warning signs, that the alcohol content in various alcoholic beverages is really the same, and that there is no cure for FAS" (Boulter, 2007, p. 16-17).

Geralyn Timler and Lesley Olswang (2001) carried out a qualitative research project whereby they investigated the home and school environments of a young child stricken with FAS to understand preemptive educational approaches that would assist his development. The boy, Ian, was eight years of age, had been adopted by a woman named Brenda, and was enrolled in a first-grade special education class at the time that the research was collected. Ian's IQ fell within normal parameters (Verbal: 81, Performance: 90, Full Scale: 83) although his behavior was interspersed with frequent outbursts, a distracted attention span, lack of intrapersonal control, and non-compliant conduct. Brenda explained Ian's behavior through a neurologically defective lens and felt that, through no fault of his own, Ian simply lacked the ability to comprehend certain directives. Moreover, she felt that the positive strides Ian made at school resulted from the vigilant structure that his special education program provided, and she felt as though he would only thrive in subsequent endeavors while under the watchful surveillance of such supervision.

On the other hand, Ian's teacher felt as though Ian had increasingly improved throughout the course of his enrollment in her program, and that this progress would surpass the confines of her class and merge nicely into the future on which he would embark. Despite these divergent views surrounding Ian's ability, the researchers reflected that Ian would excel in an academic setting in which his mother proactively collaborated with teachers through a process called "priming." Priming requires teachers to inform FAS parents ahead of time what the following day's curriculum will entail, and that parents should "prime" their children on such lectures beforehand. For example, if on Tuesday the child is scheduled to learn about "photosynthesis," the child and his parent should review core concepts on Monday night.

In an analysis of data from surveys conducted by the SAMHSA between 2009 and 2014, around one in eight children in the United States were being raised in households with at least one parent who had a substance use disorder in the previous year (Lipari & Van Horn, 2017). By 2022, this figure was estimated at one in ten (Buddy, 2022). Alcoholic parents are often ill-equipped caretakers and more prone toward becoming abusive, which increases the likelihood that their children will eventually suffer from psychological ailments such as depression, anxiety, or low self-esteem. These problems are not exclusive to the home but rather transcend into auxiliary realms of functioning such as school and peer interaction. These effects have a range of outcomes on children, some of whom are more inclined to experiment with substances themselves, others may become "parentified," or assume excessive responsibilities that surpass those that a normal child would undertake. Children are frequently shamed and worried by their parents, who tend to accrue more legal infractions due to their irresponsible lifestyles, which consequently renders these kids helpless, hopeless, or even feeling guilty that they were unable to superimpose more stability into their parents.

Viewpoints

Although research targeting children of alcoholic parents burgeoned during the 1980s and 1990s, relatively few prevention programs were developed. Of those that did exist, Pim Cuijpers (2005) categorizes the objectives that successful programs tend to collectively possess, such as social support, information, skills training, and coping skills elements. Programs reach out to children from various angles, some of which exist through school-based initiatives such as SMAAP, the STAR-project, and 'Images within.' SMAAP, for example, offers children eight film-based lessons during their formative years. According to two distinct program evaluations, the following analyses offer feedback on SMAAP's success rates:

• "Positive effect on: coping, depressive symptomatology, help seeking. No effect on self esteem" (Roosa et al., as cited in Cuijpers, 2005, p. 472)," and
• "Significant effects on knowledge and coping. Stronger effects in high-risk group" (Short et al., as cited in Cuijpers, 2005, p. 472)."

Substance abuse is a complex phenomenon that carries grave consequences, and many experts continually search for preventative strides to diminish its seductive appeal. A controversial measure has been taking place for many years on several US college campuses to combat drinking among college students. While the magnitude of college students partaking in on-campus libation has remained steady, the amount of binge drinking has progressively increased, which yields destructive results including an annual death toll of 1,825 students directly pertaining to alcohol-induced behavior as of 2015 (National Institute on Alcohol, 2015). Those with alcohol use disorder have a death rate 50 to 100 percent higher than the national average (Bezrutczyk, 2023).

In response to this dangerous trend, a group of one hundred US university presidents rallied together in an attempt to lower the drinking age from twenty-one to eighteen years of age, in a movement titled "Amethyst Initiative" (Waddell, 2008). The theory behind Amethyst Initiative is that underage college students are naturally drawn to the "forbidden fruit," or that which is deemed racy or verboten. Moreover, because these young students are unable to attend alcohol-centered outings at nearby bars and clubs, they relegate themselves to quarantined dorm rooms where they overindulge in drugs and alcohol while "the coast is clear," or outside the bounds of authoritative command. Proponents of the Amethyst Initiative theory point to European countries that generally have younger drinking age restrictions, where parents can model appropriate drinking behavior at home, and that these firsthand demonstrations prevent the emergence of binge-drinking patterns once the living arrangements of young adults become autonomous. This theory is not fool-proof, and some experts fear that granting eighteen-year-old high school students with the ability to access alcohol would encourage younger high school students to follow suit. Moreover, traffic accidents are significantly altered based on the drinking age—in 1984, the drinking restriction was raised from eighteen to twenty-one years and fatal car accidents dropped 16 percent. There is a possibility that if the Amethyst Initiative was enacted, this pattern might reverse itself. In 2023, the movement's petition was available for individuals to sign on their website.

Terms & Concepts

Amethyst Initiative: A group of one hundred US university presidents who have rallied together to advocate for lowering the drinking age in the United States from twenty-one to eighteen years of age.

Employee Assistance Program (EAP): Programs to help employees grapple with various problems, including substance abuse.

Fetal Alcohol Syndrome (FAS): A physical condition that develops in utero, during which time the fetus is exposed to harmful alcoholic properties.

Priming: An educational method that requires the teacher to inform FAS parents ahead of time what the following day's curriculum will entail so that parents can "prime" their children on such lectures beforehand.

SMART Framework: A tri-fold framework that was used as a primary source of intervention in a study conducted by Tena L. St. Pierre and colleagues (2001) that consisted of kids, teachers, and parents.

SMAAP: A preventative program for children of alcoholics that offers eight film-based lessons.

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Suggested Reading

Conyers, B. (2021). Addict in the family: Stories of loss, hope, and recovery (2nd ed.). Hazelden.

Fisher, G. L. & Harrison, T. C. (2018). Substance abuse: Information for school counselors, social workers, therapists, and counselors (6th ed.). Allyn & Bacon.

Gewin, A. M., & Hoffman, B. (2016). Introducing the cultural variables in school-based substance abuse prevention. Drugs: Education, Prevention & Policy, 23(1), 1–14. Retrieved January 10, 2018, from EBSCO Online Database Sociology Source Ultimate. http://search.ebscohost.com/login.aspx?direct=true&db=sxi&AN=112191518&site=ehost-live&scope=site

Jewell, R. (2005). My way out: One woman's remarkable journey in overcoming her drinking problem and how her innovative program can help you or someone you love. Capalo Press.

Watson-Thompson, J., Woods, N. K., Schober, D. J., & Schultz, J. A. (2013). Enhancing the capacity of substance abuse prevention coalitions through training and technical assistance. Journal of Prevention and Intervention in the Community, 41(3), 176–187. Retrieved October 29, 2013, from EBSCO online database SocINDEX with Full Text. http://search.ebscohost.com/login.aspx?direct=true&db=sih&AN=88089341