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Purpose – The purpose of this chapter is to provide a comprehensive overview of the substance use disparities among American Indian/Alaska Native (AI/AN) youth, the contributing factors to these disparities, proven and promising approaches through strengths-based methods, barriers to implementation of prevention and treatment efforts, and future recommendations for effective programs and research.

Approach – We have conducted a thorough literature review of relevant research studies, as well as a review of government, tribal, and community-based curricula and resources. This review of programs is not exhaustive but provides several examples of best practices in the field and suggestions for future directions.

Social implications – We strongly advocate that to accurately explore the true etiology of substance abuse and to respond to the concerns that AI/AN have prioritized, it is necessary to utilize a strengths-based approach and draw upon traditional AI/AN perspectives and values, and active community participation in the process. More specifically, prevention and treatment programs should use methods that incorporate elders or intergenerational approaches; foster individual and family skills-building; promote traditional healing methods to recognize and treat historical, cultural, and intergenerational and personal trauma; focus on early intervention; and tailor efforts to each Native nation or community.

Value – Ultimately, to reduce substance abuse disparities in AI/AN youth, we must find better ways to merge traditional Native practices with western behavioral health to ensure cultural competency, as well as to develop mechanisms to effect system- and policy-level changes that reduce barriers to care and promote the well-being of AI/AN youth, families, and communities.

With expanded technologic and communication resources there is growing awareness worldwide of the public health problems caused by alcohol, tobacco, and other drug use, misuse, abuse and addiction. Trends vary by culture and region but use of tobacco and alcohol is almost universal and is associated with high rates of mortality and morbidity. While nurses have not universally embraced the prevention and treatment of substance‐related disorders as their province, this is changing as a function of organisations, World Health Organization (WHO) and national initiatives, and the strengthening of nurse education. Actions to promote consensus, identify and review competencies for nurses must consider national and cultural variations, traditions of social change and the need for evidence‐based practice. Collective action by nurses in newly formed and existing organisations, which focus on addictions prevention and treatment, have resulted in initial professional steps. Such progress can be facilitated if achieved in the context of larger international policies and initiatives and in collaboration with members of other professional disciplines.

The drug abuse prevention research and practice community has recognized only in the past two decades the important relationship between findings from epidemiologic studies and the development of effective preventive interventions. Epidemiologic studies show what drugs are being used, in what ways, and by whom. They show the age at which most drug users initiate the use of illicit drugs and what characteristics and factors are most likely to be associated with increased risk to initiate drug use. This information and advances in understanding behavior change have had significant impact on the design of effective interventions to prevent drug abuse. This chapter discusses the relationship between epidemiologic and prevention intervention research in five section: (1) a brief history of drug abuse epidemiologic and prevention intervention research; (2) an overview of the epidemiology of drug abuse with an emphasis on the initiation of drug use among children and adolescents; (3) a discussion of the implications of epidemiologic findings for the design of prevention interventions; (4) a review of recent positive findings from prevention intervention research; and (5) a summary of gaps in our knowledge base requiring additional research.

The purpose of this case study is to examine the National Institute on Drug Abuse's (NIDA) use of its Sara Bellum Blog (SBB) as a means of engaging teens in the science behind drug abuse/addiction.

This case study presents how the SBB was conceptualized and is implemented. Metrics for monitoring the SBB are mostly qualitative and measure the extent of engagement (customer feedback, coverage by others).

Teens want to watch videos, see photos, hear real stories about other teens, be able to ask questions about drugs anonymously, not be preached to, and be stimulated to think for themselves. However, the extent of SBB comments was lower than expected. Multiple communication venues are needed, including engagement among intermediaries and role models for teens, such as teachers.

Data presented are process measures of use and types of use, not outcomes based.

The use of social media is a worldwide phenomenon, as is drug abuse among teens. Governments across countries can use lessons learned to inform the development of their own blogs and/or other social media tools.

While there are constraints on government agencies' use of social media, NIDA is a Federal institute that has found a way to communicate directly with teens about the sensitive topic of drugs. NIDA works with a Teen Advisory Group composed of a diverse representation of youth to inform the development of teen‐oriented messages and materials. NIDA fuses the use of social media across NIDA channels (Twitter, Facebook, YouTube) with science‐based information to empower teens to make healthy decisions.

All Stars Core is a school‐based drug abuse prevention program for 11 to 14 year olds from the United States. It focuses on five qualities that protect children from drug use: viewing drug use as uncommon and unacceptable to the peer group (norms); viewing drug use as interfering with future goals; commitment to avoid drug use; positive attention from parents; and feeling accepted at school. All Star Plus was recently developed with the goal of expanding the Core program to include the development of three competencies: goal setting, decision making, and skills to resist peer pressure resistance. Students either received All Stars Core, All Stars Plus, or were assigned to the non‐treated control group. Both programs outperformed the control group; however, All Stars Plus was more effective in preventing drug use than All Stars Core. All Stars Plus was found to reduce alcohol use, drunkenness, cigarette smoking, marijuana use, and inhalant use. The Plus program appeared to have achieved these outcomes by improving norms, increasing persistence in pursuing goals, and by increasing attention from parents.

The current study aims to examine the influence of contextual and provider‐level factors on the implementation fidelity of a research‐based substance abuse prevention program. Also, it aims to investigate whether two provider‐level factors, self‐efficacy and beliefs about the value of the program, statistically moderate and mediate the effects of a provider training intervention on implementation fidelity.

Using generalized mixed‐linear modeling, the authors examine relationships between program provider‐, organizational, and community‐level factors and implementation fidelity in a sample of 50 high school teachers from 43 high schools in eight states across the USA. Fidelity of implementation was assessed utilizing an observation procedure.

Implementation fidelity was negatively associated with the urbanicity of the community and the level of teachers’ beliefs about the value of the program, and positively predicted by the organizational capacity of the school. Comprehensive training significantly increased teachers’ self‐efficacy, which resulted in an increase in implementation fidelity.

School‐based prevention program implementation is influenced by a variety of contextual factors occurring at multiple ecological levels. Future effectiveness and dissemination studies need to account for the complex nature of schools in analyses of implementation fidelity and outcomes.

The authors’ findings suggest that both provider‐ and organizational‐level are influential in promoting implementation fidelity. Before implementation begins, as well as throughout the implementation process, training and ongoing technical assistance should be conducted to increase teachers’ skills, self‐efficacy, and comfort with prevention curricula.

The present study is one of the few to examine contextual and provider‐level correlates of implementation fidelity and use mediation analyses to explore whether provider‐level factors mediate the effects of a provider training intervention on implementation fidelity.

Considers a historical approach to the evolution of evaluation methods in alcohol and drug education in the present century. The transformations in this field can be analysed by considering two basic paradigms, the paradigm of didactic instruction and the socio‐psychological paradigm. Describes some of the main features of the two paradigms. Examines the conditions which led to the “crisis” of the paradigm of didactic instruction and the emergence of the socio‐psychological paradigm.

The purpose of this paper is to describe the topics covered by coaches assisting teachers implementing a research‐based drug prevention program and explore how coaching affects student outcomes.

The All Stars drug prevention curriculum is implemented by 16 urban teachers who received four coaching sessions. Two coaches participated. Coaches are interviewed by investigators to assess topics covered. Students completed pre‐test‐post‐test measures of mediators and substance use behaviours.

The average teacher is coached on 11.7 different topics, out of a total of 23 topics. Coaching topics most heavily emphasized include: introduction and wrap up; time management; general classroom management; teacher's movement around the class; asking open‐ended questions; using students' questions, comments and examples to make desired points; general preparation; engaging high‐risk youth; reading from the curriculum; implementing activities correctly; focusing on objectives and goals; maintaining a focus on the task; and improving depth of understanding. Seven coaching topics are found to relate to changes in student mediators and behaviour.

The current study is exploratory. Future research should explore how teachers develop the particular skills required by prevention programs and how coaches can assist them.

Five levels of skill development are postulated, which coaches may address: fundamental teaching skills, mechanics of program delivery, development of an interactive teaching style, effective response to student input, and effective tailoring and adaptation.

The paper is one of a very few studies that explores how coaching impacts outcomes in substance abuse prevention.

Services still have a long way to go in attracting and meeting the needs of black and ethnic minority drug users, while messages of health and prevention often go unheard or unheeded. In this new research Nirmal Kumari talks to young and old generic Indians1 to uncover very different perceptions of drug use. Understanding differences is vital to drug prevention and treatment. In this pioneering study, Kumari demonstrates how services can become culturally competent through research and training and by embracing new approaches to health and well‐being. Discover the practicalities of yoga and Ayurdeva in this unique blend of research, practice, mind, body and spirit.