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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.

The purpose of this study is to investigate foodservice industry employees’ experiences and perceptions related to substance abuse prevention measures in the workplace.

A qualitative approach was used for this foundational study, and data collection occurred by conducting in-depth interviews with 30 foodservice employees.

Participants reported that, in their perceptions, substance abuse prevention measures were virtually non-existent at their places of employment. The few participants that were aware of such policies indicated that they had never seen the policy actually enforced.

The results of this exploratory study suggest that foodservice employees may not be receiving adequate messages about workplace substance abuse prevention policies nor are they developing an adequate awareness of such policies. Further, where such policies are in place, they may not being adequately enforced, implying negligent business practices. Failure to display a presence and communication of workplace substance abuse policies and prevention efforts for this potentially high-risk population is both organizationally and socially irresponsible. Suggestions for the implementation of such harm reduction strategies are also provided, as is a call for further research conducted in a quantifiable method to offer more generalizable results.

No previous study has investigated employee awareness of substance abuse policies and prevention measures or harm reduction strategies in the foodservice workplace. This study provides a step toward understanding foodservice employee substance abuse and prevention that was previously lacking in the literature.

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 purpose of this paper is to explore whether there are ways in which the preventive strategies used to tackle volatile substance abuse (VSA) can be usefully applied to today’s new psychoactive substances (NPS).

In 2010-2013, with funding from the Big Lottery, Re-Solv, in partnership with St George’s, University of London, and educari, commissioned a re-analysis of both the mortality data relating to VSA and of the legislative and preventative measures taken that may have played a part in the steady downward trend in VSA mortality since. This paper is informed by Re-Solv’s research findings and the papers resulting from it, namely, Ives (2013) and Butland et al. (2013).

Efforts to reduce the harm from NPS could benefit from a re-examination of preventive approaches to VSA, which have resulted in a downward trend in mortality over the past two decades.

There is evidence from past prevention practice which could be relevant and applied to present day concerns about drugs and substances not previously available or used.

This is the first paper to explore how learning from VSA might be applied to NPS and the “legal highs” of today.

This paper aims to evaluate effectiveness of cognitive behavioral intervention (CBI) to prevent substance use among first-year university students at high risk of substance use.

Sixty university students at high risk for substance use recruited and assigned to CBI and control groups (30 students per groups). Intervention impact was assessed on measures of attitudes toward substance use at three time points: baseline, postintervention and three-months postintervention.

The analysis showed that participants’ negative attitudes toward substance use in the intervention group was increased post intervention. Although the mean score was significantly higher than the baseline (Time I) at Time II and dropped at Time III, the mean scores remained higher than time I, using repeated measure ANOVA (p < 0.05).

Findings of this study provide evidence that CBI is effective to sustain substance abstinence among this age group.

The paper is testing effectiveness CBI among a high-risk population of substance use. The study is highlighting the importance of sustaining substance abstinence using psychological preventive methods.

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.

Alcohol and cannabis are the two most commonly used substances by young people in many developed nations. The purpose of this paper is to explore the longitudinal relationships between risky substance use (binge drinking and cannabis use) and psychological distress, emotional and behavioural difficulties, and truancy among Australian adolescents.

A total of 527 students (Mage=13.4 years, SD=0.43; 67 per cent female) from seven Australian schools completed an online self-report survey on four occasions over two years (baseline, 6, 12 and 24 months). The survey assessed binge drinking (5+ standard drinks on one occasion), cannabis use in the past six months, psychological distress, emotional and behavioural difficulties (Strength and Difficulties Questionnaire), and truancy. Generalised estimating equations (GEEs) were conducted to examine the longitudinal relationship between the substance use outcomes and each predictor variable.

At baseline, 3 per cent of students reported binge drinking and 6 per cent had used cannabis in the past six months. Rates of binge drinking significantly increased over time (21.1 per cent at 24 months) however, rates of cannabis use remained relatively stable (8.8 per cent at 24 months). Multivariate GEE analyses indicated that higher levels of hyperactivity/inattention, more days of truancy and being female were independently and consistently associated with binge drinking over time. Conduct problems was the only factor to be independently associated with cannabis use over time.

These findings provide valuable information about psychosocial risk factors for harmful alcohol and cannabis use. A better understanding of these associations is critical for informing substance use prevention efforts in the future.

The purpose of this paper is to present a strategy for estimating an individual’s risk of alcohol, cigarette and cannabis use that relies on an assessment of an adolescent’s age, gender and attitude.

The authors assembled surveys from 35,987 11-17 year-olds from 36 databases to examine the relationship between attitude and behaviour.

Attitudes were strongly correlated with concurrent use of alcohol, drunkenness, smoking and cannabis, with correlations of −0.555, −0.517, −0.552 and −0.476, respectively. Logistic regression provided a means for using age, gender and attitudes to estimate an individual’s risk of engaging in substance use behaviour. Developmental changes in attitudes were estimated by analysing changes in scores associated with percentile rankings for each age and gender group. Projected year-to-year changes in attitude were used as a heuristic for estimating future risk.

Analyses relied on cross-sectional panel data. Analyses would benefit from longitudinal data in which age-related changes in attitudes could be more precisely modelled.

Information about estimated current and future risk may prove useful for motivating the adoption and implementation of effective prevention approaches by parents and care providers.

The authors present a novel method for estimating an individual’s risk of substance use knowing attitude, age and gender.

To be effective, evidence‐based programs should be delivered as prescribed. This suggests that adaptations that deviate from intervention goals may limit a program's effectiveness. This study aims to examine the impact that number and quality of adaptations have on substance use outcomes.

The authors examined 306 video recordings of teachers delivering “All Stars”, a middle school drug prevention program. Multiple observers coded each recording, noting the number and type of adaptation each teacher made. Each adaptation was given a valence rating. Adaptations that were deleterious to program goals received negative valence ratings; positive ratings were given for adaptations that were likely to facilitate achievement of program goals; neutral ratings were given to adaptations that were expected to have neither a positive nor negative impact on program goals.

All teachers made adaptations. Teachers were consistent across time in the types of adaptations they made, suggesting each teacher has a personalized style of adapting. Those who made few adaptations, and whose average adaptation was rated as being positive had a higher percentage of students who remained non‐drug users. In contrast, teachers who made many adaptations, whether their average valence rating was positive, neutral or negative, failed to have as many students remain non‐drug users. Measures of fidelity, including quality of delivery and teacher understanding, were related to valence of adaptations, with better performance related to making positive adaptations.

Through training and supervision, teachers should be guided and encouraged to follow programs directions, making few adaptations and ensuring that adaptations that are made advance the goals of intervention. Programs should define acceptable and unacceptable ways they may be adapted.

This study provides significant evidence about the challenges that face disseminated evidence‐based programs.