that problem behaviors frequently co-occur in adolescents, it has also been used to understand and address problematic involvement with alcohol and other drugs of abuse. Patterson and colleagues (Dishion, Patterson, Stoolmiller, & Skinner, 1991; Patterson, DeBaryshe, & Ramsey, 1989) are proponents of a developmental theory of conduct problems that posits that adolescent problem behavior is a consequence of poor parental family management practices interacting with the child's own aggressive and oppositional temperament. Here, temperament refers to the early and genetically determined behavioral characteristics that over time and life experiences evolve into personality. Deficits in parenting skill, such as harsh and inconsistent punishment, increased parent–child conflict, low parental involvement, and poor parental monitoring, result in school behavior and performance problems. The poorly performing and poorly behaving child may be socially rejected by average children, but he or she forms close friendships with other problematic children. This process of forming close peer relationships is augmented by the negative interactions with caregivers in the home.

As the child affiliates with more deviant children, he or she adopts deviant behavior as a norm and becomes less involved in home life. Other deviant children become powerful social role models from whom the child learns further deviant and socially unacceptable behavior, including experimentation with drugs of abuse. Early experimentation has consistently been found as a risk factor for later problematic involvement with a wide variety of drugs. These children may therefore be viewed as being on a developmental trajectory of deviancy and substance abuse that begins in infancy and is compounded by unskilled parenting and the formation of social relationships with other problem children (Vuchinich, Bank, & Patterson, 1992).

Prevention interventions based on this theoretical approach offer parenting skill training to teach parents more effective ways to discipline and monitor their children and reduce the negative environment of the home. Tutoring and other forms of education support may be provided to reduce academic failure. Social skills training may also be offered the child to reduce normal peer rejection and provide a mechanism to gracefully resist peer pressure to use alcohol and illicit drugs.

Plutarch noted 2,000 years ago that alcohol problems run in families (“Drunkards beget drunkards”; Plutarch, The Training of Children, 110 CE). More recently, research continues to demonstrate that there is significant familial aggregation of substance use disorders. If substance abuse problems run in families, then there must be some familial influence on the development of these problems. The behavior genetic theory proposes that those factors that are transmitted within families tend to make family members more similar on a given characteristic such as substance abuse. These within-family factors can be genetic, since parents, children, and siblings share about 50% of their genes; or they can be nongenetic. These nongenetic family factors include the modeling of behaviors, the teaching of values and beliefs, parenting practices, the structure of the home environment, the quality of neighborhood, and the standards of the society at-large in which the family lives. Those factors experienced uniquely by each family member tend to make family members different from each other. These nonshared factors include peers, work, school, and all aspects of life experiences outside the family. In families where there is little substance abuse but there is an adolescent with substance problems, it is less likely to be due to a family factor than to an unshared factor outside the family. If there are many within the family with substance abuse problems, then these are likely to be due to something in the family—either genes, the home environment, or the complicated effects of genes and environment working together.

Substantial evidence suggests that substance abuse, for both adolescents and adults, is a complex trait. However, while research clearly reveals that genes are an important determinant for substance abuse problems, it does not tell us which genes. For other complex traits such as high

blood pressure or diabetes or high cholesterol, it is clear that there are multiple genes involved and multiple genetic and biological pathways are involved in producing disease. It is unlikely that there is a single gene for alcoholism or cocaine dependence or cigarette addiction. There may be hundreds or thousands of genes in a given pattern producing risk, and that risk may only be present in a given environmental context. The nature of the genetic risk may be a common factor for abuse across a wide variety of drugs or a genetic risk for conduct difficulties or problem behaviors, or a set of genes that delay the maturation of the brain so one is less able to control the habituating effects of drugs. The effects of genes may be protective rather than associated with risk, and what we think of as genetic effects producing substance abuse may actually be the absence of protective genes. There is good evidence that specific genetic mutations protect against the development of alcoholism in certain ethnic groups, and some evidence that there is a mutation that protects against smoking.

Universal intervention programs are designed to reach the general population, such as all students in a given school or school district, through media campaigns, for example. Broadly speaking, universal interventions represent the most widely utilized approach to drug abuse prevention. In a review of major findings of research on adolescent risk, Jamieson and Romer (2003) have recommended special focus on universal interventions, indicating that they have “great promise.” They specifically note that early and continuous universal interventions that encourage mature decision making and healthy choices among youth have considerable potential. From a universalist intervention perspective, public health problems and their solutions are inextricably a part of the community social system; solutions are essentially universal, with some types of universal interventions facilitating access to higher-risk groups within the community that may warrant more intensive intervention. Im

plementation of these types of interventions is typically supported by local community partnerships or coalitions.

The largest group of universal programs is the in-school intervention, typified by the well-known original Drug Abuse Resistance Education (DARE), a school-based primary drug prevention curriculum designed for introduction during the last year of elementary education. DARE is the most widely disseminated school-based prevention curriculum in the United States. Despite its popularity, independent evaluations of DARE have failed to demonstrate its effectiveness (Clayton, Cattarello, & Johnstone, 1996; Lynam et al., 1999). Recently, an enhanced version of DARE has been developed and tested (DARE Plus). Additional components added to the original DARE curriculum include a peer-led parental involvement classroom program called “On the VERGE,” youth-led extracurricular activities, community adult action teams, and postcard mailings to parents. Evidence suggests that DARE Plus produced significant reductions in alcohol, tobacco, and polydrug use among boys; but had no effect on girls (Perry et al., 2003).

Other school-based universal programs provide more promising results for both boys and girls. For example, the Life Skills Training Program (Botvin, Baker, Dusenbury, Botvin, & Diaz, 1995) emphasizes teaching of drug resistance skills, self-management skills, and general social skills in the junior high school classroom setting. The program has been shown to demonstrate significant reductions in drug experimentation among student participants.

Another important group of universal interventions are family focused. An example of this type of intervention that has been rigorously evaluated and found to be effective is the Strengthening Families Program: For Parents and Youth 10–14 (SFP 10–14; Kumpfer, Molgaard, & Spoth, 1996; Molgaard & Kumpfer, 1995). Implementation of the SFP 10–14 entails seven sessions occurring once a week for 7 weeks. The SFP 10–14 has separate sessions for parents and children that run concurrently for 1 hour and focus on skills building. During the second hour parents and children participate together in a joint hour-long family session, during which they practice the skills learned in their preceding, separate sessions. The family session affords the opportunity for higher-risk families and those with special needs to identify available services. In addition, the family session includes activities designed to encourage family cohesiveness and positive involvement of the child in family activities. For the parental sessions the essential content and key concepts of the program are also presented on videotape. Further details regarding the SFP 10–14 is provided in published reports (Spoth, Guyll, & Day, 2002; Spoth, Redmond, & Shin, 2000, 2001; Spoth, Reyes, Redmond, & Shin, 1999).

Yet another group includes interventions that combine school-based interventions with those engaging parents and sometimes other community institutions. An example of this type of expanded program is Project STAR (Pentz et al., 1989). This approach attempts to involve the entire community with a comprehensive school program, a mass media campaign, a parent program, a community organizing component, and health policy change component. Project STAR has been shown to be effective in terms of reductions in drug use behavior in high school for those youth that began the program in junior high school.

In addition to these interventions, there are universal interventions that have made use of mass media in a primary role, either in one community or, in the most interesting cases, nationwide, to address drug use. Below is a discussion in some detail of a universal intervention in the form of mass media campaigns.