Lecture 1 Creation of 21st Century Addiction Science Rico Catalano Professor

1. Confederation of Northwest Addiction Research Centers: Addiction: Mechanisms, Prevention, Treatment, Conjoint 556 Lecture 1 Creation of 21st Century Addiction Science Rico Catalano Professor School of Social Work 543-6382

2. Con federation of Addiction Research Centers 150 faculty Major grants from NIAAA, NIDA, and NIMH UW Centers: Addictive Behaviors Research Center Alcohol and Drug Abuse Institute Center for Drug Addiction Research Center for Functional Genomics & HCV-Related Liver Disease Center for Healthcare Improvement for Addictions, Mental Illness and Medically Vulnerable Populations Center for the Study of Health & Risk Behaviors Fetal Alcohol and Drug Unit Fetal Alcohol Syndrome Diagnostic & Prevention Network Innovative Programs Research Group Reconnecting Youth Research Group Social Development Research Group

3. Why is Addiction a Problem? • Rates of alcohol, tobacco and other drug use begin early and increase through the mid 20’s • Early use increases the risk of addiction • Consequences of alcohol, tobacco and drug use are great. • Addiction affects all strata of society • Costs of addiction are high including death, lost productivity, costs to society and families

4. Prevalence of Binge Drinking, Tobacco Use, Marijuana Use, and Other Drug Use

5. Why is Addiction a Problem? • Rates of alcohol, tobacco and other drug use by children and adolescents and young adults are high • Early adolescent use increases the risk of addiction • Alcohol, tobacco and drug use have negative consequences. • Addiction affects all strata of society • Costs of addiction are high including death, lost productivity, costs to society and families

6. Adolescent Binge Drinking Trajectories

7. Both Early Chronic Bingers and Increasers had Problems at Age 21 • Early Chronic Bingers fewer completed high school, more were obese, and more had hypertension • Increasers were more likely to have a diagnosis of alcohol abuse or dependence Hill, et al. 2000

8. Why is Addiction a Problem? • Rates of alcohol, tobacco and other drug use by children and adolescents and young adults are high • Early use increases the risk of addiction • Consequences of alcohol, tobacco and drug use are great. • Addiction affects all strata of society • Costs of addiction are high including death, lost productivity, costs to society and families

9. Why a New Addiction Science • Research conducted over the last thirty years has identified reliable predictors of use and addiction in the social environment and the individual • New research over the last 20 years has begun to identify biological and genetic factors involved in addiction processes • Research over the last 20 years has identified effective prevention and treatment programs to reduce problem use and addiction

10. The health and behavior problems of concern to us are predicted by malleable risk and protective factors in social environments and individuals.

11. Community Family School Individual/Peer

12. Protective Factors Individual Characteristics • High Intelligence • Resilient Temperament • Competencies and Skills In each social domain (family, school, peer group and neighborhood) • Prosocial Opportunities • Reinforcement for Prosocial Involvement • Bonding • Healthy Beliefs and Clear Standards

13. Prevalence of 30 Day Alcohol Use by Number of Risk and Protective Factors

14. Prevalence of 30 Day Marijuana UseBy Number of Risk and Protective Factors

15. Prevalence of Any Other Illicit Drug Use(Past 30 Days)By Number of Risk and Protective Factors

16. Prevalence of “Attacked to Hurt”By Number of Risk and Protective Factors

17. Prevalence of Other Problemsby Number of Risk Factors Bond, Thomas, Toumbourou, Patton, and Catalano, 2000

18. Number of School Building Risk Factors and Probability of Meeting WASL Standard (10th Grade Students) Arthur et al., 2006

19. Number of School Building Protective Factors and Probability of Meeting WASL Standard (10th grade students) Arthur et al., 2006

20. Why a New Addiction Science • Research conducted over the last thirty years has identified reliable predictors of use and addiction in the social environment and the individual • Research over the last 20 years has begun to identify genetic and neurobiological factors involved in addiction processes • Research over the last 20 years has identified effective prevention and treatment programs to reduce problem use and addiction

21. Candidate genes have been identified

22. Table 1. Genes having one or more variants that have been reported to be associated with one or more addictions. Kreek et al. (Nature, Dec 2005) provides a reasonable list of candidate genes for substance use.

23. Why a New Addiction Science • Research conducted over the last thirty years has identified reliable predictors of use and addiction in the social environment and the individual • New research over the last 20 years has begun to identify biological and genetic factors involved in addiction processes • Research over the last 20 years has identified effective prevention and treatment programs to reduce problem use and addiction

24. Ineffective Prevention Strategies Universal Prevention • Peer counseling, mediation, positive peer culture • Non-promotion to succeeding grades • After school activities with limited supervision, programming • Drug information, fear arousal, moral appeal. • DARE Selected, Indicated Prevention • Gun buyback programs • Firearm training • Mandatory gun ownership • Redirecting youth behavior • Shifting peer group norms • Neighborhood Watch U.S. Surgeon General, U.S. Department of Health and Human Services, 2001; National Institute of Justice, 1998; Gottfredson, 1997.

25. Prenatal & Infancy Programs Early Childhood Education Parent Training After-school Recreation Mentoring with Contingent Reinforcement Youth Employment with Education Organizational Change in Schools Classroom Organization, Management, and Instructional Strategies School Behavior Management Strategies Classroom Curricula for Social Competence Promotion Community & School Policies Community Mobilization Wide Ranging Approaches to Prevention Have Been Found To Be Effective

26. Why We Need a New Addiction Science • Although efficacious preventive and treatment interventions have been identified, many individuals do not respond to these interventions • It is likely that there are important neurobiological differences that contribute to this non-response • We need a better understanding of the neurobiological-environment interaction as well as the neurobiological-environment-development interaction in order to develop more effective preventive and treatment interventions

27. Genetic Influences Twenty-first Century Addiction Science is Needed to Identify the Role of Genetic, Individual and Environmental influences • Persistent Problem Use: • Alcohol • TobaccoMarijuana Consistent+ FamilyManagement Individual Differences e.g.,BAS

28. Genetic Influences Behavioral Activation Syndrome (BAS) may be genetically influenced (Reuter, et al. 2005). Individual Differences BAS

29. Alcohol Dependence Symptoms Age 27 Does BAS predict Alcohol Dependence Symptoms in Adulthood? BAS 8th and 9th Grades (ages 14-15)

30. BAS is predictive of Alcohol Dependence Symptoms at age 27  = .11, p < .008 controlling for ethnicity, poverty and gender

31. Consistent+ FamilyManagement Alcohol Dependence Symptoms Age 27 Does Consistent Good Family Management Moderate this Effect? ? BAS

32. Family management practices moderate the effect of BAS on Age 27 Alcohol Dependence Symptoms  = .15, p < .01  = -.010, ns Interaction,  = -.28, p < .003

33. Genetic Influences Twenty-first Century Addiction Science is Needed to Identify the Efficacy of Interventions to Effect Individual and Environmental Influences on Addiction • Persistent Problem Use: • Alcohol • TobaccoMarijuana ? ? ? ? Intervention Consistent+ FamilyManagement Individual Differences e.g.,BAS

34. Cigarette Use Marijuana Use Other Illicit Drug Use Patterns of Use Change over the Course of Development and Provide Clues to the Timing of Influences and the Intervention Binge Drinking

35. Snowball: Risk Accumulates through Early Developmental Challenges without Protection Snowstorm: Extended Exposure to Positive Norms and Models of Problem Behavior without Protection Community Peers School Parents 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Factors Shaping Child and Adolescent Development

36. Applying Advances in Prevention Science to Children and Adolescents: The Seattle Social Development Project Richard F. Catalano, Ph.D Director Social Development Research Group School of Social Work University of Washington www.sdrg.org

37. Intervention Spectrum Treatment Prevention Case Identification Standard Treatment for Known Disorders Maintenance Compliance with long-term treatment (goal: reduction in relapse and recurrence) Indicated Selective After-care (including rehabilitation) Universal Source: Institute of Medicine (1994). Reducing risks for mental disorders: Frontiers for preventive intervention research. Patricia J. Mrazek & Robert J. Haggerty, Eds. Washington DC: National Academy Press

38. Prevention Science Framework Program Implementation and Evaluation Interventions Identify Risk and Protective Factors Define the Problem Response Problem

39. Prevention Science Research Advances Etiology/Epidemiology of Problem Behaviors • Identify risk and protective factors that predict problem behaviors and describe their distribution in populations. Efficacy Trials • Design and test preventive interventions to interrupt causal processes that lead to youth problems. Prevention Services Research • Apply lessons learned about etiology and effective interventions in real world settings.

40. Risk Factors Addressed by Seattle Social Development Project Family X X X School X X X Individual/Peer X X X

41. Prevention Science Research Advances Etiology/Epidemiology of Problem Behaviors • Identify risk and protective factors that predict problem behaviors and describe their distribution in populations. Efficacy Trials • Design and test preventive interventions to interrupt causal processes that lead to youth problems. Prevention Services Research • Apply lessons learned about etiology and effective interventions in real world settings

42. Seattle Social Development Project(SSDP) Investigators: J. David Hawkins, Ph.D. Richard F. Catalano, Ph.D. Karl G. Hill, Ph.D. Richard Kosterman, Ph.D. Robert Abbott, Ph.D. Social Development Research Group School of Social Work University of Washington 9725 3rd Avenue NE, Suite 401 Seattle, Washington 98115 Funded by: National Institute on Drug Abuse, National Institute on Mental Health, Office of Juvenile Justice and Delinquency Prevention, Robert Wood Johnson Foundation

43. Seattle Social Development ProjectIntervention Components • Component One:Teacher Training in ClassroomInstruction and Management • Component Two: Parent Trainingin Academic Support and Behavior Management • Component Three:Child Social and Emotional Skill Development

44. Teacher Education Proactive classroom management (grades 1-6) • Establish consistent classroom expectations and routines at the beginning of the year • Give clear, explicit instructions for behavior • Recognize and reward desirable student behavior and efforts to comply • Use methods that keep minor classroom disruptions from interrupting instruction Interactive teaching (grades 1-6) • Assess and activate foundation knowledge before teaching • Teach to explicit learning objectives • Model skills to be learned • Frequently monitor student comprehension as material is presented • Re-teach material when necessary Cooperative learning (grades 1-6) • Involve small teams of students of different ability levels and backgrounds as learning partners • Provide recognition to teams for academic improvement of individual members over past performance

45. Parent Education Raising Healthy Children (grades 1-2) • Observe and pinpoint desirable and undesirable child behaviors • Teach expectations for behaviors • Provide consistent positive reinforcement for desired behavior • Provide consistent and moderate consequences for undesired behaviors Supporting School Success (grades 2-3) • Initiate conversation with teachers about children’s learning • Help children develop reading and math skills • Create a home environment supportive of learning Guiding Good Choices (grades 5-6) • Establish a family policy on drug use • Practice refusal skills with children • Use self-control skills to reduce family conflict • Create new opportunities in the family for children to contribute and learn

46. Social, Cognitive and Emotional Skills Training • Listening • Following directions • Social awareness (boundaries, taking perspective of others) • Sharing and working together • Manners and civility (please and thank you) • Compliments and encouragement • Problem solving • Emotional regulation (anger control) • Refusal skills

47. Support Structures • School Staff • 5 days of teacher training • Coaching by teacher trainer • Principal support • Family • Training in each parenting curriculum • Family support coordinator

48. SSDP Design • Initiated in 1981 in 8 Seattle elementary schools. • Expanded in 1985, to include 18 Seattle elementary schools to add a late intervention condition and additional control students. • Quasi-experimental study • Full treatment (grades 1-6) = 149 Late treatment (grades 5-6) = 243 Control = 206

49. Middle High Elementary Adult SSDP Panel Retention MEANAGE G2 10 11 12 13 14 15 16 (17) 18 21 24 27 30 N 808 703 558 654 778 783 770 -- 757 766 752 747 720 % 87% 69% 81% 96% 97% 95% -- 94% 95% 93% 93% 91% Interview completion rates for the sample have remained above 90% since 1989, when subjects were 14 years old.

50. Late Full Intervention Full Intervention Control Control SSDP Changed Risk, Protection and Outcomes • Intervention has specific benefits for children from poverty through age 18. • More attachment to school • Fewer held back in school • Better achievement • Less school misbehavior • Less drinking and driving • By the start of 5th grade, those in the full intervention had • less initiation of alcohol • less initiation of delinquency • better family management • better family communication • better family involvement • higherattachment to family • higherschool rewards • higherschool bonding • By age 18 Youths in the Full Intervention had • less heavy alcohol use • less lifetime violence • less lifetime sexual activity • fewer lifetime sex partners • improved school bonding • improved school achievement • reduced school misbehavior Hawkins et al. 1999, 2005; in press; Lonczak et al., 2002. • By age 21, broad significant effects were found on positive adult functioning: • more high school graduates • more attending college • more employed • better emotional and mental health • fewer with a criminal record • less drug selling • less co-morbid diagnosis of substance • abuse and mental health disorder • At the end of the 2nd grade • boys less aggressive • girls less self-destructive • By age 27, continuing significant effects were found on mental health and risky sexual activity: • fewermental health disorders and symptoms • fewer lifetime sexually transmitted diseases Late Grade Age