Prevention of adolescent chemical dependency

Chemical dependency is part of a significant pattern of serious health problems resulting from the breakdown of social control over impulsive, pleasure-driven adolescent behavior. The drug epidemic in North America, after two decades of relentless increases, shows encouraging signs that stopping it may be possible. Chemical dependency prevention became a serious concern in the 1970s in response to the rising drug epidemic. Initial efforts focused on drug-specific education in the mass media and in the schools. After discouraging and even counterproductive results, nonspecific or generic prevention efforts were tried in both areas. These efforts, too, did not prevent drug use or drug problems. More recently, using cigarette smoking prevention initiatives in schools as a model, hopeful results have been achieved. These efforts combine education about immediate negative effects of drug use with training in skills to resist peer pressure to use drugs. These efforts also build youth peer rejection of drug use. Promising a wider community effort to prevent chemical dependency are several macro prevention programs. These include efforts to decrease tolerance for drug use and to identify drug users in four specific areas: families, schools, highways, and the workplace. Chemical dependency can be prevented by a variety of interventions, including one-to-one encounters, school-based skills training, and society-wide initiatives to reject drug use. The teenage years are a time of unique vulnerability to initiation of drug and alcohol use. The clear goal of prevention is to help young people to survive these years without using drugs, including the gateway drugs: alcohol, tobacco, marijuana, and cocaine. The pediatrician can play a vital role in successful prevention activities with patients, with their families, in communities, and in the nation as a whole.