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Recovery Month Toolkit 2004 Youth and Alcohol and Drug Use Disorders Download PDF version Download PDF version of " Recovery Month Toolkit 2004 Youth and Alcohol and Drug Use Disorders" (996 KB)


The following material on Youth and Alcohol and Drug Use Disorders was developed as part of our 2004 Recovery Month Toolkit

2004 National Drug and Alcohol Addiction Recovery Month (Recovery Month) Logo

YOUTH AND ALCOHOL AND DRUG USE DISORDERS

 

How Adults Can Help

 

Alcohol and drug use disorders, which include misuse, dependence, or addiction to alcohol and/or legal or illegal drugs, can isolate children and adolescents from their peers, family, and community, making it difficult for them to lead a normal, healthy childhood. This is true not only for those who are dependent on drugs and alcohol, but also for those with parental figures or siblings who have drug and alcohol problems. Preventing and overcoming these problems requires awareness, education, and dedicated support from family, mentors, schools, and the entire community.

 

The Scope of the Problem

 

Youth is a time of experimentation and learning about yourself and your society— and many young men and women who are exposed to drugs and alcohol give in to curiosity or peer pressure with potentially damaging results. The 2002 National Survey on Drug Use and Health conducted by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) found:

  • Among youths ages 12 to 17, 11.6 percent are illicit drug users, and 19.3 percent (7.2 million) of youths ages 12 to 20 are binge or heavy alcohol drinkers.1
  • One in 5 youths ages 12 to 17 has used marijuana.2
  • Cocaine has been used by 2.7 percent of youths ages 12 to 17. More than 11 percent of youths have used prescription pain relievers non-medically.3


Studies indicate that the younger a person begins using drugs or alcohol, the greater the chance that he or she will develop an alcohol or drug use disorder that will carry on into adulthood.4 Other risk factors for developing dependence on drugs or alcohol include family history of alcohol and drug use disorders, early aggressive behavior, lack of parental supervision, drug availability, and poverty.5

Youth dependence on alcohol or other substances often leads to academic difficulties, health-related problems, eating disorders, and criminal behavior—not to mention motor vehicle crashes, unwanted sex, and conflicts in social and family relationships. Youth with parental figures or siblings who have drug and/or alcohol problems also suffer consequences. For example, children of alcoholics exhibit symptoms of depression and anxiety more often than children of non-alcoholics.6

Some of the additional consequences that can occur among youths who develop alcohol and drug use disorders at a young age include depression, developmental delays, conduct problems, personality disorders, suicidal thoughts, apathy, withdrawal, and other psychological dysfunctions. Moreover, many youths who use alcohol and drugs engage in behavior that puts them at greater risk of HIV/AIDS and other sexually transmitted diseases, unintended pregnancy, and sexual violence.7

But there are positive signs that many young people are making smarter health decisions. Statistics show that use of marijuana, Ecstasy, LSD, cigarettes, and alcohol decreased significantly from 2001 to 2003 among 8th, 10th, and 12th grade students in U.S. schools, according to the National Institute on Drug Abuse's Monitoring the Future study.8

Still, there is much work to be done on this complex issue—specifically to help young people in need of treatment and recovery services and those who are suffering from co-occurring disorders, such as depression. Alcohol and drug use disorder treatment programs specifically designed for adolescents, as well as family-oriented approaches, can make a difference. For example, a national study of community-based treatment programs for adolescents found that reported weekly marijuana use dropped by more than half in the year following treatment. Results also showed a decrease in drinking, illicit drug use, and criminal involvement—in addition to better psychological adjustment and improved school performance.9

 

Access to Recovery

 

Currently, only 1 in 10 adolescents who has an alcohol or drug problem receives treatment for it—and only 25 percent of those receive adequate treatment to support sustained recovery.10 One of the barriers to achieving recovery is the limited availability of alcohol and drug treatment programs designed specifically to meet the complex needs of adolescents. Progressive assessment systems, funding to increase treatment capacity, recovery management check-ups, comprehensive services, and improved outreach from schools and healthcare professionals are among the essential components needed for an effective youth treatment and recovery system.11

Because alcohol and drug use disorders involve almost every aspect of an adolescent's life, the recovery process requires treatment tailored to the individual, taking into account factors such as severity of substance use, presence of co-occurring disorders, age, level of maturity, cultural background, gender, and family and peer environment. Once these factors have been assessed, the appropriate treatment and recovery services can be determined to meet the adolescent's needs.12 An emerging body of research and clinical experience supports the use of the Screening, Brief Intervention and Referral Treatment (SBIRT) approach for non-dependent persons who are experiencing problems related to the use of illicit drugs. More information about the SBIRT approach, an HHS/SAMHSA/CSAT program, can be found at http://ncadi.samhsa.gov/govpubs/BKD341/.

To address the need to improve access to individualized treatment programs, President Bush has developed Access to Recovery, a new initiative to increase the availability and effectiveness of treatment programs. By providing vouchers to people in need of treatment, the Access to Recovery grant program promotes individual choice for substance abuse treatment and recovery services. It also expands access to care, including access to faith- and community-based programs, and increases substance abuse treatment capacity.

 

Making A Difference: What Can I Do?

 

If you are a parent, a family member, a teacher, or someone else who spends time with youth regularly, there are things you can do every day—starting today—to touch the lives of the young people around you.

Embrace the power of parenting. Preventing, identifying, and treating a child's drug or alcohol use starts in the home—and a good relationship with a parent (or guardian) is the most underutilized tool in combating the problem. The National Youth Anti-Drug Media Campaign recommends that in addition to regularly observing his or her activities and behavior, you may wish to spend quality time with your child, hold family meetings, ensure that your children have some form of supervision between 3 p.m. and 6 p.m. instead of leaving kids alone after school, eat meals together as often as you can, consistently establish ground rules and expectations, and talk to your son or daughter about the dangers of drugs and alcohol.13 Research shows that youths are less likely to use a substance if they think their parents disapprove of it.14


Know the signs. You know your child best—so if he or she begins to exhibit unusual behavior, take notice. Warning signs that may indicate an adolescent's unhealthy alcohol or drug use include:

  • Sudden changes in personality with no known cause
  • Loss of interest in hobbies, sports, or other activities
  • Sudden decline in performance or attendance at school or work
  • Changes in friends and reluctance to talk about new friends
  • Deterioration of personal grooming habits
  • Forgetfulness or difficulty paying attention
  • Sudden aggressive behavior, irritability, nervousness, or giddiness
  • Increased secretiveness or heightened sensitivity to inquiry


Help make the treatment "fit." If you suspect that your child or a young person you know has an alcohol or drug problem, first consult a physician or other knowledgeable professional to have the child screened for alcohol and drug use disorders. Then help the young person and an age-appropriate treatment program. Ideally, the program should be tailored to the teen's gender, ethnicity, cultural background, family structure, cognitive and social development, and readiness for change.15 Some program and information resources are provided at the end of this document. There are "sober schools" that provide an alcohol- and drug-free learning environment available in some parts of the country for students in recovery. Additionally, because young people with an alcohol or drug use disorder frequently may have a mental disorder (this refers to any mental or emotional disorder, including eating, anxiety, mood and depression disorders, bipolar disorders, and schizophrenia), it is important to recognize the critical need for concurrent mental health treatment, both during and following treatment for their drug or alcohol problem.16


Lend your ears—and voice. Become a friend and mentor to a young man or woman you know. Offer advice, help with problems, act as an advocate, or simply listen to him or her. Children who live in alcohol- and drug-dependent families are particularly vulnerable and learn not to trust adults. By providing assurance and validation, you can counteract much of that mistrust and make a positive impact on a child's life.17 These children often need clinical intervention or counseling—so be alert to withdrawn or depressed behavior.


Go back to school—as a teacher (or volunteer). Approach school officials, the principal, school nurse, or teachers in your area and offer your talents within the school community. Additionally, educators can make a tremendous impact on their students' lives by modeling positive behaviors, providing guidance and support on a personal level, building self-esteem, and helping them make smart decisions.


 

Making a Difference: What Can Schools Do?

 

Schools can help those with alcohol and drug use disorders, co-occurring disorders, or parental figures or siblings with alcohol or drug problems by:

  • Providing student assistance programs to intervene and support students;
  • Training school staff to recognize the signs of substance use and mental disorders and how to respond, including providing appropriate referrals for students in need of treatment;
  • Providing strong "no-use" messages from preschool through the 12th grade tailored to the age, culture, and sophistication of the child;
  • Developing and enforcing strong substance use policies, balanced with strong educational and supportive strategies;
  • Improving and expanding existing prevention and intervention programs;
  • Creating a school environment that engages and supports parents (and other family members) in each child's education, and specifically in matters dealing with alcohol and drug use; and
  • Opening their doors to twelve step fellowships designed for youth.


School personnel also should foster positive student-staff interactions to encourage students to feel attached to their school, and help students build supportive peer groups so they can resist negative peer pressure.18 Schools and other institutions oriented to youth and young adults can find examples of successful interventions to address alcohol and drug use in SAMHSA's Model Programs (http://www.modelprograms.samhsa.gov). This index describes programs with proven strategies and techniques to improve key interpersonal, social, decision-making and academic skills, and performance. The Web site and companion publication outline the evidence-based programs in terms of age, gender, ethnicity, setting, outcomes, and costs.

 

Making a Difference: How Can I Contribute to Recovery Month?

 

Parents, teachers, youth group leaders, coaches, clergy, counselors, health professionals, social workers, and other people who interact with youth on a regular basis can use the following tools to contribute to and observe the 15th annual National Alcohol and Drug Addiction Recovery Month (Recovery Month) in September 2004.

  • MOTIVATION. Encourage young people in recovery who are willing to share their stories with peers to conduct presentations at area schools or author first-person accounts of their experiences in an article for a school or local newspaper.
  • EDUCATION. Create awareness and understanding among parents, guardians, and young people in your community by educating them about alcohol and drug use disorders.
  • Set up an educational booth in shopping centers and malls, grocery stores, public libraries, places of worship, county or state fairs, coffeehouses, bookstores, movie theaters, large-arena concerts, or other high-traffic areas in your community where young people like to gather.
  • Distribute fliers with information about effective treatment options and contact numbers for local recovery programs.
  • Conduct an informational seminar for parents, grandparents, step parents, foster parents, and legal guardians on how to recognize the signs and symptoms of alcohol and drug use disorders, what to do if they suspect their child has a problem, how to support children who have a close family member with a drug or alcohol problem, and where to turn for help in their community for counseling and treatment services.
    Publicize seminars through local newspapers and by posting fliers at area schools and in grocery stores, community centers, libraries, and other central locations.
  • TASK FORCES. Establish an alcohol and drug use disorder treatment task force to address alcohol- and drug-related issues in your community; and support and expand existing treatment and recovery services. Enlist the participation of leaders from the treatment community, local government, criminal justice system, religious institutions, social and child welfare services, educational system (including school committees), parenting organizations, people in recovery, and other relevant groups that care about young people and can contribute to this issue.
  • LOCAL SUPPORT. Work with a local youth-related organization to organize a poster, song, photography, or essay contest for young people during Recovery Month to highlight the importance of treatment for alcohol and drug use disorders and supportive services for affected family members. Call on area schools to encourage student participation, local radio stations to promote the contest to listeners as a public service, and local businesses to donate prizes.Go to the Recovery Month Web site at http://www.recoverymonth.gov (click on the 2004 icon and look under events) to get information about local events in your community. If no activities are scheduled, offer to help develop some. Community-based associations, foundations, local businesses, and faith-based organizations are some groups you can work with when organizing an event.
  • RESOURCES. SAMHSA resources, such as A Quick Guide to Finding Effective Alcohol and Drug Addiction Treatment (Publication Number: PHD877) and You Can Help: A Guide for Caring Adults Working with Young People Experiencing Addiction in the Family (Publication Number: PHD878), are available free to parents and other adults who need guidance on how to help young people cope with alcohol and drug problems. You can search for a treatment program near you by visiting the Web site http://www.findtreatment.samhsa.gov. Another SAMHSA resource is the Children's Program Kit: Supportive Education for Children of Addicted Parents (Publication Number: CPKIT). To order, call SAMHSA's National Clearinghouse for Alcohol and Drug Information (NCADI) at 800-729-6686 or 800-487-4889 (TDD).

For additional Recovery Month materials, visit our Web site at http://www.recoverymonth.gov or call 1-800-662-HELP.

 

YOUTH-RELATED RESOURCES

 

 

General Information

 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS)
Information and resources on alcohol and drug use disorders and health insurance/Medicaid issues
200 Independence Avenue SW
Washington, D.C. 20201
877-696-6775 (Toll-Free)
http://www.hhs.gov

HHS, Substance Abuse and Mental Health Services Administration (SAMHSA)
Information, research, and education on prevention, treatment, and rehabilitative services for alcohol and drug use disorders and mental illnesses
5600 Fishers Lane Parklawn Building, Suite 13C-05
Rockville, MD 20857
301-443-8956
http://www.samhsa.gov

HHS, SAMHSA National Clearinghouse for Alcohol and Drug Information
Comprehensive resources for drug and alcohol information
P.O. Box 2345
Rockville, MD 20847-2345
800-729-6686 (Toll-Free) 800-487-4889 (TDD) (Toll-Free) 877-767-8432 (Spanish) (Toll-Free)
http://www.ncadi.samhsa.gov/features/youth

HHS, SAMHSA Center for Mental Health Services (CMHS)
Child and adolescent mental health information
5600 Fishers Lane Parklawn Building, Room 17-99
Rockville, MD 20857
301-443-2792
http://www.mentalhealth.samhsa.gov

HHS, SAMHSA Center for Substance Abuse Prevention (CSAP)
Resources to improve accessibility and quality of substance use disorder prevention services
5600 Fishers Lane Rockwall II, Suite 900
Rockville, MD 20857
301-443-0365
http://www.samhsa.gov/centers/csap/csap.html

HHS, SAMHSA Center for Substance Abuse Treatment (CSAT)
Information on treatment programs, publications, funding opportunities, and resources
5600 Fishers Lane Rockwall II
Rockville, MD 20857
301-443-5052
http://www.samhsa.gov/centers/csat2002

National Council on Alcoholism and Drug Dependence, Inc.
Facts and information for youths and parents
20 Exchange Place, Suite 2902
New York, NY 10005-3201
800-NCA-CALL (Hope Line) (Toll-Free) 212-269-7797
http://www.ncadd.org/facts/index.html

 

Treatment

 

HHS, SAMHSA National Directory of Drug Abuse and Alcoholism Treatment Programs

SAMHSA National Helpline
Confidential information on substance use disorder treatment and referral
800-662-HELP (800-662-4357) (Toll-Free) 800-487-4889 (TDD) (Toll-Free) 877-767-8432 (Spanish) (Toll-Free)
http://www.findtreatment.samhsa.gov

Association of Recovery Schools
Supports students in recovery from alcohol or other drug dependence
117 Lyle Lane
Nashville, TN 37210
615-248-8206
http://recoveryschools.org

Physicians and Lawyers for National Drug Policy "Adolescent Substance Abuse: A Public Health Priority"
Recommendations for adolescent substance use problems
Center for Alcohol and Addiction Studies
Brown University Box G-BH
Providence, RI 02912
401-444-1817
http://www.plndp.org

Phoenix House
A non-profit substance use disorder treatment organization
164 West 74th Street
New York, NY 10023
212-595-5810
http://www.phoenixhouse.org

 

For Parents and Teachers

 

HHS, SAMHSA CSAP Web sites
Family Guide to Keeping Youth Mentally Healthy and Drug Free
http://www.family.samhsa.gov

U.S. DEPARTMENT OF EDUCATION (ED) Office of Safe and Drug-Free Schools
Information on drug-free school programs and activities
400 Maryland Avenue SW
Washington, D.C. 20202-6123
202-260-3954
http://www.ed.gov/offices/OESE/SDFS

U.S. DEPARTMENT OF JUSTICE (DOJ), Drug Enforcement Administration (DEA)
Parent-teacher resources
2401 Jefferson Davis Highway
Arlington, VA 22301
202-307-7936 (Office of Demand Reduction)
http://www.dea.gov/resources/parents_teachers.html

HHS, NIH National Institute on Drug Abuse (NIDA)
Information for parents and teachers
6001 Executive Boulevard Room 5213
Bethesda, MD 20892-9561
301-443-1124 Telefax fact sheets: 888-NIH-NIDA (Voice) (Toll-Free) or 888-TTY-NIDA (TTY) (Toll-Free)
http://www.drugabuse.gov/parent-teacher.html

National Education Association Health Information Network
Resources on youth alcohol and drug use prevention
1201 16th Street NW, Suite 521
Washington, D.C. 20036
202-822-7570
http://www.neahin.org/programs/substance/index.htm

Partnership for a Drug-Free America
Tips and resources for parents and caregivers
405 Lexington Avenue, Suite 1601
New York, NY 10174
212-922-1560
http://www.drugfreeamerica.org

 

Youth-Only Web Sites

 

HHS, NIH
Drug information for teens
http://teens.drugabuse.gov/

HHS, NIH, SAMHSA, National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Information on alcoholism and alcohol use
http://www.thecoolspot.gov

HHS, NIH, NIDA Information for Students
Research about the effects of drug use on the brain
http://www.drugabuse.gov/students.html

DOJ, DEA
Facts about drugs
http://www.usdoj.gov/dea/pubs/straight/cover.htm

National Youth Anti-Drug Media Campaign
Information on drugs for teens and inspiration to stay sober
http://www.freevibe.com
http://www.theantidrug.com

Drug Strategies
Anonymous, accurate information on drugs
http://www.bubblemonkey.com

National Association for Children of Alcoholics
Works on behalf of children of alcohol- and drug-dependent parents
http://www.nacoa.net/kidspage.htm

Children of Alcoholics Foundation
Break the cycle of parental substance abuse and reduce the pain and problems that result from parental addiction
http://www.coaf.org

 

Alcohol-Specific Information

 

HHS, NIH, NIAAA
Leadership to Keep Kids Alcohol Free Campaign Initiative to prevent alcohol use by children ages 9 to 15
c/o The CDM Group, Inc. 5530 Wisconsin Avenue, Suite 1600
Chevy Chase, MD 20815-4305
301-654-6740 301-656-4012 (Fax)
    http://www.niaaa.nih.gov/

HHS, NIH, NIAAA National Advisory Council on Alcohol Abuse and Alcohol Prevention
Task Force on College Drinking Research and information on college drinking
5635 Fishers Lane 6000 Executive Boulevard
Bethesda, MD 20892-9304
301-443-3860
http://www.collegedrinkingprevention.gov

Mothers Against Drunk Driving
Research and policy at the Federal, State, and local levels to stop drunk driving, support victims, and prevent underage drinking
511 East John Carpenter Freeway, Suite 700
Irving, TX 75062
800-GET-MADD (800-438-6233) (Toll-Free)
http://www.madd.org

National Association for Children of Alcoholics
Help for children affected by substance use disorders in the family
11426 Rockville Pike, Suite 100
Rockville, MD 20852
888-55-4COAS (888-554-2627) (Toll-Free)
http://www.nacoa.org

Child Welfare and Community Organizations

 

Child Welfare League of America
A membership organization of over 1,100 public and private non-profit agencies promoting the well-being of children, youth and their families, and protecting every child from harm
440 First Street NW, Third Floor
Washington, D.C. 20001-2088
202-638-2952
http://www.cwla.org

Children's Defense Fund
Child welfare and health programs
25 E Street NW
Washington, D.C. 20001
202-628-8787
http://www.childrensdefense.org

Community Anti-Drug Coalitions of America
A group that builds and strengthens the capacity of community coalitions to create safe, healthy, and drug-free communities
625 Slaters Lane, Suite 300
Alexandria, VA 22314
800-54-CADCA (Toll-Free)
http://www.cadca.org

Teen Challenge International
A dynamic network of 191 centers throughout the United States that provides youth, adults, and families with effective and comprehensive faith-based solutions to life-controlling drug and alcohol problems. Local centers provide a wide range of prevention services and residential recovery programs
5445 Chicago Avenue
Riverside, CA 92507
909-538-9615


 

Culture-Specific Information

 

Latino American Youth Center
Outpatient counseling services for Hispanic individuals, families, and groups
1419 Columbia Road NW
Washington, D.C. 20009
202-319-2225
http://www.layc-dc.org

National Asian Pacific American Families Against Substance Abuse
A private, non-profit membership organization that involves service providers, families, and youth to promote health and social justice and address the alcohol, tobacco, and other drug issues of Asian and Pacific Islander populations on the continental United States, Hawaii, the six Pacific Island jurisdictions, and elsewhere
340 East Second Street, Suite 409
Los Angeles, CA 90012
213-625-5795
http://www.napafasa.org

National Indian Child Welfare Association
Organization dedicated to well-being of Native Indian children and families
5100 SW Macadam Avenue, Suite 300 Portland, OR 97239
503-222-4044
http://www.nicwa.org

National Latino Children's Institute
Research, educational materials, programs, and services focused on Latino children
1325 North Flores Street, Suite 114
San Antonio, TX 78212
210-228-9997
http://www.nlci.org

Wellbriety for Youth Movement
Sobriety, recovery, prevention, and wellness learning resources for Native American youth
6145 Lehman Drive, Suite 200
Colorado Springs, CO 80918-3440
877-871-1495 (Toll-Free) 719-548-1000 (Office)
http://www.whitebison.org

Mutual Support Groups

 

Al-Anon/Alateen
Support for families and friends of alcoholics
Al-Anon Family Group Headquarters, Inc.
1600 Corporate Landing Parkway
Virginia Beach, VA 23454-5617
888-4AL-ANON/888-425-2666 (Toll-Free)
http://www.al-anon.alateen.org

Alcoholics Anonymous
Support group that provides sponsorship and a twelve step program for life without alcohol
475 Riverside Drive, 11th Floor
New York, NY 10115
212-870-3400
http://www.aa.org

Narcotics Anonymous
Organization for people recovering from a drug use disorder
P.O. Box 9999Van Nuys, CA 91409 818-773-9999
http://www.na.org

 

Sources

 

1Overview of Findings from the 2002 National Survey on Drug Use and Health. DHHS Publication No. (SMA) 03-3774. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies, 2003, pp. 4, 5.

2ibid, p. 5.

3ibid., pp. 37, 6.

4Adolescent Substance Abuse: A Public Health Priority. Providence, RI: Physician's Leadership on National Drug Policy, Center for Alcohol and Addiction Studies, Brown University, August 2002, p.1.

5Preventing Drug Use Among Children and Adolescents. NIH Publication No. 04-4212(B). Bethesda, MD: U.S. Department of Health and Human Services, National Institute on Health: National Institute on Drug Abuse, 2003, p. 8.

6Center for Substance Abuse Prevention (CSAP). Posted on CSAP's Web site at http://ncadi.samhsa.gov/govpubs/ms417/, September 28, 2000, para. 1.

7Ecstasy use falls for second year in a row, overall teen drug use drops. The University of Michigan Institute for Social Research. Press release. December 19, 2003. http://www.nida.nih.gov/Newsroom/03/2003MTFDrug.pdf, p. 1. Accessed February 24, 2004.

8Johnston, L.D., O'Malley, P.M. & Bachman, J.G.. Monitoring the Future: National Results on Adolescent Drug Use; Overview of Key Findings, 2002. NIH Publication No. 03-5374. Bethesda, MD: National Institutes of Health, National Institute on Drug Abuse, 2003, p. 3.

9Hser, Y., Grella, C., Hsieh, S., and Anglin, M.D. National Evaluation of Drug Treatment for Adolescents. Los Angeles, CA: University of California at Los Angeles Drug Abuse Research Center. Paper presented at the College on Problems of Drug Dependence Annual Meeting, June 1999, Slides 9-16.

10Adolescent Substance Abuse: A Public Health Priority, p.31.

11ibid, pp. 32-35.

12ibid, p. 23.

13Parents. The Anti-Drug. http://www.theantidrug.com/advice/tips_involved.html. Accessed February 1, 2004.

14Overview of Findings from the 2002 National Survey on Drug Use and Health, p. 25.

15Teen Tipplers: America's Underage Drinking Epidemic. New York, NY: National Center on Addiction and Substance Abuse, Columbia University, February 2002, p.50.

16Foxhall, K. Adolescents aren't getting the help they need. Monitor on Psychology 32(5), June 2002. http://www.apa.org/monitor/jun01/adolescents.html, para. 9-14. Accessed February 11, 2004.

17You Can Help: A Guide for Caring Adults Working with Young People Experiencing Addiction in the Family. DHHS Publication No. (SMA) 03-3785. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment, 2001, brochure.

18Malignant Neglect: Substance Abuse and America's Schools. New York, NY: National Center on Addiction and Substance Abuse, Columbia University, August 1997, p. 8. 
 
 



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