Substance abuse has the identifying characteristics of other major diseases: it is primary, chronic, treatable, and can be fatal if not treated. Treatment of substance abuse also parallels treatment strategies of other major diseases; treatment is coupled with measures to prevent spread of the disease. Using the public health model of preventive medicine (see Bloom, 1981) the tertiary prevention level focuses on the post-acute patient who is suffering from the residual effects of the disease. Efforts are directed toward preventing further deterioration and promoting remission and rehabilitation. The secondary intervention level aims at detection of preclinical states where disease symptoms are not yet obvious. Assessment for secondary intervention focuses on "at risk" populations and the contributing pathological conditions. Primary intervention focuses on the prerequisite conditions that precipitate the disease with emphasis on general measures such as education and social services to intercept the pathogenic agents.
The preventive intervention model assumes that the disease symptoms and causes are understood, but the disease of substance abuse is as complex as the individuals affected by it. No one model has been developed that fully explains the cause of substance abuse. Present theories are bound by reductionist interpretations from different disciplines. Psychological theories tend to focus on the individual rather than on environmental and cultural contributors to individual behavior. Sociological theories tend to focus on external factors, which has the effect of ignoring individual differences.
This study stems from a larger, multiyear psychosocial study of emergent adolescent drug involvement that considers both the environment and the intrapsychic forces as they interact on the individual. The study has tracked students from the fifth grade and is following them through completion of the ninth grade. The cross-sectional findings were derived from analysis of sample data collected when the youths were in the seventh and eighth grades. The central question addressed is: How well does the integrated psychosocial model explain adolescent drug involvement?
PSYCHOSOCIAL FACTORS RELATED TO ADOLESCENT DRUG USE
A review of the literature on adolescent drug and alcohol use and abuse was conducted prior to the study and the development of data collection instrumentation. Aside from the basic demographic information of age, sex, and race, the factors related to adolescent drug use fell into two major categories: external (labelled externalities) or the environmental, and internal (labelled internalities) which are the intrapsychic characteristics and qualities of the individual.
Externalities influence the child's developing self-concept and establish boundaries for acceptable behavior. The range of influences on adolescent drug use are representative of three sociological theories: social control theory (Hirschi, 1969); social learning theory (Bandura, 1977); and subcultural theory (Cohen, 1955; Miller, 1958). Common among these theories is the assertion that outside forces (e.g., community, peers, family, school, organizations) affect the adolescent's emerging behavioral patterns in the direction of socially acceptable behavior if the youth is sufficiently bonded to persons or organizations that adhere to normative expectations. Insufficient bonding and/or bonding with those that do not adhere to normative expectations leads to criminal or aberrant behavior such as drug use and abuse. The association between drug use and social bonding with drug-using peers has been found in several studies. Ried, Martinson, and Weaver (1987) observed that association with drug-abusing peers and having a favorable attitude toward drug use accounted for fifty-five percent of the variance in drug use, with peer association accounting for twice as much variance as favorable personal attitude. …