DROPOUTS AND SUBSTANCE USE

The Monitoring the Future project (High School Senior Survey) and other studies of school-age youths have helped us to understand the substance-use patterns of Adolescents who remain in and graduate from high school. In contrast, not nearly as much is known about the substance use of those who become high school dropouts. Nonetheless, by putting together evidence from a variety of sources, including the National Household Survey on Drug Abuse and the Epidemiologic Catchment Area surveys sponsored by the U.S. government, it is possible to say that high school dropouts are much more likely to have started using Tobacco, Alcohol, and other drugs, as compared with their peers who remained in school. There also is some evidence that dropping out of high school is associated with an increased risk of adult-onset alcohol-dependence syndromes, even among persons whose dropping out could not have been caused by the consequences of starting to drink during the adolescent years. Whether this conclusion also holds for adult-onset Dependence on other drugs such as Cocaine or Marijuana is not yet clear but is under study.

In trying to understand how it might happen that dropouts are more likely to be substance users, the possibility should be considered that substance use has caused some people to drop out of school, as well as the possibility that some schools suspend or expel students for smoking tobacco, drinking alcohol, or using other drugs. By themselves, these circumstances could be enough to explain why high school dropouts are more likely to have taken illicit drugs or started underage smoking or drinking.

In addition, when students drop out before graduating from high school, they often begin spending more time with older youths and adults, some of whom serve as role models for substance use and who may give the dropouts cigarettes or offer them opportunities to try alcohol or other drugs for the first time. As a result, not only is there the possibility that substance use may lead to dropping out, but it is also possible that dropping out may lead to substance use.

More complicated possibilities must also be taken into account. A developmental perspective makes it possible to imagine that the greater frequency of substance use among high school dropouts might have its origins in the earlier years of childhood, so that it is not a simple matter of substance use leading to dropping out, or dropping out leading to substance use. For example, it has been found that youngsters who frequently broke rules, got into fights, and had trouble adapting to elementary school were more likely to become heavy drug users ten or more years later. Conduct problems at school are other signs that help to predict who will drop out before completing high school. This provides some evidence that sometimes there can be an underlying common cause in earlier stages of growth and development and that it is essential to consider these earlier stages in observing a link between later substance use and dropping out of school.

Working along these lines, Judith Brook and her research team have looked into school grades and poor school achievement with the idea that students who did not do well in elementary school might be at greater risk for later drug use, in the same way that not doing well in school was a sign of greater risk for dropping out. Her research group also sought to determine whether later improvements in academic performance might modify the risk profiles of low achievers in primary school.

In studying a large sample of school-age youth from primary school through high school, this team of researchers has found a moderately strong linkage between early poor school achievement and later drug use, but also discovered that the linkage was substantially weaker when low achievers in primary school did much better in later school years. This type of developmental evidence is important and needs to be replicated by others before strong conclusions can be drawn. It does suggest that it might be possible to use achievement-strengthening programs not only to reduce school dropout rates but also to reduce rates and levels of teenage drug use.

Several research groups are carrying out rigorous field experiments to see whether intervention programs directed at entire classrooms of first- and second-graders might change their risks for later drug use, conduct problems, and dropout rates. These very early interventions are not drug-education classes. The first- and second-grade teachers are working with the students to help promote their learning and school achievement in new ways and to help them behave themselves and adapt better to the rules of the elementary school classroom.

Other research groups are trying to reduce dropout rates and substance use by targeting the more vulnerable or higher-risk elementary school and middle school students, and giving them and their Families special programs to promote learning and a sense of mastery over schoolwork; sometimes this is being done in connection with social-influences intervention programs. In contrast with interventions directed at all students in the first- and second-grade classrooms, these involve "pull-out" programs for the specially targeted higher-risk students.

Future research will provide more definitive evidence on the underlying mechanisms that account for observed associations between dropping out of high school and substance use, as well as for the newer suspected associations between dropping out of school and the risk for adult-onset alcohol-dependence syndromes (Crum et al., 1993). If the intervention programs are found to reduce dropout rates and also levels of alcohol, tobacco, and other drug involvement, this will provide some powerful evidence on the causal significance of the early developmental antecedents and will help to explain why dropouts are more likely to be drug users.

In the meantime, the broad range of unfortunate effects of dropping out of school makes it important to sustain and increase the vigor of stay-in-school programs as well as outreach programs for youths who are chronically absent from school or who actually have dropped out before graduation. These programs may help the individual youths, their families, and society in many ways; they may not only confer benefits in relation to schooling and better preparation for adult life, but also reduce the amount of substance use in the teenage years, prevent the occurrence of alcohol and drug problems in adulthood, and possibly prevent other psychiatric disorders such as major Depression.

(See also: Attention Deficit Disorder ; Coping and Drug Use ; Education and Prevention ; Epidemiology of Drug Abuse ; Vulnerability As Cause of Substance Abuse )

BIBLIOGRAPHY

Brooks, J. S., et al. (1988). Personality, family and ecological influences on adolescent drug use. A developmental analysis. Journal of Chemical Dependency Treatment, 1, 123-162.

Crum, R. M., Helzer, J. E., & Anthony, J. C. (1993). Level of education and alcohol abuse and dependence in adulthood: A further inquiry. American Journal of Public Health, 83 (6), 830-837.

Dishion, T. J., Reid, J. B., & Patterson, G. R. (1988). Empirical guidelines for a family intervention for adolescent drug use. Journal of Chemical Dependency Treatment, 1 (2), 189-224.

Dryfoos, J. D. (1991). Adolescents at risk. New York: Oxford University Press.

Gallo, J. J., Royall, D. R., & Anthony, J. C. (1993). Risk factors for the onset of depression in middle age and later life. Social Psychiatry and Psychiatric Epidemiology, 28 (3), 101-108.

Hawkins, J. D., Von Cleve E., & Catalano, R. F., Jr. (1991). Reducing early childhood aggression. Results of a primary prevention program. Journal of American Child and Adolescent Psychology, 30 (2), 208-217.

Johnston, L. D., O' Malley, P. M., & Bachman, J.G. (1992). National survey results on drug use from the Monitoring the Future Study, 1975-1992 (vol. 1). Rockville, MD: National Institute on Drug Abuse.

Kellam, S. G., et al. (1994). The course and malleability of aggressive behavior from early first grade into middle school: Results of a developmental epidemiologically-based preventive trial. Journal of Child Psychology, Psychiatry and Allied Disciplines, 35 (2), 259-281.

Werthamer-Larsson, L. A. (1994). Methodological issues in school-based services research. Special section: Mental health services research on children, adolescents and their families. Journal of Clinical Child Psychology, 23 (2), 121-132.

Eric O. Johnson