The Professional Counselor | Volume 11, Issue 3 353 “window of opportunity” for the establishment of neural pathways that may protect against the development of drug and alcohol use problems (Whyte et al., 2018). Brain structure may impact function in the areas of working memory, attention, and cognitive and social skill development in adolescence (Fuhrmann et al., 2015; Randolph et al., 2013). The developmental tasks of adolescence, such as identity formation, social connectedness, and patterns of interpersonal relatedness, may also be negatively impacted by substance use (Finkeldey et al., 2020; Lee et al., 2018). Incidents of adolescent intoxication may lead to early sexual debut, high-risk sexual activity, physical altercations, or other regrettable behavior (Clark et al., 2020). Moreover, drug use has consistently been linked to depression, anxiety, and poor school performance (e.g., D’Amico et al., 2016; M. S. Dunbar et al., 2017; Ohannessian, 2014). Suicidality and non-suicidal self-injury have also been associated with substance use (e.g., Carretta et al., 2018; Gobbi et al., 2019). In a study of 4,800 adolescents, illicit drug use was more strongly associated with suicidal behavior than other high-risk behaviors (Ammerman et al., 2018). The risks of adolescent drug and other substance use are sweeping, significant, and important for informing prevention efforts. Early identification and intervention for adolescents is critical for preventing later substance use disorders and staving off this public health problem (Levy et al., 2016). In 2011, of young adults aged 18–30 admitted for substance use disorder treatment, 74% initiated use at age 17 or younger (SAMHSA, 2014). Research suggests that the increase of lifetime problem alcohol use increases by a factor of four when adolescents drink prior to age 15, compared to those who drink prior to age 20 (Kuperman et al., 2013). The current literature identifies a clear relationship between early alcohol and marijuana use and future patterns of prescription opioid abuse (B. R. Harris, 2016). A recent study of over 1,300 adolescents found that those who screened positive for highest risk in a simple 2-question assessment were shown to have a higher number of drinking days and to be at higher risk for alcohol use disorder 3 years later (Linakis, 2019). School Personnel as Frontline Responders to Adolescent Substance Use Risk School personnel and the school community have important roles to play in promoting mental health and preventing substance use among students (E. T. Dunbar et al., 2019; Eschenbeck et al., 2019; Lintz et al., 2019). School-based services may range from prevention to treatment, with efficacious results demonstrated using motivational interviewing and other evidence-based approaches (Winters et al., 2012). A number of prevention programs implemented by school leaders or trained youth facilitators have demonstrated efficacy, including Youth to Youth (Wade-Mdivanian et al., 2016), an empowermentfocused, positive youth development approach for ages 13–17 in a 4-day summer conference format. Another is Refuse, Remove, Reasons (RRR; Mogro-Wilson et al., 2017), a 5-session curriculum for ages 13–17 delivered in health classrooms by clinical service providers from the community. The RRR involves caregivers and uniquely focuses on mutual aid between students. The keepin’ it R.E.A.L. program (Hecht et al., 2003), designed for younger adolescents, Grades 6–9, involves urban or rural culturally grounded curricula focused on social norms and networking to make behavior change and has been adopted by the national Drug Abuse Resistance Education (D.A.R.E.) program. The Life Skills Training program (Botvin & Griffin, 2004), designed for middle school students, relies on cognitive behavioral principles to help students develop self-management and social skills. Also designed for middle school students, the All Stars curriculum (McNeal et al., 2004), emphasizes social skills, social norms, and debunking inaccurate beliefs about adolescent substance use, violence, and early sexual debut. All Stars uses 22 sessions, with some groups outside of class and in a one-on-one meeting format. Each of the programs described here has contributed to the efforts to prevent drug and alcohol abuse among young people; however, none of these offer a school counselor–implemented classroom guidance curriculum specifically designed for middle adolescence, including students aged 14–17 years.
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