The Professional Counselor | Volume 11, Issue 3 355 of risk reduction is a response to data suggesting that abstinence-only approaches may not be effective for adolescents (Blackman et al., 2018). There is arguably no acceptably low risk level for adolescents. However, when used as a complement to MI, risk reduction ideas can be used to demonstrate that the ultimate decision to use can only be made by the adolescent. Instead of fighting against the developmental task of individuation, this approach could allow adolescents to freely choose whether or not to use and begin to consider future levels of substance use as an adult. Evaluating Consequences: The CRAFFT The CRAFFT (Car, Relax, Alone, Forget, Friends, and Trouble) is a simple screening instrument incorporated into MCARR to assess substance use consequences and identify problem substance use (Knight, 2016; Knight et al., 1999). The CRAFFT 2.0 instrument is composed of six questions related to use of drugs and alcohol in the prior year, in various situations such as use in motor vehicles, use to relax or when alone, problems with memory related to intoxication, problems with friends, and violations resulting in trouble with school or legal entities. The MCARR curriculum encourages students to consider substance use situations presented on the CRAFFT not to screen peers, but rather as “red flags” to inform healthier decision-making and action. Neurobiological Education for Risk Literacy In the MCARR program, students learn about the neurological and physiological impacts of substance abuse in adolescence, including neural plasticity and the functional and structural changes that may permanently affect working memory, attention, and other processes in the developing brain (Fuhrmann et al., 2015). A meta-analytic study by Day and colleagues (2015) suggested that alcohol use can lead to problems with executive functioning, including attention and mental flexibility, as well as mechanisms of self-control. Some drinking and drug use behaviors may be associated with the development of mood and anxiety-related problems (Pedrelli et al., 2016). In addition to this information, MCARR also presents the physiological impact of alcohol and specific drugs, including fatigue, muscle weakness, and damage to organs. MCARR applies these concepts to the daily routine of an adolescent, including specific examples of how these changes may impact athletic performance, academic performance, or social interactions. This information may inform decision-making and contribute to risk literacy, or the ability to consider, interpret, and act on accurate information to make decisions about whether one will engage in substance use (Nagy et al., 2017). Refusal Skills Adolescent expectations about the positive or negative effects of substance use may be an important factor in prevention and refusal skills (Lee et al., 2020). For instance, cannabis use is less likely when adolescents perceive it as riskier (Miech et al., 2017). Knowledge about the various impacts of drugs and alcohol have been correlated with the development of beliefs about use, including social aspects, physiological aspects, and general expectancies of use (Zucker et al., 2008). Attitudes about drugs and alcohol and their risks appear to be an important part of effective prevention efforts (Miech et al., 2017; Stephens et al., 2009). For these reasons, the development of healthy attitudes about drug and alcohol use becomes an important life task (Schulenberg & Maggs, 2002). Peer Influence Understanding the power of peer influence in adolescent substance use (Henneberger et al., 2019), the MCARR approach also employs the social context of the caring school community to support primary prevention efforts and promote overall student wellness. It is well documented that social pressures are particularly heightened during adolescence, when the desire to affiliate with peers and find acceptance within a peer group is highly valued (Trucco et al., 2011). During the adolescent
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