Youth and Substance Abuse: Prevention, Intervention, and Recovery, by Lori Holleran Steiker. 2016. 270 pages, Lyceum Books, Inc, Chicago, Illinois, paperback, $39.95, ISBN 978-1-935871-63-7.

If you want a comprehensive look at youth and substance abuse, one that translates theory and research into practice and action, this wonderful new book is for you. Lori K. Holleran Steiker, PhD, ACSW, is Associate Professor at the School of Social Work at the University of Texas at Austin. She has worked for years as a clinical psychiatric social worker and addictions therapist with adolescents and adults and helped develop DRS or Drug Resistance Strategies [culturally grounded substance abuse prevention videos coupled with a curriculum]. Holleran Steiker has particular expertise in culture and prevention efforts, especially culturally grounded substance abuse prevention with high-risk youth (eg, GLBTQ [gay, lesbian, bisexual, transgender, and queer] youth, Latino youth, low-income housing youth, homeless youth, youth in alternative school settings, and incarcerated youth and those on probation). She has begun working with student veterans on college campuses and has published extensively on substance abuse prevention interventions and cultural adaptation. Her professional interests and areas of expertise include substance abuse prevention, culturally grounded social work practice, adult and adolescent substance abuse and recovery, and social work with groups. But I think one of her greatest strengths involves translating research into action and practice; she works to translate her research and experience about substance abuse issues to the university and wider community.

Each chapter of this meaty book features key terms, discussion questions, and references. Section 1, Conceptualization of Adolescence, Substance Use, Addiction, and Theory, provides an overview of substance misuse (epidemiology and etiology, physiology and mechanisms of substance misuse, and biopsychosocial-spiritual model); substance misuse implications for children and adolescents (developmental issues, cultural issues, and research-supported risk factors); and substance misuse models and theories (overview of theoretical frameworks). Section 2 looks at substance misuse prevention (overview of substance misuse prevention approaches, the law of prevention in the United States, classifications of prevention, and ethnicity/culture and prevention); and family and parental interventions and attitudes (family dynamics, warning signs and red flags, and families, resilience, and recovery). Section 3 is devoted to empirically supported screening and assessment (youth and adolescent substance misuse screening, assessment, and diagnosis, overview of the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) and substance use disorders, engaging youth in the diagnostic process, and tools and techniques for screening and assessment). Section 4 looks at evidence-based treatment (such as motivational enhancement therapy, case studies, measuring Stages of Change, cognitive behavioral therapy, relapse prevention, family systems approach, and various other modes of evidence-based family therapy); and support groups, 12 step and other paths to recovery (peer-to-peer mutual aid groups, and addressing challenges for the practitioner). Section 5, or current issues, looks at young people in recovery-a new life (eg, resources and settings, and alternative peer groups); substance-abusing youth in the juvenile justice system (eg, drug courts); and current issues, policies, and future directions (influence of the media and role models in sports and entertainment, and policy issues, including where we go from here).

Holleran Steiker has all the training, education, and boots-on-the-ground experience to write this slender volume. She has worked with youth and families around addiction issues and is a cofounder of Austin's first recovery high school as well as the liaison to the University of Texas at Austin Center for Students in Recovery. In this book, she keeps students firmly grounded in the context of family and peers and she focuses on both risk and protective factors. She says that families will resort to begging, pleading, bargaining, negotiating, manipulating, bribing, praising, screaming, snooping, arguing, defending, denying, and constant emoting (pp. 93-94). She points out that stigma can get in the way of treatment and recovery and we must see youth embedded in the environment, community, and culture.

In the section on Stages of Change, I was surprised that Holleran Steiker did not cite the seminal work of Prochaska, Norcross, and Di Clemente, who wrote the book on Stages of Change and who virtually coined the terms "precontemplation," "contemplation," "preparation," "action," "maintenance," "recycling" (referring to learning from relapse), and "termination." But what this may indicate is that Prochaska's work is so widely accepted and used now that it is part of the literature (much as the term "Kleenex" is now used for all tissue, although it is a patented term). In future editions of the book, the author might want to consider adding in Prochaska's Stages of Change along with a brief overview of each stage, as his work in directly relevant to what she is discussing.

I was likewise surprised that in the case studies (see pp. 158-168), Holleran Steiker used examples of alcohol, pills, marijuana, and heroin but not meth. Nationwide, we see widespread and highly destructive use of meth, with its concomitant health issues. I remember talking about meth use with my dentist. He had a young patient recently, an incarcerated 20-year-old man, who was a long-time meth user. The dentist was forced to remove all of his teeth (the teeth, gums, and underlying bone structure had all been compromised). This young patient was stunned to realize that he had to wait at least a year to get replacement implants, until his mouth had fully healed. He was going to spend at least a year without teeth to support his facial features. It was then that he began to realize what meth use really meant to him, his health, and appearance.

The author could also make more, I think, of relapse and what it means (see pp. 174-176). It is not uncommon for those who are working to overcome bad habits to move their live forward in a positive way to relapse 7 to 9 times before succeeding in making the change. A relapse is not the end of the world, but we need to get back on the horse, so to speak, and try again and again.

Holleran Steiker points out that unlike some adults, adolescents are usually sent to treatment programs against their will and may not be ready or willing to make changes to their behavior concerning their alcohol/drug use. Clinicians working with adolescents and youth who misuse substances also need to be very concerned about suicide and suicidal ideation. As I always like to say, for teens and young people, their emotions can be a huge roller coaster of ups and downs ... everything that happens to them is happening for the very first time (breaking up with a girlfriend, smashing a car, getting a bad grade in school), so their emotions can be intense and very mercurial. The author also points out that in the past, counselors subscribed to the idea that users had to "hit bottom" and had to totally abstain from their drug of choice; today, counselors understand that there may be many roads to sobriety and that individuals may have different definitions of abstinence (see p. 205). Some of the newer models to help adolescents with their substance abuse issues include CRPs or collegiate recovery programs, AGPs or alternative peer groups, recovery high schools, medicated assisted recovery programs, smartphone apps, and culturally sensitive programs designed by and for diverse cultural groups.

There is a strong association between youth in the juvenile justice system and school/family problems, involvement with negative peer groups, lack of neighborhood/community social controls, and physical/emotional/sexual abuse (often in the home within the family). From this list, we can see that the substance misuse in youth may be associated with a whole constellation of other issues (and may be a symptom of all that is going wrong) that will have to be dealt with in addition to drug/alcohol abuse. These youth primarily commit income-generating crimes (to get money for further substance abuse) and violence. It can be virtually impossible for researchers and counselors to keep up with new drugs and variants flooding the market every year and being sold over the Internet.

This is an excellent and comprehensive book that pulls together theory, research, and practice and focuses on families and youth. The author uses a holistic biopsychosocial-spiritual model of assessment and intervention planning. Key terms and discussion points at the end of each chapter allow readers to review and assimilate what they have read. There are even exercises that encourage active reader engagement.

The audiences for this book are legion. It should be read by upper-level high school and college students, graduate students, anyone working with families in any capacity, school and college staff and administrators, and public policy makers and planners. PTA and reading groups could profit from reading the book as well, and parents might consider reading the book with their teenagers and discussing the various chapters and points.

Holleran Steiker has done us all a great favor in pulling this book together with the latest research, practice, and theory, including experiential exercises and supplemental materials. The book is written in a very clear and direct fashion, with easy-to-follow sections and points. The layout is especially helpful to anyone not yet familiar with the field. And, most importantly, the author includes what we know (and don't yet know) about the very important cultural adaptations of drug prevention/intervention programming. I strongly recommend this book to anyone with an interest in families and family life, in schools and colleges, and in community health and safety.

-Marcie Parker, PhD, CFLE

Certified Family Life Educator

Parker and Associates

Excelsior, Minnesota

[email protected]