Applied & Preventive Psychology 10:135-154 (2001). Cambridge UniversityPress. Printed in the USA. Copyright © 2001 AAAPP 0962-1849/01 $9.50 DOI: 10.1017.S0962184902010053 Prevention of adolescent drug abuse: Targeting high-risk children with a multifaceted intervention model The Early Risers "Skills for Success" Program GERALD J. AUGUST, GEORGE M. REALMUTO, AND KEN C. WINTERS University of Minnesota JOEL M. HEKTNER North Dakota State University Abstract This article describes a comprehensive drug abuse preventive intervention called the Early Risers "Skills for Success" Program. Early Risers is an example of an indicated prevention strategy designed to alter the developmental trajectory leading to drug use and abuse in high-risk children as indexed by the presence of early-onset aggressive behavior. An "early-starter" developmental model to alcohol, tobacco, and other drugs provides the theoretical underpinnings for selection of the program's child and family intervention targets. Social development and social ecology theories provide the conceptual foundation for content of the major intervention components, CORE and FLEX, respectively. CORE is a coordinated set of standardized child-focused interventions that promote developmental competence by teaching skills pertinent to emotional regulation, prosocial peer affiliation, and school adjustment. This component is delivered within the context of child- and parent-focused education and skills training programs during summer and regular school year periods. The FLEX component is a family support, empowerment, and service-brokerage intervention that is individually tailored in response to the unique assets and needs of individual families. Access to services is organized by home-visiting family advocates who provide consultation, support, and brief interventions to assist families in solving daily hardship and stress-related problems. When more serious basic living and health problems are identified, family advocates broker specialized services with community agencies. Key words: Prevention, Drug abuse, Competence, Family support Despite ambitious nationwide media and law enforcement campaigns against drug use over the past 25 years and a gen- eration of school-based drug awareness and education initia- tives (e.g., Project DARE), the use and abuse of alcohol, to- bacco and other drugs (herein referred to as ATOD) remains one of the most daunting public health maladies facing Amer- ican youth in the new millennium. Although drug-use rates have remained relatively stable or even declined slightly among older age groups in recent years, illicit use among chil- dren and adolescents continues to rise. The first national drug- use survey to include elementary school children reported alarming levels of cigarette and marijuana smoking, alcohol consumption, and use of inhalants among children in grades Send correspondenceand reprint requests to: Gerald J. August, Division of Child & AdolescentPsychiatry,Universityof MinnesotaMedical School, F256/2B West, 2450 RiversideAve.. Minneapolis, MN 55454-1495. E-mail: august001@umn.edu 135 four through six. Indeed, among fourth graders, 4% reported past-year cigarette use and 8% reported past-year use of beer. These rates increased to 15% by grade six (National Parents' Resource for Drug Education-PRIDE, 1999). It is becoming clear that the "war against drugs" cannot be waged exclu- sively by social and legal actions that seek to limit the supply and sale of drugs, but must also include new and innovative approaches that target reduction of the demand for drugs. There are both human and financial costs related to drug use, abuse, and dependency. From a public health standpoint, youth ATOD has far-reaching personal, social, and econom- ic ramifications, particularly when the onset is early and when use progresses to addiction. Adverse consequences as- sociated with youth ATOD include violent behavior and crim- inal offending (Dembo et al., 1991; National Institute of Jus- tice, 1994), psychiatric morbidity and suicidality (Kaminer, 1990; Shedler & Block, 1990), mortality from drug-related