Self-Leadership and Caring as Foundations of Relational Accountability in Nursing Clinical Judgement: A Conceptual Analysis.

Substance use disorder (SUD), specifically in adolescents, is a maladaptive behaviour which can lead to other problem behaviours, severe adverse health outcomes, and detrimental social consequences. It is a major contributor to the worldwide disease burden and therefore, effective interventions are mandatory to combat this burden. Designing targeted and culturally suitable educational and preventive programs about SUD for vulnerable populations like students help combat misconceptions and improve preventive awareness. Adolescence is an important stage of risk for SU initiation and related consequences. Implementation of targeted SU interventions could benefit certain youth populations combined with wider population-level prevention programs that aim to decrease risk factors and enhance protective factors related to youth SU. Early initiation of SU in adolescence is a definite risk factor for the later development of SUD in adulthood. Several factors influence adolescent initiation of SU such as peer norms, parental surveillance, community background, and also changes due to continuing brain maturation such as enhanced reward sensitivity, decreased inhibitory control, and changed brain network engagement in decision-making. Recognizing these early factors enables identification of at-risk adolescents and helps in designing more effective and targeted prevention programs. Most universal SU prevention efforts target early adolescents aiming to delay or prevent its onset. The “Life Skills Training” is a school-based prevention program that uses cognitive/behavioral skills-training techniques to augment social and personal competence skills and drug refusal skills. In a large-scale randomized trial, the “Life Skills Training” program was implemented on junior high school students, and then after 13 years, the rates of overall lifetime illegal drug use were found to be lower among young adults who received the program during junior high school compared with the control participants. The “keepin’ it REAL” program is an evidence-based SU prevention curriculum designed for youth. REAL is an acronym for four resistance strategies (Refuse, Explain, Avoid, Leave). The delivery of elementary school “keepin’ it REAL” by the Drug Abuse Resistance Education (D.A.R.E.) America officers have deterred the onset of alcohol use and vaping. The “Communities That Care” (CTC) is a community-level prevention system that trains and assists community alliances to build evidence-based and data-driven conclusions on local prevention efforts allowing community-wide and sustained positive youth development. A clinical trial reported that implementation of the CTC prevention system in early adolescence promoted positive development and decreased health-risking behavior into young adulthood. Early interventions including those conducted in school settings have been shown to reduce SU-related problems among adolescents. A prospective study on young Australian adults concluded that problem behaviours in early adolescence can predict long-term SUD. Therefore, prevention strategies should target adolescents with early manifestations of problem behaviours. The family management factors (including parental discipline, monitoring, behavioural control, and rewards set by parents to support good behaviours) showed either protective or predisposing effects on the adolescent SU. There is a vicious circle between the family problems, SU, and criminal conduct. Adolescents whose parents are justice-involved are more likely to be involved in SU and illegal acts. Positive and supportive relationships with parents could decrease these risks. Consequently, clinical interventions for at-risk adolescents should be multidimensional focusing more on the family context, for instance, family-based approach therapy for preventing and treating SU and criminal behavior among youth. However, there was inconclusive empirical evidence in the assessment of the long-term efficacy and the sustainability of SU programs for adolescents. Family is central at the confluence of several social systems (e.g., school, community, and peer), thus evidence-based family programs were more effective than several other approaches.