Blockchain Papers

L. L. Wynn, Susanna Trnka, Jesse Hession Grayman

Anthropologists like to tell stories about how they were wrong. These stories are part of our collective identity. Consider Briggs's (1970) classic ethnography, Never in Anger. Briggs tells a story about doing fieldwork in Nunavut (then the Canadian Northwest Territories) in the early 1960s. She showed anger on behalf of the Inuit group she was living with when they were wronged by a white outsider. To her surprise, her Inuit interlocutors reacted by ostracizing her for months. She describes feeling devastated, lonely, and depressed, but in slowly working her way back to personhood with her Inuit participants, she learned in a powerfully embodied fashion a core principle of their culture: that adults never show anger or make demands, and that to lose one's temper is to demonstrate a dangerous lack of control, even insanity. She documents how this emotional control is inculcated in children from a very young age. Thus her awful moment of social failure is transformed into a profound reflection on affect and socialization in Nunavut culture. The resulting ethnography became one of that era's most famous. Even when our failures and mistakes are less obvious than Briggs's and don't threaten to derail our research projects, many ethnographic writings reflect on moments when the author realized they had brought a bad assumption into the field with them and, as a result, learned something from their research participants—something that shifted their methodological or theoretical approach, or changed what they were studying. These stories are particularly prevalent among graduate students returning from their first fieldwork experiences. The stories go something like this: I went to the field planning to study x, and when I was in the field, I listened to my interlocutors and realized that what I really needed to study was y. For example, in her book Food, Sex and Pollution, Meigs (1984) writes about going to the field intending to study divorce, but when she gets there, everyone seems bored and uninterested when she asks about the topic. Instead, they want to talk to her about sex, gender, and the pollution rules that govern what they can and can't eat. It's such a collective concern that she describes their interest in the topic as a “religion.” Responding to this, she changes her research topic and commits to addressing her research participants’ interests, letting them chart the direction of her work. Briggs tells a similar story: she goes to the Inuit planning to study shamanism, but when she arrives, she finds that the small group she is living with have converted to Christianity and don't want to discuss their “pagan” past. That, combined with her attempts to process the social ostracism caused by her angry outburst, leads her to a whole new project on emotions and socialization. Without having systematically reviewed all the different ways that anthropologists have described their “I was wrong” moments, the AE editors suspect that many, if not most, ethnographies include stories like this, even if most are not as dramatic as Meigs's or Briggs's. These stories are not just about ourselves as individual fieldworkers but about anthropology as a discipline. We tell them to remind ourselves and to teach our students about the discipline's orientation toward a radically inductive and collaborative approach to building knowledge. By telling stories about being wrong, we might seem to be sacrificing our own dignity and authority, but in fact we are shoring up our authority as authentic ethnographers. These stories illustrate our willingness to be humbled by what we don't know, demonstrating our commitment to what Lederman (2007, p. 310) calls anthropology's “systematic openness to contingency.” In short, anthropology is a discipline that has staked its methodological approach on the possibility of mistake and failure. In taking an iterative approach to co-constructing knowledge with our research participants and collaborators, we insist that when we realize we are wrong, we must acknowledge it to move forward. As we were reflecting on this as editors, we thought of our own “I was wrong” stories. For Lisa, it was less a moment and more of a dawning realization. She had been doing research in Egypt on emerging reproductive health technologies, including sildenafil (the generic name for the drug more commonly known as Viagra). As she visited acquaintances and friends in Cairo and Alexandria, she asked them, “Who uses Viagra, and why?” The first time someone mentioned using sildenafil and tramadol (a painkiller) in the same sentence, as if they were synonyms, she dismissed it as ignorance. The man she was interviewing was an illiterate fisherman. He probably didn't use either drug, she assumed, and didn't have the knowledge to realize that they were radically different, having completely different mechanisms of action. Sildenafil produces erections; tramadol, as an opioid narcotic, would be intrinsically erection-wilting, she assumed—and, indeed, recent Egyptian research has demonstrated this (Hashim et al., 2020). The second time someone described using sildenafil and tramadol for the same purpose, she again ignored it. It was not until the third time that an interviewee described the drugs as equivalent that she started to catch on that something significant was afoot. She realized that she had neglected a fundamental point of critical drug studies since at least the 1970s, namely, that a drug's effect is produced not by the drug alone but by the intersection of three elements: the drug and its neuropharmacology; the mindset of the person taking the drug and their expectations about what it will do; and the social context in which they use the drug (Zinberg, 1984). This led Lisa to ask a question that would prove important to her research: Why did people see these drugs as part of a semantic continuum, and what did that say about how Egyptians understand masculinity and its relationship to pharmaceuticals (Wynn, 2022)? In retrospect, I realized that scars were slowly being formed. More precisely, they were being encouraged to form through a communitywide cultivation of silence. Rather than silence being considered an inhibitor of healing, as it is in much of Western medical, psychological, and cultural discourse, this was a case of a community encouraging silence as a means of promoting healing. After several moments when her research participants gently corrected her social blunders, she realized something not just about them and their philosophies of trauma and healing, but about her own deeply held assumption about trauma: that to heal, you need to talk. In contrast, for her research participants, “to break the silence [about past trauma] would be akin to breaking open the wound” (Trnka, 2008, p. 180). Jesse had a key “I was wrong” realization during his PhD research in Aceh, Indonesia (Grayman et al., 2009), where he was studying postconflict humanitarian recovery programs. Jesse was working with an Indonesian medical team that was tasked with providing psychosocial and psychiatric support to civilian survivors of the separatist war (1976–2005). He gave the team a short training on ethnographic methods, with a focus on managing trauma and the ethics of discussing painful conflict memories. Later, during a field exercise, an overeager nurse interviewed a village head about his conflict experience, pressing on despite the man's visible discomfort. As a crowd gathered, the village head recounted horrific torture, evoking tears from an elderly observer. When the conversation ended, the leader quietly remarked, “Sometimes I think there is no need to remember the past like this.” Jesse wondered whether he had misconceived his effort to upskill the medical team with ethnographic methods. Afterward, Jesse reflected on this as a moment of failure, noting that confessional narratives, central to many mental health models, are not always therapeutic. While some participants thanked the team for listening, it was nearly impossible to discern the few who might not benefit from talk therapy. Though Jesse turned the experience into a teachable moment, he regrets that the researcher's moment of learning unfolded in a real community, with real people and real leaders, just barely coming to terms with peacetime after living through decades of political violence. Even today, remembering the event makes Jesse anxious and embarrassed. This draws our attention to another key aspect of the way anthropologists process being wrong. We often experience our mistakes as embodied, visceral moments of regret, embarrassment, frustration, or humiliation. Thus, perhaps recounting our mistakes is not just about asserting our ethnographic achievements and authority, but about helping ourselves process our dark, painful feelings and difficult memories of fieldwork. Wanting to reflect more deeply on these issues, we invited anthropologists to submit to a special forum in which they discuss their moments of being wrong and what these can tell us about our discipline. We asked them to recount events when they realized a flaw in their methodological approach, an interpretive error, an ethical mistake, an event that triggered a theoretical paradigm shift, or a realization that their approach to teaching or doing anthropology needed an overhaul. We asked them to address these questions: When did you realize you were wrong? How did you come to that realization? What did you learn? How did you change the way you do or teach or write anthropology? As we read the submissions to this special forum, we were struck by three recurring themes. The first was embodiment and affect. As described in Jesse's and Susanna's stories of being wrong, and in Briggs's powerful ethnography, it can feel like swimming in dark emotions to realize that you are wrong and to process what it means for how we understand our past and our future in a society. Coming to terms with our mistakes is both an intellectual and an affective process, one that is experienced and felt deep in the body, both as we live the moments of mistake and process them later. A second theme was scale. Being wrong can be a tiny realization leading to a subtle reorientation in focus or approach, a microrecalibration of knowledge or of everyday fieldwork practice, or a grand, dramatic moment that causes a seismic shift in perspective. Of course, it's rarely one or the other. As Kuhn (1962) notes of paradigm shifts, they might seem like revolutions, dramatically overthrowing old modes of thinking, but in reality they take place gradually: anomalies slowly accumulate until the dominant paradigm topples under their weight. The third theme is temporality: “I was wrong” can be a light bulb moment or a slow, unfolding realization, a moment in the field or a decades-later discovery. Some “mistakes” do not reveal themselves until several years or even decades after one's fieldwork, reshaping one's sense of not only their research or the people they spent time with, but of themselves. In My Life as a Spy, Verdery (2018) reflects on how state security services labeled her a CIA agent during her three years conducting ethnography in Romania in the 1970s and 1980s. Their mistaken interpretation of her as a foreign agent began, she suggests, through her own error in judgment—motorbiking alone through the Romanian countryside in search of a field site, she inadvertently strayed into a restricted military zone, missing the sign warning “Entry prohibited to foreigners” (“I had made a stupid mistake. It would not be the last time,” Verdery [2018, p. 3] dryly remarks). the way I carried myself was suspect. At least, so it seemed to my friend Emilia, who told me that when she met me in 1990 she immediately thought I might be a spy: “You were dressed very modestly, you didn't hold yourself above us. Your style was to reduce the difference between yourself and Romanians, under-communicating it.” In short, my manner of dress was a form of hiding. Eventually she came to see it as my way of trying to form good relations with villagers, but her first thought was, “Maybe she's a spy. Instead of seeming like someone from a totally different world, you seemed to be one of us”—that is, she thought I had been specifically trained to fit in. (p. 17) recognize me as a spy because I do some of the things they do—I use code names and write of “informants,” for instance, and both of us collect “socio-political information” of all kinds rather than just focusing on a specific issue. … When I read in the file that I “exploit people for informative purposes,” can I deny that anthropologists often do just that, as Securitate officers do? In 1962 the US Department of Commerce, without authorization or permission from the author, translated from French into English the anthropologist Georges Condominas’ ethnographic account of Montagnard village life in the central highlands of Vietnam. The Green Berets used the document for assassination campaigns targeting village leaders. For years, neither publisher nor author knew this work had been reprinted in English for military ends. How can one accept, without trembling with rage, that this work, in which I wanted to describe in their human plenitude these men who have so much to teach us about life, should be offered to the technicians of death—of their death! … You will understand my indignation when I tell you that I learned about the “pirating” [of my book] only a few years after having the proof that Srae, whose marriage I described in Nous Avons Mangé la Forêt, had been tortured by a sergeant of the Special Forces in the camp of Phii Ko. Condominas's outrage changed how anthropologists think about their writing, their politics, and their ethics of representation. As Price (2007) notes, ethics committees often focus on any immediate risks to research participants, including whether they could be harmed by certain questions (as in Jesse's recounting of interviews about a violent past). Examples like Condominas's, however, show that anthropologists also need to think about the different scales and temporalities of ethnographic work and its possible harms. These themes—embodiment and affect, scale and temporality—come up in fascinating ways in this forum's commentaries. Rejecting the simple binary of right or wrong, Veena Das dismantles the AE editors’ language of “moments” of realization. Instead, she sees anthropological knowledge as a long, dialectical process: the anthropologist slowly finding their way between, on the one hand, the dominant theories and theorists of their time, and on the other, their interlocutors, the “figures of thought” influencing them in the field. She describes a sense of incompleteness or poor fit with existing theories, one that slowly accumulates and eventually compels the anthropologist to see something in a new way, or notice what they haven't been seeing. “By taking a long-term perspective on the vulnerability of knowledge, which reveals itself over time,” Das aims to “draw attention, instead, to the connections between the knowledge of the alien and our own everyday modes of knowing. We miss these connections if we stay with the stark oppositions of truth and falsity, mistakes and correction.” Like Das, Carole McGranahan sees anthropological theory as formed not only in the relationship between fieldworkers and theorists, but also by the theorists in the field. Reflecting on her own training, she writes, “The ethnography often, though not always, came to me pretheorized. People shared stories with me alongside observations, musings, and explanations. Analysis was by no means only the scholar's domain. It belonged to narrator and audience alike.” Gil Hizi thinks through a series of unexpected moments during his PhD research and describes his mistakes as the “naivete of early graduate studies.” In studying practices of among young Hizi learned that after the is no with a but to the that come from interlocutors, in are studying While he at first that they would take no interest in the of an in his Hizi finds the Hizi from these unexpected moments with mistaken come and he through them to his with his realization of his mistakes from to decades He describes feeling early in his during his first with a he he was wrong until interviews when of the difference between the and the [of became account is through with embodied affect. when one to talk with in the of a field at a to being and even more and when he how to his field notes and back to the US without He up with a that … seems of you are wrong, after the when in the field you knew something was but didn't how to with it. writes about finding on an at a in one of which is about the impossible of a The of this with about medical issues, such as the of back into old anthropological about the to and is certain that the only to that the is from the on an from This to the of her and, like Das, her by asserting the of and the of knowledge. writes a account that a different to the of the anthropologist as about being as an and from and working to open up to the makes a that leads her to being Afterward, she her in terms of a intersection of gender, and also with In an dark and that many of us will she that she is not to for being she can't over what she did wrong. She to how it so that she can make in the one be wrong without being at and In her we the of stories about being wrong that don't stories that people don't feel powerful to or that don't to our authority, that are or or the of trauma among who work in of political and violence. In research with in US knew this work might trauma and health was in not other, more and ways to both for individual such as and for the discipline as a which could do more to PhD students and a new of who are ethnography, for as work. forum are a of names and finding their in the field. Their on both recent mistakes and made over not only tell individual but also describe both subtle and dramatic of what ethnographic fieldwork and ethical research the of writing, and and the of old theoretical even as we to think in new reflect of things we have wrong as as the realization of in as Das it. are stories and perhaps the most that all these is their on and to our research and participants’ for to participants’ to who offered after the own The the anthropological in terms of and the willingness to be Thus, an “I was wrong” realization is the of a commitment to It anthropology as a discipline that is and to

Aldren Gonzales, Scott R. Smith, Prashila Dullabh, Lauren Hovey · 7 authors

The scale and severity of the opioid epidemic call for innovative, multipronged solutions. Research and development is key to accelerate the discovery and evaluation of interventions that support pain and substance use disorder management. In parallel, the use and integration of blockchain technology within research networks holds the potential to address some of the unique challenges facing opioid research. This paper discusses the applications of blockchain technology and illustrates potential ways in which it could be applied to strengthen the validity of outcomes research on the opioid epidemic. We reviewed published and gray literature to identify useful applications of blockchain, specifically those that address the challenges faced by opioid research networks and programs. We then convened a panel of experts to discuss the strengths, limitations, and feasibility of each application. Blockchain has the potential to address some of the issues surrounding health data management, including data availability, data sharing and interoperability, and privacy and security. We identified five primary applications of blockchain to opioids: clinical trials and pharmaceutical research, incentivizing data donation and behavior change, secure exchange and management of e-prescriptions, supply chain management, and secondary use of clinical data for research and public health surveillance. The published literature was limited, leading us to rely on gray literature, which was also limited in its discussion of the technical aspects of implementation. The technical expert panel provided additional context and an assessment of feasibility that was lacking in the literature. Research on opioid use and misuse is challenging because of disparate data stored across different systems, data and system interoperability issues, and legal requirements. These areas must be navigated to make data accessible, timely, and useful to researchers. Blockchain technologies have the potential to act as a facilitator in this process, offering a more efficient, secure, and privacy-preserving solution for data exchange. Among the 5 primary applications, we found that clinical trial research, supply chain management, and secondary use of data had the most examples in practice and the potential effectiveness of blockchain. More discussions and studies should focus on addressing technical questions concerning scalability and tackling practical concerns such as cost, standards, and governance around the implementation of blockchain in health care. Policy concerns related to balancing the need for data accessibility that also protects patient privacy and autonomy in revoking consent should also be examined.

H. Adger, Shonali Saha

Alcohol is the drug of choice among youth, with 12% of 8th-graders, 22% of 10th-graders, and 29% of 12th-graders reporting heavy episodic drinking. Although prevalence rates are at historic lows, alcohol use continues to be widespread among adolescents, and pediatricians must screen for underage and family alcohol use in health assessment visits.After completing this article, readers should be able to:National surveys make it clear that the use of alcohol among adolescents is both widespread and harmful. By the 12th grade, close to three-quarters of adolescents in high school report ever having an alcoholic drink, and more than one-quarter report having their first drink before age 13 years. Data from Monitoring the Future, an annual survey of youth in the United States, show that 71% of high school seniors reported some experience with alcohol in the past; 41% reported use in the last 30 days and, of great concern, 3% reported daily use. More than one-half (58%) of 10th-graders and more than one-third (36%) of 8th-graders report having consumed alcohol at some point in their lives, and more than one-third of 10th-graders (37%) and one of six 8th-graders (16%) report having been drunk in the past. (1) The good news is that the use of alcohol by teens, as well as the use of many of the illicit drugs, has declined over the past decade. The bad news is that, although these declines are encouraging, alcohol remains the drug of choice among youth.The pattern of alcohol use that is exhibited by many adolescents is one of drinking too much and at too early an age, thereby creating problems for themselves, for people around them, and for society as a whole. Underage drinking is a leading public health problem in this country. Underage drinkers consume, on average, four to five drinks per occasion approximately six times per month. By comparison, older adult drinkers, ages 26 and older, consume, on average, two to three drinks per occasion approximately nine times per month. A particularly worrisome trend is the high prevalence of heavy episodic or binge drinking in adolescents, which is defined often as five or more drinks in a row in a single episode. Monitoring the Future data show that 12% of 8th-graders, 22% of 10th-graders, and 29% of 12th-graders report engaging in heavy episodic drinking.Studies find that drinking alcohol often starts at very young ages. Moreover, studies indicate that the younger children and adolescents are when they begin to drink, the more likely they are to engage in behaviors that can harm themselves and others. Those who start to drink before age 13 years, for example, are nine times more likely to binge drink frequently as high school students than those who begin drinking later. Data from recent surveys show that approximately 10% of 9- to 10-year-olds have already started drinking; nearly one third of youth begin drinking before age 13, and more than one in four 14-year-olds report drinking within the past year. (2)(3)A number of studies show that the early onset of alcohol use, as well as the escalation of drinking in adolescence, are risk factors for the development of alcohol-related problems in adulthood. Initiating alcohol use earlier in adolescence or in childhood is a marker for later problems, including heavier use of alcohol and other drugs. Individuals who report initiation of alcohol use before age 15 years were four times more likely to meet criteria for alcohol dependence and two times more likely to meet criteria for alcohol abuse as those individuals who began drinking after age 21 years. (4)The consequences of underage drinking include a range of physical, academic, and social problems. Perhaps most frightening is the fact that alcohol is the leading contributor to morbidity and mortality in youth. Alcohol use is the leading contributor to death due to injuries, the primary cause of death in individuals younger than 21 years of age. Annually, 5,000 youth die of alcohol-related injuries that involve underage drinking. This includes injuries sustained in motor vehicle crashes (∼1,900), homicides (∼1,600), and suicides (∼300), as well as unintentional injuries not related to motor vehicle crashes. Among studies of adolescent trauma victims, alcohol is reported in 32% to 45% of hospital admissions. The association between alcohol use and violent behavior is well documented. Numerous studies of adolescents report that alcohol use is linked to both violent behavior and to violence-related injuries. (5)(6)Other harmful behaviors and negative consequences frequently related to excessive drinking among adolescents are high-risk sexual behaviors (unplanned and unprotected intercourse); sexual misconduct, including rape; and assaults. Having multiple sexual partners, failing to use condoms, and performing other high-risk sexual behaviors have been associated with alcohol use in adolescents. Furthermore, alcohol use by the offender, victim, or both has been linked to sexual assault, including date rape.As youth move from adolescence to young adulthood, they encounter dramatic physical, emotional, and lifestyle changes. Developmental transitions, such as puberty and increasing independence, have been associated with alcohol use. Because drinking is so widespread among adolescents, simply being an adolescent may be a key risk factor for initiation of alcohol use, as well as for drinking dangerously.Data from imaging studies show that the brain continues developing well into the twenties, during which time it continues to establish important communication connections and further refines its function. Many believe that this lengthy developmental period may help to explain some of the behaviors characteristic of adolescence, such as the propensity to seek out new and potentially dangerous situations. For some adolescents, thrill-seeking includes experimenting with alcohol use. Developmental changes also may offer a possible physiologic explanation for why teens act so impulsively, often not recognizing that their actions—such as drinking—have consequences.How adolescents view alcohol and its effects also influences their drinking behavior, including whether they begin to drink and how much. An adolescent who expects drinking to be a pleasurable experience is more likely to drink than one who does not. Beliefs about alcohol are established very early in life, even before entering elementary school. Before age 9 years, children generally view alcohol negatively and see drinking as bad and associated with adverse effects. By approximately age 13 years, however, their expectancies shift, becoming more positive. Accordingly, adolescents who drink the most also place the greatest emphasis on the positive and arousing effects of alcohol.Differences between the adult brain and the brain of the maturing adolescent may explain why many young drinkers are able to consume much larger amounts of alcohol than adults before experiencing the negative consequences of drinking, such as drowsiness, lack of coordination, and withdrawal or hangover effects. This unusual tolerance may help to explain the high rates of binge drinking among many adolescents and young adults. At the same time, adolescents appear to be particularly sensitive to the positive effects of drinking, such as feeling more at ease in social situations, and young people may drink more than adults because of these positive social experiences.Children who begin to drink at a very early age (before age 12 years) often share similar personality characteristics that may make them more likely to start drinking. Young people who are disruptive, hyperactive, and aggressive—often referred to as having conduct problems or being antisocial—as well as those who are depressed, withdrawn, or anxious, may be at greatest risk for alcohol problems. Other behavior problems associated with alcohol use include rebelliousness, difficulty avoiding harm or harmful situations, and a host of other traits seen in young people who act out without regard for rules or the feelings of others (ie, disinhibition).Some of the behavioral and physiologic factors that converge to increase or decrease a person’s risk for alcohol problems, including tolerance to alcohol’s effects, may be linked directly to genetic factors. For example, being a child of an alcoholic or having several alcoholic family members places a person at greater risk for alcohol problems. Children of alcoholics (COAs) are between 4 and 10 times more likely to become alcoholics themselves than are children who have no close relatives with alcoholism. (7) COAs also are more likely to begin drinking at a young age and to progress to drinking problems more quickly.Research shows that COAs may have subtle brain differences that could be markers for developing later alcohol problems. For example, by the use of newer brain-imaging techniques, scientists have found that COAs have a distinctive feature in one brainwave pattern (called a P300 response) that could be a marker for later alcoholism risk. (8) Some studies suggest that these brain differences may be particularly evident in people who also have certain behavioral traits, such as signs of conduct disorder, antisocial personality disorder, sensation-seeking, or poor impulse control. (9)Drinking and alcohol-related problem behavior reflect a complex interplay between inherited and social-environmental factors, the implications of which are only beginning to be explored in adolescents. And although even more is understood about the role and contribution of genetics, this knowledge still does not tell the entire story.Social and environmental factors, such as the influence of parents and peers, also play a role in alcohol use. For example, parents who drink more and who view drinking favorably may have children who drink more. Other influences, such as the impact of the media, have been examined and are felt to play an important role. Today, alcohol is widely available and aggressively promoted through television, radio, billboards, and the Internet.Although the severe health problems associated with harmful alcohol use are not as common in adolescents as they are in adults, studies show that adolescents who drink heavily may put themselves at risk for a range of health problems.Chronic heavy drinking during adolescence and into young adulthood appears to be associated with detrimental effects on brain development, brain functioning, and neuropsychological performance. Recent evidence suggests that heavy drinking during adolescence is associated with poorer neurocognitive functioning during the young adult years and is associated particularly with impairment of attention and visuospatial skills. (10)Brain imaging and studies of event-related potentials have demonstrated subtle but significant abnormalities in brain structure and function. In a recent study, researchers used magnetic resonance imaging to determine the effects of heavy drinking on the changing brain structure of teens and young adults with alcohol use disorders. Hippocampal volumes were smaller in youths with alcohol use disorders than in matched controls and correlated with the onset of alcohol use disorder and with the duration of alcohol use disorder. (11) The earlier an individual developed an alcohol use disorder and the longer the duration of the alcohol use disorder, the smaller was the volume of his or her hippocampus. (12) Other studies have looked at the effect of alcohol on the structure of white matter and have demonstrated that white matter integrity was reduced in the corpus callosum of youths with alcohol use disorders.Research studies indicate that a number of factors seem to influence how and to what extent alcohol affects the brain, including:Elevated liver enzymes, indicating some degree of liver damage, have been found in some adolescents who drink Young drinkers who are or liver enzymes, even with only of both and puberty is a period associated with including in the and in increase of other and factors, which are for alcohol during this period of and development (ie, before or during may the for development of and are the in the in of At the same time, they experience high rates of mortality and morbidity because of their behavior, including the use of many including adolescence is a time of risk and for many young people in some of that alcohol use. 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an or more positive to the can be a positive which the for is to screen for alcohol problems in not to family alcoholism. A positive on the a greater risk for alcoholism in the family and should be by a more In a recent study, one positive on the was more sensitive than about family alcohol problems. The of the for family alcohol problems was the positive the and the negative The also with family family communication problems, and use of other than to use the in this the for greater for the adolescent encounter and for a of about or from and By the drug use for drinking, the also can be used to screen for use of other than signs and of alcohol use disorders in adolescents often are More than signs may be the of A in school or in other may become more as alcohol or other drug use with or the often become more evident as use such as in and or and or may be of problem alcohol assessment of an functioning is the most important of a for alcohol or may be to begin with a of including and family school and and and and The can to a of whether alcohol or other drug use is a cause of behavioral and to the degree of is no single screen that has been for adolescents, the which has been in adolescents, is a that has been used by many and is to use. find such as the to be because it about drinking and binge behavior, with about the consequences of drinking. A recent developed by the on Alcohol and a more and suggests that a of two one about drinking and one about the drinking The on to on positive and negative and for and help to those individuals most likely to have a problem related to alcohol or other drug use. should help to whether is a for assessment by the primary or a is to in that is an important and first to the of a but that from assessment and a is a more and lengthy to determine the extent of the and in Although the to an assessment and make an may be the time and of many primary are for and or Moreover, adolescent and other primary health can play an important role in adolescents for behavior in an to the adverse health associated with adolescent alcohol of how problem alcohol use to developmental transitions, including how individual characteristics and to these an important for and in adolescents. the past in this related to adolescents out that the many that during adolescence of for to the many of behavior of adolescents that are already The suggests that by potentially developmental can not only in of but also can the for health and adolescence and young and have five that can be used to and family members in and with to The and for begin with the that the and for within the or family the is to a of that the or the family for and to The health is to the of those individuals as well as those positive in their The this role is to great for the adolescent and or should be a of person and for the of the The and family of and for are is important to to the adolescent that person’s drinking or drug use is not their and that they be for changing they are for and can their drinking is and on the that is to the adolescent or family The role of the is than The of such is widely in is a key to an of also them in the of for when people a between they are and they to The to and attention on such with regard to the drinking In certain it may be first to the of the by the of the consequences related to alcohol which to should be to have the or a The does not seek to or by or the the adolescent and family in the of the drinking used the adolescent or family and not the the for not meet but the with a of adolescent and family in the is as not and is explored are from the adolescent or family than by the who are that they have a problem still not move is for is a of behavior in the that one can a behavior or a (ie, to a In this of be or The can be a and play an important role by the and family with and The is to the about in in a of and is the of this article, it is to in these when having a with or to adolescents and family This often adolescents and family members with on health and associated the adolescent or family for and the impact of failing to clear or the for in a and than a of for as a for to the on and and and that the adolescent or family can important of to behavior changes in adolescents and use of the of is to the of the entire in clear and and to the use of and when not the influence of and family members and the role that they play in the of