Substance-Abuse Prevention

What are the three major levels of intervention in substance-abuse prevention strategies?

It can be helpful to think about substance-abuse prevention strategies along the lines of differing levels of intervention based on the population of individuals that an intervention program wants to reach and the specific goals of the program. It should make sense to you that more than one type of intervention strategy is needed because not everyone who abuses or is otherwise dependent on a drug will be at the same stage of use or confront the same challenges.

Some individuals may be very early in the process and only contemplating whether or not they would like to experiment with taking a drug. In situations like these, the role of the family, the peer group, and having basic knowledge about the drug under consideration is very relevant. At other times, individuals may already be using a drug on a fairly regular basis and/or have experienced one or two instances where their drug-seeking or drug-taking behaviors have negatively impacted important aspects of their lives. In those instances, a more targeted approach, geared to their current degree of drug use, is needed.

The first level of intervention is that of primary prevention programs. These are strategies that are targeted to individuals who have not yet had any direct experience or had only minimal exposure with the drug in question. As you would expect, these types of programs typically target children and young adolescents and the information that is imparted to them is often through school-based curriculum or media campaigns. It is common for these programs to demonstrate scenarios where a child or teen might be offered the opportunity to use an illicit drug, and then role-play different ways to respond to the social press from another peer. These programs also provide the individual with basic knowledge regarding the risks and unwanted side effects associated with the specific drug being targeted. Drugs that are typically targeted at this level are the ones that are most accessible to children: tobacco, alcohol, marijuana, and prescription medications.

The next level of intervention to help prevent drug abuse and dependence is found in secondary prevention programs. Since, in this instance, individuals already have had some experience using the drug, the content of the intervention is geared toward limited the continued exposure the individual with the drug.  The goal of these programs is to limit (and possibly discontinue) the use of the drug and to prevent an increase in the frequency of drug use or escalation of drug use toward more dangerous and illegal substances. As you would expect, messages of this nature will be targeted toward older individuals, typically teenagers to young adults. At times, these programs also teach strategies for responsible drug use when used in legal circumstances (e.g., alcohol use for young adults).

The final level of intervention in terms of substance-abuse prevention programs is that of tertiary prevention. These types of programs are targeted toward individuals who have been identified as having a substance abuse and/or dependence problem and are in treatment for the condition. As such, the goal is more in line with what you would think of in terms of conventional interventions – to help remove the remnants of drugs out of the individual’s bodily system and work toward a drug-free life and to not relapse upon discharge from a treatment program. If one can live independently at the completion of treatment without incidents of relapse, then the intervention can certainly be said to have been successful.

What are approaches to substance-abuse prevention that have been unsuccessful?

There have certainly been examples in our country of substance-abuse prevention programs that have been unsuccessful. At times, they have oversimplified the problem or didn’t sufficiently grasp the complexities of the many variables which influence the decision an individual makes to try and drug or to maintain using one. Prevention programs that take into account both the accumulated research on the risk factors associated with use, in addition to the research on the resiliency factors that help it to not occur, tend to have the best outcomes. How one chooses to measure the success of prevention programs (e.g., student self-report, parent satisfaction, number of school suspensions) also comes into play in the evaluation of the efficacy of a program. The most robust outcome measure really should be: has the actual prevalence of use, abuse, and/or dependence decreased in relation to a control group (i.e., a group of same-age peers who did not receive the prevention program)?

There have been several approaches to drug prevention in our society that have failed in their goals. Attempts at reducing the sheer availability of drugs through law enforcement and attempts to decrease international drug trafficking haven’t yielded significant results. These legislative and law enforcement strategies have, in effect, decreased the overall supply but, in addition, have also increased the demand or cost as a result. The vacuum created by decreasing the availability of one drug in an area has often resulted in an increase in the availability and/or use of another. Further, efforts at curtailing international drug smuggling have been limited at best. Similarly, increasing the amount of punishment that a society hands out to those who break the laws relating to illicit drug possession, distribution and use has not demonstrated a significant decrease in the rates of substance abuse or dependence. In short, the threat of being arrested or convicted of a drug crime has had limited impact in affecting change in drug abuse in our society.

Finally, the use of scare tactics and other negative advertisement campaigns have been largely unsuccessful in decreasing instances of drug use and abuse. Appeals to fear are often delivered to the adolescent population who, developmentally speaking, are already “wired” to mistrust the credibility and authenticity of adults in their world. As such, these types of messages often do nothing but to reinforce their belief that adults tend to “blow things out of proportion,” expect the worse from teenagers, and are too simplistic, lacking an understanding about the reasons behind why a person might use drugs.

What elements help make school-based substance-abuse prevention programs successful?

Out of the ashes of several of the failed prevention programs of the past, and based more on evidence-based research in terms of effective outcomes, many of today’s school-based substance-abuse prevention programs have made some headway in reducing the prevalence of drug use in children. In particular, successful programs have focused on building those skills in children that have been positively correlated with resilience and factors that decrease the risk of experimenting with drugs. Examples include programs that train children to develop a repertoire of social and behavioral skills – and the self-esteem necessary to – refuse advances or social presses by their peers to try a drug when presented to them. Helping children develop skills and resources to reduce anxiety and perceptions of stress in their life – often a precursor to drug use – can also pay back big dividends toward continued abstinence.

What role can the family play in substance-abuse prevention?

The role of the family in substance-abuse prevention cannot be underscored enough; in effect, it is where the beginning of resilience and inoculation occur against many of societies’ ills, including drug abuse. On the other end of the spectrum, the family also plays a significant role in the outcome of treatment for drug abuse and dependence as well. However, gaining access to the parents or caregivers of those children who are considered to be the most at-risk for drug use can be difficult because they themselves may struggle with their own psychosocial challenges and problems in living. When they are available and engage in a prevention program, caregivers provide very powerfully persuasive factors to children, particularly as role models, conveyors of information about the risks associated with drug use, and as rule makers with regards to consequences for infractions as it relates to their children using drugs.