Mental Health Wellness and Promotion – Substance Use Prevention Evidence-Based Resource

Mental Health Wellness and Promotion Practices on SUPER

SUPER now features a list of mental health wellness and promotion practices to support counties, tribal entities, and community-based organizations in their behavioral health efforts. Incorporating mental health wellness practices on SUPER is beneficial, as many risk and protective factors for substance use also affect mental health.

By addressing these shared risk and protective factors, mental health wellness and promotion practices can also reduce the likelihood of substance use. In addition, youth who are effectively managing anxiety, depression, or other mental health challenges are less likely to turn to substances to cope with their symptoms. It may be beneficial to consider implementing both mental health wellness and promotion practices and traditional substance use prevention strategies.

DHCS Behavioral Health Continuum of Care: a half-wheel showing the prevention-to-recovery spectrum. Inner segments left-to-right: Promotion, Universal, Selective, Indicated, Case Identification, Standard Treatment for Known Disorders, Compliance with Long-term Treatment (Goal: Reduction in Relapse and Recurrence), and After-care (including Rehabilitation). Outer arcs group these into BHSA Population Prevention, SUBG Primary Prevention, BHSA Early Intervention, Treatment, and Recovery. — DHCS-approved Institute of Medicine Continuum of Care prevention spectrum (funder spec p.17).

Adapted from the Institute of Medicine Continuum of Care Model. BHSA — Behavioral Health Services Act SUBG — Substance Use Prevention, Treatment, and Recovery Block Grant

Socio-Ecological Model for Mental Health Wellness and Promotion

Mental health wellness and promotion can occur at multiple levels. The Substance Abuse and Mental Health Services Administration (SAMHSA) Socio-Ecological Model describes how there are four levels—the individual, relationship, community, and society—that influence each other and may impact youth's mental well-being.

Individual Level

Individual-Level factors include age, education, income, health, and psychosocial problems that may correspond with mental health challenges.

For example, youth who experience persistent negative thoughts and have difficulty regulating their emotions are at higher risk for developing anxiety or depression.

Relationship Level

Relationship-Level factors include close social circles—family members, peers, teachers, and other close relationships—that contribute to youth's range of experience and may influence their behavior.

For example, youth who experience frequent family conflict or who lack supportive relationships at home are more likely to develop symptoms of depression or anxiety.

Community Level

Community-Level factors include the settings in which social relationships occur, such as schools, workplaces, and neighborhoods.

For example, youth attending schools where bullying is common or where mental health resources are limited experience higher rates of anxiety, depression, and suicidal ideation.

Society Level

Society-Level factors include social and cultural norms, social drivers of health, and educational and social policies that contribute to economic and/or social inequalities or lack of opportunities.

For example, social norms that stigmatize mental illness can prevent youth from seeking help, leaving symptoms untreated and worsening over time.

Risk and Protective Factors

Mental health risk and protective factors are conditions in people's lives that make them more or less likely to develop mental health problems. Effective mental health wellness and promotion services reduce risk factors while boosting protective factors. In addition, since many risk and protective factors related to substance use are related to mental health, several mental health risk and protective factors can also impact substance use behaviors.

See the tables below for an overview of key mental health risk and protective factors, as well as the shared risk and protective factors that impact both substance use and mental health.

Youth Mental Health Risk and Protective Factors

Level	Risk Factors	Protective Factors
Individual	Conflicting thoughts around religious/spiritual beliefs Difficult temperament (e.g., low positive mood, inflexibility, withdrawal) Exposure to stressful and/or traumatic life situations Insecure attachment Low self-esteem Negative emotional state Perception of being inherently flawed beyond repair or irredeemable Poor coping skills and behaviors Poor nutrition and lack of sleep Poor social skills (e.g., communication, problem-solving skills) Shyness	Achievement motivation Emotional self-regulation Healthy diet and development High self-esteem Optimism Personal engagement in two or more of the following: school, peers, athletics, employment, religion/spirituality, culture Positive physical development Positive self-regard Secure attachment style Strong coping skills (e.g., problem-solving skills, ability to stand up for beliefs and values) Strong orientation for the future Subjective sense of self-sufficiency
Family and Relationships	Caregiver experiences of anxiety and/or depression Divorce Experiences of child abuse/maltreatment Family conflict Family experiences of poverty Family history of mental health problems Family management problems Substance use among caregivers	Attachment between caregivers and youth, including unity, warmth, and attachment Clear expectations for behaviors and values Communication and contact between caregivers and youth Family environment with structure, rules, predictability, and parental supervision Supportive relationships with family
School, Peer, and Community	Academic failure Aggression towards peers Bullying (either a victim or perpetrator) Community-level poverty Community-level stressful/traumatic events or violence Experiences of discrimination Having few friends or few healthy friendships Lack of access to support services Low commitment to school Norms favorable towards substance use Peer rejection School violence Substance use among peers	Ability to make friends and get along well with others Academic achievement Clear expectations for behavior Opportunities for prosocial engagement in the school and community Physical and psychological safety Positive social norms Presence of mentors and healthy adults for positive emotional support Strong peer relationships

Shared Substance Use and Mental Health Risk and Protective Factors

Level	Risk Factors	Protective Factors
Individual	Negative emotional state Poor coping skills and behaviors	Emotional self-regulation High self-esteem Personal engagement in two or more of the following: school, peers, athletics, employment, religion/spirituality, culture Strong coping skills (e.g., problem-solving skills, ability to stand up for beliefs and values)
Family and Relationships	Family conflict Family experiences of poverty Family management problems Substance use among caregivers	Attachment between caregivers and youth, including unity, warmth, and attachment Clear expectations for behaviors and values Communication and contact between caregivers and youth Family environment with structure, rules, predictability, and parental supervision Supportive relationships with family
School, Peer, and Community	Academic failure Low commitment to school Norms favorable towards substance use Substance use among peers	Opportunities for prosocial engagement in the school and community Physical and psychological safety Positive social norms Presence of mentors and healthy adults for positive emotional support

Practice Components

Effective substance use prevention and mental health wellness and promotion blend diverse practice components such as skills training, educational interventions, community engagement, and policy development. These elements are vital for driving meaningful change at individual, relationship, community, and societal levels.

The tables below outline common components found in effective mental health wellness and promotion practices.

Individual-Level Practice Components — Mental Health Wellness and Promotion

Practice Component	Description
Anger Management	Exercises or techniques designed to promote youth's ability to regulate or prevent anger or aggressive expression and seek productive resolutions to problems.¹
Assertiveness Training	Exercises designed to promote youth's ability to assert needs appropriately with others.¹
Behavioral Modification	Interventions that utilize principles of rewards, punishment, and/or reinforcement to facilitate behavior change.²
Civic Responsibility	Teaching youth civic engagement, respect for people and property, advocacy and volunteerism.¹
Cognitive Behavioral Strategies	Services that help youth alter their interpretation of thoughts, recognize situations in which they are most likely to use substances, and/or how to avoid and appropriately cope with those situations. Techniques designed to alter interpretation of events through examination of youth's reported thoughts.¹
Communication Skills	Training in how to communicate more effectively with others.¹
Cultural/Religious Focus	Interventions that utilize or leverage culture and/or religion in prevention programming.²
Goal Setting	Explicit selection of a life goal for youth to work towards.¹
Insight Building	Activities specifically designed to help youth achieve greater self-understanding.¹
Mental Health Education	Teaching youth about mental disorders, reducing stigma, and increasing awareness.⁴
Motivational Enhancement	Discussions that utilize reflective listening, open-ended strategies, and comparisons of behavior or feelings to normative standards.⁵
Problem Solving	Training in the use of techniques, discussions, or activities designed to bring about solutions to targeted problems.¹
Psychoeducation	Discussion focused on handling day-to-day life issues that may directly or indirectly impact substance use. Promoting behavior change by providing education and information intended to promote healthy behavior decision-making.⁶
Relaxation	Techniques or exercises designed to induce psychological calming.¹
Self-Efficacy/Self-Esteem Enhancement	Techniques to enhance self-confidence and improve self-efficacy.¹
Self-Monitoring	Repeated measurement of a target index by youth. Observation and regulation of mood and behavior.⁴
Skills Training	An interactive approach that helps youth develop social, emotional, and behavioral competencies that enable them to navigate high-risk situations effectively.^1,4

Relationship-Level Practice Components — Mental Health Wellness and Promotion

Practice Component	Description
Parenting Education/Skills	Services that enhance parent supportiveness, communication, involvement in youths' lives, monitoring, and supervision.¹
Support Networking	Strategies to explicitly identify, engage, develop, or otherwise increase the involvement or effectiveness of individuals in the youth's life. Identification of a group of people who can provide emotional and practical help to manage difficult situations.²

References

Individual-Level Practice Components

Boustani, M. M., Frazier, S. L., Becker, K. D., Bechor, M., Dinizulu, S. M., Hedemann, E. R., ... & Pasalich, D. S. (2015). Common elements of adolescent prevention programs: Minimizing burden while maximizing reach. Administration and Policy in Mental Health and Mental Health Services Research, 42(2), 209-219. doi: 10.1007/s10488-014-0541-9
Tanner-Smith, E. E., Wilson, S. J., & Lipsey, M. W. (2013). The comparative effectiveness of outpatient treatment for adolescent substance abuse: A meta-analysis. Journal of Substance Abuse Treatment, 44(2), 145-158. doi: 10.1016/j.jsat.2012.05.006
Shernoff, E. S., Kratochwill, T. R., Ballard, S. C., Chen, S. M., & Boustani, M. M. (2025). Identifying common practice elements among consultation studies showing promising social and behavioral outcomes: A systematic review. Journal of School Psychology, 110, 101463. doi: 10.1016/j.jsp.2025.101463
Skeen, S., Laurenzi, C. A., Gordon, S. L., Du Toit, S., Tomlinson, M., Dua, T., ... & Melendez-Torres, G. J. (2019). Adolescent mental health program components and behavior risk reduction: A meta-analysis. Pediatrics, 144(2), e20183488. doi: 10.1542/peds.2018-3488
Tanner-Smith, E. E. & Grant, S. P. (2019). Brief Interventions as Evidence-Based Prevention Strategies. In Z. Sloboda, H. Petras, E. Robertson, & R. Hingson (Eds). Prevention of Substance Use. Springer: Switzerland. doi: 10.1007/978-3-030-00627-3
Helland, S. S., Mellblom, A. V., Kjøbli, J., Wentzel-Larsen, T., Espenes, K., Engell, T., & Kirkøen, B. (2022). Elements in mental health interventions associated with effects on emotion regulation in adolescents: a meta-analysis. Administration and Policy in Mental Health and Mental Health Services Research, 49(6), 1004-1018. doi: 10.1007/s10488-022-01213-2

Relationship-Level Practice Components

Helland, S. S., Mellblom, A. V., Kjøbli, J., Wentzel-Larsen, T., Espenes, K., Engell, T., & Kirkøen, B. (2022). Elements in mental health interventions associated with effects on emotion regulation in adolescents: A meta-analysis. Administration and Policy in Mental Health and Mental Health Services Research, 49(6), 1004-1018. doi: 10.1007/s10488-022-01213-2
Skeen, S., Laurenzi, C. A., Gordon, S. L., Du Toit, S., Tomlinson, M., Dua, T., ... & Melendez-Torres, G. J. (2019). Adolescent mental health program components and behavior risk reduction: A meta-analysis. Pediatrics, 144(2), e20183488. doi: 10.1542/peds.2018-3488