Substance Use Prevention

Universal prevention is prevention services/activities for the general public or a whole population group that has not been identified on the basis of individual risk. Universal prevention includes strategies that can be offered to the full population, based on the evidence that it is likely to provide some benefit to all (reduce the probability of disorder), which clearly outweighs the costs and risks of negative consequences. There are two main types of universal prevention:

• Universal Direct Prevention: Service recipients are present and are not receiving primary prevention services based on individual risk, also referred to as individual-based programs/services. Examples of universal direct programs include school prevention curricula, after-school programs, and parenting classes.
• Universal Indirect Prevention: Service recipients are not present, and services support capacity-building and awareness for the entire population, also referred to as population-based programs/services. Examples of universal indirect programs include establishing alcohol, tobacco, and other drug policies and modifying advertising practices.

Selective prevention is prevention services/activities for individuals or a subgroup of the population whose risk of developing substance use disorders are significantly higher than average. The risk may be imminent or it may be a lifetime risk.

Risk groups may be identified on the basis of biological, psychological, or social risk factors that are known to be associated with the onset of a disorder. Those risk factors may be at the individual level for non-behavioral characteristics (e.g., biological characteristics such as low birth weight), at the family level (e.g., children with a family history of substance abuse but who do not have any history of use), or at the community/population level (e.g., schools or neighborhoods in high poverty areas).

Selective prevention refers to strategies for subpopulations identified as being at an elevated risk for developing a substance use disorder.

Examples of selective prevention include programs for children of parents with substance use disorders and programs for families who live in high-crime or low-income neighborhoods.

Indicated prevention is prevention services/activities for high-risk individuals who are identified as having minimal but detectable signs or symptoms that foreshadow a substance use disorder, as well as biological markers that indicate a predisposition in a person for such a disorder but who does not meet diagnostic criteria at the time of the intervention.

Indicated prevention includes services for individuals who are identified (or individually screened) as having an increased vulnerability for a substance use disorder based on some individual assessment but who are currently asymptomatic.

Examples of indicated prevention include driving under the influence education programs and programs for youth who face disciplinary issues related to substance use at school.

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

For example, youth who exhibit poor self-regulation, impaired control, and impulsiveness are more likely to engage in binge alcohol use.

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 spend time with peers who believe cannabis use is beneficial and not harmful are more likely to use cannabis.

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

For example, living in neighborhoods with chronically high rates of disorganization, crime, and unemployment is associated with higher risk for substance use.

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 and cultural norms that portray substance use as commonplace or as a rite of passage are associated with higher rates of youth substance use.

This strategy provides awareness and knowledge of the nature and extent of alcohol, tobacco and drug use, abuse and addiction and their effects on individuals, families, and communities. It also provides knowledge and awareness of available prevention programs and services. Information dissemination is characterized by one-way communication from the source to the audience, with limited contact between the two.

Examples of information dissemination include media campaigns, community and school outreach events, and the development of printed materials or websites.

This strategy involves two-way communication and is distinguished from the Information Dissemination strategy by the fact that interaction between the educator/facilitator and the participants is the basis of its activities. Activities under this strategy aim to affect critical life and social skills, including decision-making, refusal skills, critical analysis (e.g. of media messages) and systematic judgment abilities.

Examples of educational activities include group sessions for youth, community/school educational services, and mentoring.

This strategy provides for the participation of target populations in activities that exclude alcohol, tobacco, and other drug use. The assumption is that constructive and healthy activities offset the attraction to, or otherwise meet the needs usually filled by alcohol, tobacco and other drugs and would, therefore, minimize or obviate resort to the latter.

Examples of alternatives include community service activities, social/recreational activities, and youth-adult leadership activities.

This strategy aims at identification of those who have indulged in illegal/age-inappropriate use of tobacco or alcohol and those individuals who have indulged in the first use of illicit drugs to assess if their behavior can be reversed through education. It should be noted, however, that this strategy does not include any activity designed to determine if a person needs treatment.

Examples of problem identification and referral include student assistance programs, driving while under the influence/driving while intoxicated education programs, and brief interventions.

This strategy aims to enhance the ability of the community to provide prevention and treatment services more effectively for alcohol, tobacco, and drug abuse disorders. Activities in this strategy include organizing, planning, enhancing efficiency and effectiveness of services implementation, inter-agency collaboration, coalition building and networking.

Examples of community-based process include coalition and workgroup activities, community and volunteer training, and system planning.

This strategy establishes or changes written and unwritten community standards, codes and attitudes, thereby influencing incidence and prevalence of the abuse of alcohol, tobacco, and other drugs used in the general population. This strategy is divided into two subcategories to permit distinction between activities which center on legal and regulatory initiatives and those which relate to the service and action-oriented initiatives.

Examples of environmental prevention include promotion and enforcement of effective alcohol, drug, and tobacco use policies, modification of advertising practices, and product pricing strategies.