Factors in Preventive Interventions

The drug pathways young people take are highly complex and dynamic with their AOD use attitudes and behavior shifting through adolescence and on into young adulthood. Therefore, if we are looking for drug prevention strategies or programs that will meet the needs of a highly segmented and dynamic population which is at different levels and stages of AOD knowledge, experience, and information needs, then it is almost impossible to do so using a universal preset curriculum and delivering it, as is the norm, to whole classes or groups. What is needed is prevention programs targeted at specific populations using different prevention strategies and techniques (Robert Wood Johnson Foundation, 2000).

Prevention Principles

There are at least four populations for drug prevention programs. The four populations are distinguished by their attitudes toward drugs, drug trying and regular using behavior, self-defined drug status, and intentions regarding future drug use:

1. Abstainers are those who have never tried AOD and who currently never intend to try any AOD in the future (They hold relatively strong anti-AOD attitudes.).
2. Former AOD Users have tried AOD, often experimentally, but who do not intend to do so again (They hold relatively negative attitudes towards drug use.).
3. Transition Users refers to a group who may or may not have tried a drug, but who think they might do so in the future (They tend to hold somewhat pro-AOD attitudes.).
4. Current Users have all tried drugs, currently use AOD, and plan to do so in the future (They hold strong pro-AOD attitudes.).

Knowledge of risk and protective factors can guide the development of theory-based prevention programs. The Center for Substance Abuse Prevention (2003) has identified six multi-dimensional prevention strategies that, in combination, can be used to develop programs focusing on risk and protective factors for AOD use:

1. Information Dissemination: information about the nature and prevalence of AOD use and abuse and the psychological and social effects of AOD abuse
2. Prevention Education: teach participants critical life and social skills;
3. Alternatives: voluntary participation in drug-free activities with both other youth and adult mentors
4. Problem Identification and Referral: identifying youth who already have initially tried AOD or developed AOD use problems and referring them to appropriate treatment options
5. Community-Based Process: building interagency coalitions and training community members and agencies in substance use education and prevention
6. Environmental Approach: changing community policies and practices that encourage or allow AOD use (Schinke, Brounstein, & Gardner, 2002).

The National Institute of Drug Abuse (2003a) has identified 16 prevention principles for children and adolescents:

1. Prevention programs should be designed to enhance protective factors and reverse or reduce risk factors.
2. Prevention programs should address all forms of drug abuse, alone or in combination, including the underage use of legal drugs, the use of illegal drugs, and the inappropriate use of legally obtained substances.
3. Prevention programs should address the AOD use problems in the local community, target modifiable risk factors, and strengthen identified protective factors.
4. Prevention programs should be tailored to address risks specific to population or audience characteristics, such as age, gender, and ethnicity, to improve program effectiveness.
5. Family-based prevention programs should enhance family bonding and relationships including parenting skills; practice in developing, discussing, and enforcing family policies on substance abuse; and training in drug education and information.
6. Prevention programs can be designed to intervene as early as preschool to address factors for drug abuse, such as aggressive behavior, poor social skills, and academic difficulties.
7. Prevention programs for elementary school children should target improving academic and social-emotional learning to address risk factors for drug abuse, such as early aggression, academic failure, and school dropout. Education should focus on developing the skills of self-control, emotional awareness, communication, social problem solving, and academic support.
8. Prevention programs for middle or junior high and high school students should increase academic and social competence with the following skills: study habits and academic support, communication, peer relationships, self-efficacy and assertiveness, drug resistance skills, reinforcement of anti-drug attitudes, and strengthening of personal commitments against drug abuse.
9. Prevention programs aimed at general populations at key transition points such as transition to middle school and high school, can produce beneficial effects even among high-risk families and children. Such interventions do not single out risk populations and, therefore, reduce labeling and promote bonding to school and community.
10. Community prevention programs that combine two or more effective programs such as family-based and school-based programs can be more effective than a single program alone.
11. Community prevention programs reaching populations in multiple settings, for example, schools, clubs, faith-based organizations, and the media, are most effective when they present consistent, community-wide messages in each setting.
12. When communities adapt programs to match their needs, community norms, or differing cultural requirements, they should retain core elements of the original research-based intervention which includes structure, content, and delivery.
13. Prevention programs should be long-term with repeated interventions to reinforce the original prevention goals. Research shows that the benefits from middle school prevention programs diminish without follow-up programs in high school.
14. Prevention programs should include teacher training on good classroom management practices. Such techniques help to foster student positive behavior, achievement, academic motivation, and school bonding.
15. Prevention programs are most effective when they employ interactive techniques, such as peer discussion groups and parent role-playing that allow for active involvement in learning anti-drug abuse and reinforcing skills.
16. Research-based prevention programs can be cost-effective. Research shows that for each dollar invested in prevention, a savings of up to $10 in treatment for alcohol and other substance abuse can be seen.

Prevention Strategies

The Institute of Medicine (1996) categorizes preventive interventions along a risk continuum according to the vulnerability of the target audience. They identify three types of prevention approaches reflecting increasing degrees of risk.

Universal prevention strategies are directed at all youth, regardless of individual risk, and are designed to prevent initiation of AOD use. Universal programs are delivered to large groups without any prior screening of individuals’ risk for AOD abuse based on the assumption that all members of the population are at risk for AOD abuse and will benefit from the prevention program.

The purpose of universal prevention programs is to deter the onset of AOD use by providing all individuals in the population with the information and skills necessary to prevent AOD use. Rather than focus on individual risk factors, universal prevention programs target environmental risks such as community values, school support, and society norms.

Typically, universal prevention programs use mass media, television, and advertising campaigns to help establish norms against AOD use and increase awareness about the problems. Universal prevention programs tend to focus on AOD abuse prevention efforts in the school, family, and the community.

Research suggests that universal prevention programs are not particularly effective, but they are most effective when they are comprehensive and target the school, family, and community simultaneously. Schools may be a suitable place to give students greater knowledge about the risks of AOD use, but it is usually a place where adolescents do not feel safe in discussing their own use problems.

Success is contingent upon clearly defining multiple targeted audiences, understanding their attitudes, beliefs, and behavior, and then developing engaging and multidimensional strategies that will address their needs. In addition to formally structured programs, there should also be places and people available where young people can talk about their AOD problems and get appropriate information and help if needed (Aldridge, Parker, & Measham, 1998).

Selective prevention strategies are directed toward youth who are at greater risk of AOD use due to environmental or biological risk (i.e. low income, high crime, parents who abuse substances,). The purpose of selective prevention is to deter and/or delay the onset of substance use by directly targeting and reducing identified risk factors and increasing protective factors.

Selective prevention programs also focus on skills training to improve youth’s school, family, peer-group, and community functioning. Selective prevention strategies generally work better than universal prevention strategies if they are able to identify and engage the selected populations. Because selective prevention programs target groups at increased risk of substance use, to be effective, they must be of longer duration and more intensive than universal strategies. The research shows that programs that focus on both youth and parents/guardians demonstrate greater effectiveness.

Indicated prevention strategies are directed toward youth who are already using AOD or are displaying precursors of AOD use, such as risk-taking behavior, aggression or conduct disorders, or significant problems in school or in the community. Because most individuals targeted for this type of program are already experimenting with substances, the goal of these programs is to prevent the progression of use to abuse and/or reduce the severity of substance use.

To be effective, these types of programs should also target associated psychological and social problem behaviors. These types of programs may be more expensive to operate, but they have proven to be effective if there is good matching of program characteristics with the needs of adolescents and their families (Center for Substance Abuse Prevention, 2003).