Approaches to Preventing Substance Abuse

In order to prevent substance abuse among young people, both supply and demand reduction strategies are critical. Supply reduction strategies include any method used to reduce the availability of drugs, such as border patrols, confiscation of drug shipments, and penalties for drug use and drug dealing. In recent years, ''community'' police officers have been increasingly used in neighborhood and secondary school settings to prevent the local sale and distribution of drugs. Within the realm of legal substances, such as alcohol and tobacco, effective supply reduction strategies include increasing taxes, increasing the legal age of use, increasing law enforcement, reducing product advertising, reducing the number of sales outlets, and imposing penalties for sales of these products to minors.

Demand reduction strategies are designed to reduce the demand for drugs. Prevention and treatment are part of demand reduction. Prevention attempts to reduce demand by decreasing risk factors and increasing protective factors associated with substance abuse, while treatment is designed to decrease demand by stopping substance abuse in addicted or abusing individuals.

Prevention programs are organized along a targeted audience continuum—that is, the degree to which any person is identified as an individual at risk for substance abuse. Universal prevention strategies address the entire population (e.g., national, local community, school neighborhood) with messages and programs aimed at preventing or delaying the use of alcohol, tobacco, and other drugs. Selective prevention strategies target subsets of the total population that are deemed to be at risk for substance abuse by virtue of their membership in a particular population segment—for example, children of adult alcoholics, dropouts, or students who are failing academically. Indicated prevention strategies are designed to prevent the onset of substance abuse in individuals who do not meet medical criteria for addiction but who are showing early danger signs, such as truancy, falling grades, and cigarette smoking.

Research shows that there are many risk factors for drug abuse, each having a different impact depending on the phase of development. Risk factors can be associated with individual characteristics as well as social contexts. Individual risk factors include: genetic susceptibility to addiction, high sensation seeking, impulsive decision making, conduct problems, shyness coupled with aggression in boys, rebelliousness, alienation, academic failure, and low commitment to school.

Family risk factors include: substance abusing or emotionally disturbed parents; perceived parent permissiveness toward drug/alcohol use; lack of or inconsistent parental discipline; negative communication patterns and conflict; stress and dysfunction caused by death, divorce, incarceration of parents or low income; parental rejection; lack of adult supervision; poor family management and communication; and physical and/or sexual abuse. School risk factors include: ineffective classroom management, failure in school performance, truancy, affiliations with deviant peers, peers around deviant behaviors, and perceptions of approval of drug using behaviors in the school, peer, and community environments.

Certain protective factors have also been identified. These factors are not always the opposite of risk factors, and their impact varies along the developmental process. The most salient protective factors include: strong bonds with the family; experience of parental monitoring with clear rules of conduct within the family unit and involvement of parents in the lives of their children; success in school performance; and strong bonds with prosocial institutions such as the family, school, and religious organizations. Other factors—such as the availability of drugs, alcohol, and tobacco, and beliefs that substance use by young people is generally tolerated—also influence a number of youth who start to use drugs.

A young boy rolls a marijuana cigarette. Adolescents are most likely to experiment with alcohol and tobacco before trying marijuana—all are considered to be "gateway drugs." (Joan Slatkin/Archive Photos, Inc.)

During the 1990s, the federal government made a concerted effort to test and disseminate prevention programs that met rigorous scientific standards for effectiveness. For example, school districts had to select effective programs and evaluate their progress toward specific goals for reduction of substance use by students, in order to receive funding through the Safe and Drug Free Schools program. Agencies such as the National Institute on Drug Abuse and the Center for Substance Abuse Prevention funded national and local studies to test whether youth who participate in prevention programs actually experience a reduction in risk factors, an increase in protective factors, and/ or reductions in substance use. Federal agencies, scientific societies, and private foundations developed criteria for assessing the evidence about the effectiveness of various approaches and programs, and many provided recommendations to the public about particular programs and approaches through web sites and print media. Changing behavior is exceedingly complex, but informed efforts by parents, schools, and communities can help protect young people from the harms of substance abuse.


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