In 1994, the Committee on Prevention of Mental Disorders first introduced the formal Behavioral Health Continuum of Care Model, which recognized multiple components to address mental health issues, including substance use disorders:
- Promotion strategies that are focused on creating conditions that support mental health and reinforce resilience to withstand stress and other challenges
- Prevention strategies that are delivered to individuals before they haven’t identified disorder (e.g., a substance use disorder) and are intended to reduce the risk of developing a particular problem
- Treatment services that are specifically designed to be implemented with people who have already been diagnosed with a substance use disorder or other mental health disorder
- Recovery services that are designed to support people who have been diagnosed and treated with a substance use disorder or other mental health disorder, and help them continue to be productive and maintain their treatment progress
The difference between treatment and prevention is that treatment strategies are focused on getting individuals to stop using drugs, remain abstinent, and be productive, whereas prevention strategies are targeted at specific risk factors that are identified that can increase the probability that an individual may develop a substance use disorder. This article will discuss the components of effective prevention programs.
Interestingly, while it makes conceptual sense to devote a good percentage of resources to prevention, these resources are often allocated ineffectively or targeted incorrectly. One can simply look at the policies regarding prescription drug abuse by the current administration and determine the focus is on treatment and enforcement of laws regarding illegal procurement of these substances, and not on early prevention strategies. While treatment for individuals who have developed these disorders is certainly crucial, the best long-term strategy is to implement effective prevention measures on a national level in order to effectively reduce the risk of the number of individuals who develop substance use disorders. There is a wealth of research that outlines how effective substance use disorder prevention programs can be implemented.
Principles of Effective Prevention
The empirical research regarding the components of effective prevention programs has suggested that there are several principles that these programs should attempt to follow or promote.
- Prevention programs targeted at substance use disorders should attempt to strengthen protective factors in individuals and/or reduce the presence of risk factors. A protective factor is some type of environmental situation, internal disposition, or other variable that reduces the risk of developing a substance use disorder. Individuals who are at risk to develop substance use disorders have a number of potential protective factors that include:
Regarding the last point, it is important to make sure that when prevention programs attempt to enhance protective factors, they do so with the appropriate group in mind. Targeting aimed at different protective factors will have different effects depending on the individual’s age, ethnic background, environment, and even gender.
- Prevention programs can be tailored to address specific types of risks or groups, such as specific age groups, individuals with a specific ethnic or cultural background, or other specific characteristics. When this is done, it can improve the effectiveness of the prevention program.
- Prevention programs should address all forms of substance abuse and can also be targeted at addressing specific types of substance abuse that may be more common in local communities. By doing this, they can target specific risk factors and increase identified protective factors in these communities.
- Prevention programs targeted at families should also be aimed at enhancing bonding and relationships of family members, developing and enforcing family policies on substance use, and training in the education of drugs and alcohol use and abuse.
Prevention programs targeted at children in elementary school are most effective if they focus on improving academic skills and emotional factors in young children. These improvement programs should be designed to:
- Support academic skills, particularly in developing competent reading skills
- Develop self-control in children
- Develop communication skills
- Develop emotional awareness and the ability to discuss feelings
- Introduce antidrug attitudes
- Develop problem-solving skills
- Continued facilitation of academic support and study habits
- Continued concentrations on reading proficiency
- Developing assertiveness and problem-solving efficacy skills
- Continued open communication and development of communication skills
- Strengthening peer relationships
- Positive reinforcement of antidrug attitudes
- Continued development of resistance skills regarding the use of drugs
- Continuing to strengthen commitments against drug abuse
- Community prevention programs should attempt to combine two or more prevention programs (e.g., school-based and family-based programs). These can be more effective than single community-based programs alone. Community prevention programs are designed to reach populations in multiple settings, and they are more effective when they transmit community-based messages.
- Aiming prevention programs at specific populations can be targeted for populations during key transition points (e.g., the transition from elementary to middle school).
- An overall approach to the structure of prevention programs should:
- Be long-term
- Have repeated interventions to reinforce goals (e.g., Middle school prevention programs may be effective but this effectiveness diminishes if there are no follow-up programs in high school.)
- Include training for teachers regarding classroom management, fostering positive behavior, motivating students academically, and bonding with the teacher and other authority figures
- Employ interactive techniques that include things like pure discussion, role-playing for parents to teach prevention skills, and active involvement in learning about drug abuse
- The cost-effectiveness of prevention programs indicates that this is one of the most efficient ways to reduce the burden of drug abuse. A number of research studies indicate that even though the cost of organizing these prevention programs can be substantial, they often save up to 10 times their original cost. On a practical scale, this means that for every $1 spent on implementing a prevention program a potential $10 in treatment costs is saved. Thus, treatment is effective but it is far more expensive than implementing solid research-based prevention programs.
There is a qualitative difference between the treatment of substance use disorders and focusing on their prevention. Prevention-based programs are very involved and require a strong commitment at different levels of development in order to be effectively implemented. In addition, prevention programs require a broader focus of resources in order for them to be effective. However, prevention programs are far more cost-effective than treatment programs in the long run. Prevention programs that foster protective factors lead to a decreased potential for risk factors to develop. Their actual effect is to reduce the prevalence of substance abuse in individuals. Part of the problem in implementing effective prevention programs on a national scale is that the results of these programs are dependent on being implemented early and continued throughout the child’s development. They also do not demonstrate concrete results for years after their implementation.
Treatment programs can provide immediate evidence regarding their effectiveness, but they are only implemented after the fact – after individuals have already developed significant substance abuse problems. Prevention programs can help individuals before the disorder has a chance to take hold. If effective prevention programs can be implemented, their potential to reduce the burden of substance abuse is far greater than treatment. Substance abuse counselors can enhance the effectiveness of their own interventions by actively participating in community-based prevention strategies.
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