During Substance Use Prevention Month and throughout the year, there are many opportunities for the prevention sector to work collaboratively (across sectors and partners) to develop and implement comprehensive prevention approaches.
Prevention seeks to prevent the initiation of substance use, to prevent the progression of substance use (to a substance use disorder), and to prevent substance use-related harm.
Effective prevention strategies focus on strengthening protective factors and reducing risk factors (PDF | 146 KB) — in individuals, families, schools, communities and society (based on social ecological model). These factors include the social determinants of healthcultural influences and traumatic experiences.
It is important to recognize that substance use disproportionately affects underserved communities and individuals (e.g., people of color, members of religious minorities, lesbian, gay, bisexual, transgender and queer (LGBTQ+), people with disabilities, people living in rural areas areas and people otherwise adversely affected by persistent poverty or inequality).
The path taken after first substance use is not predetermined (although it can be influenced by genetic and other factors) and is not the same for everyone. Substance use prevention is enhanced by considering the multitude of factors that contribute to an individual’s journey, such as social climates, environmental cues, childhood experiences, and more.
There are three categories of prevention interventions: universal, selective and indicated.
- Universal interventions typically include policies (such as minimum legal drinking age), school-based programs, positive social norms (beliefs, attitudes, group behaviors), skill development (emotion management, problem solving, communication), and healthy alternatives .
- Selective interventions are specialized, for use with populations at increased risk.
- Indicated interventions are for those who are already involved in a risky behavior (such as substance use or abuse), or are beginning to experience problems, but have not yet developed a substance use disorder.
Prevention Categories (PDF | 3.1 MB)
| Audience | Goal | |
|---|---|---|
| Global | An entire population (school, neighborhood, community, state, nation) | Prevent (or delay) initiation of use |
| Selective | A subpopulation (a subgroup) with a higher than average risk | Prevent (or delay) the start of use. Prevent usage progression |
| It is indicated | People who use a substance or engage in high-risk behaviors | Prevent usage progression. Damage prevention and reduction |
Psychosocial factors (psychological factors such as beliefs, emotional factors such as coping skills, and social factors such as social support) influence how individuals engage in prevention interventions.
All prevention efforts must include flexible, holistic interventions that increase reach (especially to reach individuals and groups facing complex systemic barriers).
Strategic collaboration on universal, selective and indicated prevention programs is critical. By working together, prevention programs can share resources to achieve synergies in strategy, goals, and outcomes. This approach will strengthen the prevention system and address the multitude of variables that put people at risk.
Social Determinants of Health
Social determinants of health (SDoH) are the conditions in the environments where people are born, live, learn, work, play, worship and age that influence a wide range of health outcomes and risks, functioning and quality of life. SDoH includes economic stability, access and quality of education, access and quality of health care, neighborhood and built environment, and social and community context. Each of these five domains contributes to increasing risk and protective factors that can influence substance use patterns and substance use-related harms in a community.
It is important to recognize the fundamental effects of social determinants of health, adverse childhood experiences (ACEs), and traumatic events that increase risks for substance use and harm. In addition, SDoH has intergenerational effects that can create cycles of adversity for families.
Note that there is overlap in risk and protective factors for both SDoH and substance use. Common risk factors include:
- Early life adversity in the family.
- Low level of family ties.
- Low socioeconomic status.
- Dropping out of school (before completion).
- Unsanitary housing.
- Neighborhood adversity.
- Structural oppression (such as racism, classism, sexism, heterosexism).
Common protective factors include:
- Positive parent-child interactions.
- Parental involvement.
- Family acceptance.
- Grooming environments.
- A sense of belonging and connection.
- Culture (connection to one’s culture).
- Access to quality education.
Understanding these effects (SDoH, ACEs, and trauma) on substance use risk provides prevention professionals and prevention partners with a roadmap for action. It is a road map for improving and strengthening comprehensive prevention systems and strategies that can improve the lives of individuals, families and communities.
Prevention is stronger together
Prevention strategies must include understanding the life experiences (into which people are born) that influence risks and protective factors—and moving upward to overcome these challenges.
- Build coalitions (and cross-sector partnerships) to work together to identify risk and protective factors — and develop and implement action plans to address those factors — at the community, city, county, and state levels. These collaborative models seek to create synergy between and within sectors to create real change.
- Integrate community anchor organizations (community-led organizations that pursue holistic, multi-level solutions) into prevention planning.
- Take a strengths-based approach while recognizing the fundamental impacts of SDoHs, ACEs and traumatic events.
- Take a holistic approach. This includes addressing multiple, interrelated health conditions (such as substance use, mental health conditions, sexually transmitted infections) and SDoH that may interact in a population and negatively impact health.
- Incorporate lived experiences by including people from underserved communities in program design, development, and implementation.
To build a strategic, robust prevention system that maximizes resources, responds to the needs of individuals and communities, and moves upward to address the challenges of substance use, we must:
- Collaborate across the prevention continuum.
- Embrace culture — including culture as a protective factor.
- Address the social determinants of health.
- Build coalitions and partnerships across the board.
- Ensure that prevention work focuses on the voices and experiences of those most affected.
We are stronger together.
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