Value of ATOD Prevention

alcohol, tobacco, other drug and related violence prevention a rationale for the field

from the staff of the Minnesota Prevention Resource Center, April 2010

Research shows that when people have certain protective factors in their lives, they are less likely to use drugs or alcohol or to engage in other harmful behaviors. As a result, prevention efforts seek to increase the number of those protective factors and reduce the number of risk factors in people's lives. Some examples of protective factors are: healthy beliefs and clear standards; strong bonds/attachment/commitment to families, schools, communities and peers; opportunities; recognition; and a nurturing environment in the home, school and community. Some people refer to these traits as community assets and they seek to build and strengthen them. Meanwhile, some of the risk factors that prevention efforts seek to minimize are: availability of drugs and firearms; family history of problem behavior; family conflict; favorable parental attitudes towards, or involvement in the problem behavior; academic failure beginning in late elementary school; lack of commitment to school; early and persistent antisocial behavior; friends who engage in the problem behavior, and so forth.

In the past, some anti-drug programs focused on providing extensive information about drugs. Although many of those programs were very popular, evaluation of their long-term effectiveness demonstrated that they produced a measurable increase in students' knowledge about drugs, but had negligible effects on the students' substance abuse related attitudes and behavior.

Having individuals in recovery from drug and alcohol abuse speak to youth was another popular, well-intentioned strategy, however misguided. Although young people will often appear to be moved by a recovering user's story, there is no evidence that these presentations have any long-term impact on use. In some cases, the presentations seem to result in "glamorizing" the alcohol and drug-using behavior. In other cases, such as those that employ scare tactics, audiences may reject the messages as "over the top".

At one time, some prevention programs expressed the idea that children could be "taught" self-esteem and that increasing their self-esteem would prevent them from using drugs. A panel of experts convened by the Center for Substance Abuse Prevention reviewed all the available evidence and concluded that improving adolescent self-esteem does not necessarily protect them against substance abuse and that poor self-esteem alone is not predictive of future substance abuse. What we do know is that self-esteem is represented in one of five prevention domains and that building resilience and personal assets is an important construct in concert with other parallel processes that occur within the other prevention domains of peer, family, school and community. Individual assets are positively reinforced when there are many messengers representing assets from the other domains.

Thus, today's prevention programs no longer focus only on reaching individuals and imparting knowledge about alcohol and drugs. Rather, they emphasize programs and policies that affect everyone, not just individuals, and that shape knowledge, beliefs and behavior by changing the social, cultural and political environments. Providing information/education, of course, remains a part of our efforts. To be effective, prevention efforts must be comprehensive and ongoing. A comprehensive approach uses a variety of strategies such as: social marketing, technology and engineering, economic, legal/policymaking, and education. Used in concert, these strategies can affect lasting, positive change among people at risk and encourage everyone to take better care of themselves and others. As Minnesota Institute of Public Health Executive Director Jerry Jaker is fond of saying, "In the end, what we are about is the best use of resources to protect and promote the health and well-being of the public."

What doesn't work

Ineffectiveness of one-time events or using recovering addicts as prevention speakers

According to the National Institute on Drug Abuse (NIDA) and other research organizations, prevention programs should avoid the following components:

• Scare tactics and moralistic appeals.
• Curricula that rely solely on information about drugs and their dangers. When used alone, knowledge-oriented interventions designed to supply information about the negative consequences of substance use do not produce measurable and long-lasting changes in substance use-related behaviors or attitudes and are considered among the least effective educational strategies (Tobler, 1986).
• Curricula that only work to promote self-esteem and emotional well being, rather than providing training that promotes self confidence in resistance skills (otherwise known as self-efficacy).
• "Single shot" assemblies and presentations.
• Testimonials by former addicts, because they reinforce a negative norm that "everyone uses drugs" at some point in their lives.
• For the selected youth population, grouping these youth together in early adolescence may inadvertently reinforce problem behavior (Williams, 2003; Dishion, 1999). In one follow-up study after prevention programming, at-risk youth grouped with peers were actually exhibiting more problem behaviors than those who had not been grouped with peers (Dishion, 1999).

References for the above:

1. Drug Strategies. (1999). Making the grade: A guide to school drug prevention programs. Washington, DC.
2. Dishion, T. J., McCord, J., and Poulin, F. (1999). When interventions harm: Peer groups and problem behavior. American Psychologist, 54(9), 755-764.
3. Tobler, N. S. (1986). Meta-analysis of 143 adolescent drug prevention programs: Quantitative outcome results of program participants compared to a control or comparison group. Journal of Drug Issues, 16(4), 535-567.
4. Williams, J. S. (2003). Grouping high risk youths for prevention may harm more than help. NIDA Notes, 17(5).

Conclusion: What we know is that alcohol, tobacco and other drug prevention is an integral component to public health for a community. What is critical is that a community needs to be ready, grounded in the facts about concerns specific to the social ills of the abuse of mood altering substances and empowered to take action. Then the community needs to be able to sustain on a consistent basis, community messages for health - from all stakeholders, in all of the domains-individual, peer, family, school and community!

Contact Kevin Spading for more information about any of these strategies or to respond to your questions about ATOD and related issues.