Chapter 17: Preventing Substance Abuse

As our society seeks to prevent drug abuse by limiting the availability of illicit drugs, it is also obvious that to attack the source of the problem, we must reduce the demand for drugs.  Currently, most drug prevention programs take place in a school setting, although there are also community and workplace programs focused on substance abuse.  We can distinguish between education programs with the goal of imparting knowledge and prevention programs aimed at modifying drug-using behavior.

Prevention activities can be classified in several ways.  According to the public health model, primary prevention programs are aimed at young people who have not yet tried drugs, secondary prevention programs are aimed at people who have experimented with drugs, and tertiary prevention programs are focused on preventing relapse in past drug abusers.  The Institute of Medicine uses a different classification scheme based on the intended target audience.  Universal prevention programs are designed for an entire population, while selective prevention programs are designed for high-risk groups within a population.  Finally, indicated prevention strategies are targeted at individuals who already show signs of developing substance abuse problems.

Many different approaches toward substance abuse prevention have been tried.  However, most of the research over the past 30 years has failed to demonstrate that prevention programs can produce clear, meaningful, long-lasting effects on drug-using behavior.  The knowledge-attitudes-behavior model is based on the assumption that giving students information about drugs will change their attitudes about drugs and in turn change their behavior. Research has found that such programs do increase student knowledge but that this increase in knowledge does not reduce drug use.  Affective education programs popular in the 1970’s focused on helping students clarify their personal values, but they have been criticized for being too value-free and for not teaching students needed skills.

Recent prevention programs have been based on the social influence model, which was first used in successful smoking prevention programs. Key elements of programs based on this model are training in refusal skills, public commitment, countering advertising, normative education, and use of teen leaders.  Several programs based on the social influence model have been demonstrated to be effective in reducing tobacco and other drug use and abuse.

The Drug Abuse Resistance Education program, known by its acronym DARE, has been adopted rapidly and widely, despite research showing limited impact on drug-using behavior.  The program includes techniques from both the social influence model and affective education. DARE's lack of proven effectiveness is a dilemma in light of its widespread popularity and extended versions of the program are now being used and tested.

Non-school drug prevention programs are also in use.  Peer-based programs may involve after-school groups or activities with broad personal growth and academic goals.  Parent and family programs may be informational or skills-based or may involve support groups. Community-based programs can bring a variety of resources to bear on the problem of drug use and are most effective when they have widespread support.  Workplace programs are usually based on random drug tests and typically have the overall goal of preventing drug use by making it clear that it is not condoned.