Lesson 9: Interventions Used in the Prevention of Substance Use

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This is the last lesson exploring the established and innovative approaches that have been used to treat and prevent substance use and substance use disorders. Specifically, this lesson focuses on examining the evidence associated with effective and ineffective prevention programs.

In lessons 2–4, we learned about the risk and protective factors for substance use and substance use disorders. If you need a refresher, have a look at the Stone et al. (2012) article from Lesson 4. In Lesson 8, we considered some of the larger challenges faced by members of Canada’s substance abuse workforce, learned about what works and what doesn’t in treatment interventions, and examined the methods that the substance use workforce uses to make such determinations. This lesson gives the same considerations to prevention interventions.

Prevention programs use a universal population health approach to the onset of substance use and substance use disorders. The primary location for substance use prevention programs is in schools or the family. This lesson examines systematic reviews that have been conducted to evaluate substance use prevention programs.

The aim of the readings associated with this lesson is to expand our perspective on prevention interventions, and to consider what is currently believed to be effective and what is not. The perspective taken in this lesson is that of population health. Historically, prevention programs were described as primary, secondary, and tertiary; but more recently, they have been designated as universal, selected, or indicated. In this lesson, we will focus on evaluating the effectiveness of universal prevention programs for youth. As we know, from the previous readings, the average age of the first onset of substance use is 14 or 15, and so universal substance use prevention programs may start as early as 10 years of age. The first activity provides a number of resources for you to review to help you feel comfortable with the context and principles of substance use prevention programs. The video with Dr. Gilbert Botvin is well worthwhile taking the time to look at if you haven’t spent a lot of time working with prevention programs.

The second activity in this lesson asks our standard question for this course: What does the evidence say is effective in substance use prevention programs. Although the reading in this section is substantial, much of it can be perused.

The third activity turns our attention to the question of effective prevention interventions for youth with concurrent disorders. We continue to focus on youth because, as we have learned in the previous lesson, this is the population with which prevention can have the greatest impact (i.e., better prevention than incredibly challenging treatment).

Throughout this lesson, reflect on the prevalence (or lack of) of substance use prevention programs in your community/province, and ask yourself the following question: Why are the relatively inexpensive prevention programs being diluted in the continuum of substance use services when the implementation of these programs is relatively easy compared to the incredibly challenging application of effective treatment interventions for people with moderate to severe substance use disorders?

Topics

Lesson 9 addresses the following three topics:

  • Overview/introduction of prevention principles
  • Review of evidence basis of prevention programs
  • Prevention programs for youth with concurrent disorders

Learning Outcomes

After you complete this unit, you should be able to:

  • Assess the current approaches employed in the prevention of substance use and substance use disorders.
  • Use EBDM skills to evaluate the evidence in support of long-standing and innovative practices for the prevention of substance use or substance use disorders.
  • Recognize that some effective prevention strategies have been developed and proven through scientific investigation.
  • Assess the evidence in support of selected effective prevention interventions for problematic substance use.
  • Assess the evidence that reveals the ineffectiveness of some prevention approaches.

Resources

Foxcroft, D. R., & Tsertsvadze, A. (2011). Universal school-based prevention programs for alcohol misuse in young people. Cochrane Database of Systematic Reviews (Issue 5). Art. No.: CD009113. DOI: 10.1002/14651858.CD009113.

Foxcroft D. R., & Tsertsvadze, A. (2011). Universal family-based prevention programs for alcohol misuse in young people. Cochrane Database of Systematic Reviews (Issue 9). Art. No.: CD009308. DOI: 10.1002/14651858.CD009308.

Foxcroft D. R., & Tsertsvadze, A. (2011). Universal multi-component prevention programs for alcohol misuse in young people. Cochrane Database of Systematic Reviews (Issue 9). Art. No.: CD009307. DOI: 10.1002/14651858.CD009307,)

Foxcroft, D. R., & Tsertsvadze, A. (2012). Universal alcohol misuse prevention programs for children and adolescents. Perspectives in Public Health, 132(3), 128–134.

Hart, K., Ksir, C., Hebb, A., Gilbert, R., & Black. S. (2012). Preventing substance abuse. In Drugs, behaviour, and society (1st Canadian ed., pp. 378-392). Whitby, ON: McGraw Hill Ryerson.

Web links

CAMH Centre for Prevention Science

CCSA: Preventing Youth Substance Use

College of Human Ecology, Weill Cornell Medical College (Producer) (2011, June 8). Preventing Adolescent Drug Abuse through Life Skills Training: Empirical Findings and Translational Challenges.

Available Through TRU Library

Lipp, A. (2011). Universal school-based prevention-programmes for alcohol misuse in young people. International Journal of Evidence-Based Healthcare, 9(4), 452–453.

Salvo, N., Bennett, K., Cheung, A., Chen, Y., Rice, M., Rush, B., Bullock, H., Bowlby, A., & the Evidence on Tap Concurrent Disorders Collaborative Team. (2012). Prevention of substance use in children/adolescents with mental disorders: A systematic review. Journal Canadian Academy Child Adolescence Psychiatry, 21(4), 245–252.

Optional Reading

You may want to review the following free online textbook (approximately 600 pages) published by the National Research Council and Institute of Medicine. This is an excellent resource for your practice.

National Research Council and Institute of Medicine. (2009). Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities. Committee on the Prevention of Mental Disorders and Substance Abuse Among Children, Youth, and Young Adults: Research Advances and Promising Interventions. Mary Ellen O’Connell, Thomas Boat, and Kenneth E. Warner, Editors. Board on Children, Youth, and Families, Division of Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press. Available at: http://www.ncbi.nlm.nih.gov/books/NBK32775/pdf/TOC.pdf

Livingston, J. A., Testa, M., Hoffman, J. H., & Windle, M. (2010). Can parents prevent heavy episodic drinking by allowing teens to drink at home? Addictive Behaviors, 35, 1105–1112.

Activity Checklist

Following is a checklist of the learning activities you will be completing in Lesson 9. You may find it useful for planning your work.

✔ Activity

☐ Activity 1: Overview of prevention principles

☐ Activity 2: Systemic review of prevention practices

☐ Activity 3: Youth with concurrent disorders