During Substance Use Prevention Month and year-round, many opportunities exist for the prevention field to work collaboratively (across sectors and partners) to develop and implement comprehensive prevention approaches.
Prevention seeks to prevent initiation of substance use, prevent progression of substance use (to a substance use disorder), and prevent harms associated with substance use.
Effective prevention strategies focus on strengthening protective factors and reducing risk factors (PDF | 146 KB) ― in individuals, families, schools, communities, and society (based on the social ecological model). These factors include the social determinants of health, cultural influences, and traumatic experiences.
It is important to acknowledge that substance use disparately impacts underserved communities and individuals (e.g., persons of color; members of religious minorities; lesbian, gay, bisexual, transgender, and queer (LGBTQ+) persons; persons with disabilities; persons who live in rural areas; and persons otherwise adversely affected by persistent poverty or inequality).
The path traveled after first use of substances isn’t predetermined (although it might be influenced by genetics and other factors), and it is not the same for everyone. Substance use prevention is strengthened by accounting for the multitude of factors that contribute to an individual's journey, such as social climates, environmental components, childhood experiences, and more.
There are three categories of prevention interventions: universal, selective, and indicated.
- Universal interventions commonly include policies (such as a minimum legal drinking age), school-based programs, positive social norms (beliefs, attitudes, behaviors of a group), skill-building (managing emotions, problem solving, communication), and healthy alternatives.
- Selective interventions are specialized, for use with audiences at increased risk.
- Indicated interventions are directed to those who are already involved in a risky behavior (such as substance use or misuse), or are beginning to have problems, but who have not yet developed a substance use disorder.
Prevention Categories (PDF | 3.1 MB)
| Audience | Goal | |
|---|---|---|
| Universal | An entire population (school, neighborhood, community, state, nation) | Prevent (or delay) initiation of use |
| Selective | A sub-population (a sub-group) at higher-than-average risk | Prevent (or delay) initiation of use; Prevent progression of use |
| Indicated | Individuals who use a substance or are engaging in high-risk behaviors | Prevent progression of use; Prevent and reduce harms |
Psychosocial factors (psychological factors such as beliefs, emotional factors such as coping abilities, and social factors such as social support) affect the way that people engage with prevention interventions.
All prevention efforts need to include flexible, holistic interventions that increase reach (especially to reach people and groups that face complex systemic barriers).
It is critical that there is strategic collaboration across universal, selective, and indicated prevention programs. 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 place 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 affect a wide range of health, functioning, and quality-of-life outcomes and risks. SDoH include economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context. Each of these five areas helps drive the risk and protective factors that can influence substance use patterns and substance use-related harms in a community.
It is important to acknowledge the foundational effects of social determinants of health, adverse childhood experiences (ACEs), and traumatic events that increase risks for substance use and harms. Further, SDoH have intergenerational effects that can create cycles of adversity for families.
Note that there is overlap in the risk and protective factors for both SDoH and substance use. Shared risk factors include:
- Early-life adversity in the family.
- Low level of family bonding.
- Low socioeconomic status.
- Discontinuing school (before completion).
- Unhealthy housing.
- Neighborhood adversity.
- Structural oppression (such as racism, classism, sexism, heterosexism).
Shared protective factors include:
- Positive parent-child interactions.
- Parental involvement.
- Family acceptance.
- Nurturing environments.
- Sense of belonging and connection.
- Culture (connection to one’s culture).
- Access to quality education.
An understanding of these impacts (SDoH, ACEs, and trauma) on substance use risk provides prevention practitioners and prevention partners with a roadmap for action. It is a roadmap to enhance and strengthen comprehensive prevention systems and strategies that can improve the lives of individuals, families, and communities.
Prevention That’s Stronger Together
Prevention strategies must include an understanding of the life experiences (into which people are born) that influence risk and protective factors — and move upstream to get ahead of those challenges.
- Build coalitions (and partnerships across multiple sectors) 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 across and within sectors, to create true change.
- Incorporate community anchor organizations (community-led organizations that are pursuing holistic, multi-level solutions) into prevention planning.
- Take a strengths-based approach, while acknowledging the foundational effects of SDoH, 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 can interact within a population to adversely affect health.
- Integrate lived experiences by including people from underserved communities in program design, development, and implementation.
To build a strategic, robust prevention system that maximizes resources, meets the needs of individuals and communities, and moves upstream to get ahead of substance use challenges, we need to:
- Collaborate across the prevention continuum.
- Embrace culture — including culture as a protective factor.
- Address social determinants of health.
- Build coalitions and partnerships across sectors.
- Ensure our prevention work is centered in the voices and experiences of those most impacted.
We are stronger together.
SAMHSA Resources