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Lessons from Prevention Research

In more than 20 years of drug abuse research, the National Institute on Drug Abuse (NIDA) has identified important principles for prevention programs in the family, school and community. NIDA-supported researchers have tested these principles in long-term drug abuse prevention programs and have found them to be effective.

        Prevention programs should be designed to enhance "protective factors" and move toward reversing or reducing known "risk factors." Protective factors are those associated with reduced potential for drug use. Risk factors are those that make the potential for drug use more likely:

        Protective factors include strong and positive bonds within a prosocial family; parental monitoring; clear rules of conduct that are consistently enforced within the family; involvement of parents in the lives of their children; success in school performance; strong bonds with other prosocial institutions, such as school and religious organizations; and adoption of conventional norms about drug use.

        Risk factors include chaotic home environments, particularly in which parents abuse substances or suffer from mental illnesses; ineffective parenting, especially with children with difficult temperaments or conduct disorders; lack of mutual attachments and nurturing; inappropriately shy or aggressive behavior in the classroom; failure in school performance; poor social coping skills; affiliations with deviant peers or peers displaying deviant behaviors; and perceptions of approval of drug-using behaviors in family, work, school, peer and community environments.

        Prevention programs may target a variety of drugs of abuse, such as tobacco, alcohol, inhalants and marijuana or may target a single area of drug abuse such as the misuse of prescription drugs.

        Prevention programs should include general life skills training and training in skills to resist drugs when offered, strengthen personal attitudes and commitments against drug use and increase social competency (e.g., in communications, peer relationships, self-efficacy and assertiveness).

        Prevention programs for children and adolescents should include developmentally appropriate interactive methods, such as peer discussion groups and group problem solving and decision-making, rather than didactic teaching techniques alone.

        Prevention programs should include parents' or caregivers' components that train them to use appropriate parenting strategies, reinforce what the children are learning about drugs and their harmful effects and open opportunities for family discussions about the use of legal and illegal substances and family policies about their use.

        Prevention programs should be long-term (throughout the school career), with repeat interventions to reinforce the original prevention goals. For example, school-based efforts directed at elementary and middle school students should include booster sessions to help with the critical transitions such as from middle to high school.

        Family-focused prevention efforts have a greater impact than strategies that focus on parents only or children only.

        Community programs that include media campaigns and policy changes, such as new regulations that restrict access to alcohol, tobacco, or other drugs are more effective when they are accompanied by school and family interventions.

        Community programs need to strengthen norms against drug use in all drug abuse prevention settings, including the family, the school, the workplace and the community.

        Schools offer opportunities to reach all populations and also serve as important settings for specific subpopulations at risk for drug abuse, such as children with behavior problems or learning disabilities and those who are potential dropouts.

        Prevention programming should be adapted to address the specific nature of the drug abuse problem in the local community.

        The higher the level of risk of the target population, the more intensive the prevention effort must be and the earlier it must begin.

        Prevention programs should be age-specific, developmentally appropriate and culturally sensitive.

        Effective prevention programs are cost-effective. For every $1 spent on drug use prevention, communities can save $4 to $5 in costs for drug abuse treatment and counseling.*

The following are critical areas for prevention planners to consider when designing a program:

        Family Relationships - Prevention programs can teach skills for better family communication, discipline and firm and consistent rule making to parents of young children. Research also has shown that parents need to take a more active role in their children's lives, including talking with them about drugs, monitoring their activities, getting to know their friends and understanding their problems and personal concerns.

        Peer Relationships - Prevention programs focus on an individual's relationship to peers by developing social-competency skills, which involve improved communications, enhancement of positive peer relationships and social behaviors and resistance skills to refuse drug offers.

        The School Environment - Prevention programs also focus on enhancing academic performance and strengthening students' bonding to school by giving them a sense of identity and achievement and reducing the likelihood of their dropping out of school. Most curriculums include the support for positive peer relationships (described above) and a normative education component designed to correct the misperception that most students are using drugs. Research has also found that when children understand the negative effects of drugs (physical, psychological and social), and when they perceive their friends' and families' social disapproval of drug use, they tend to avoid initiating drug use.

        The Community Environment - Prevention programs work at the community level with civic, religious, law enforcement and governmental organizations.  Prevention programs enhance antidrug norms and prosocial behavior through changes in policy or regulation, mass media efforts and community-wide awareness programs. Community-based programs might include new laws and enforcement, advertising restrictions, and drug-free school zones all-- designed to provide a cleaner, safer, drug-free environment.

Preventing Drug Use Among Children and Adolescents: A Research-Based Guide for the community is available from the National Clearinghouse for Alcohol and Drug Information (NCADI) at 1-800-729-6686.

* Pentz, M.A. "Costs, benefits, and cost effectiveness of comprehensive drug abuse prevention." In W. J. Bukoski, ed. Cost Effectiveness and Cost Benefit Research of Drug Abuse Prevention: Implications for Programming and Policy. NIDA Research Monograph. In Press.

* NHSDA is an annual survey conducted by the Substance Abuse and Mental Health Services Administration. Copies of the latest survey are available from the National Clearinghouse for Alcohol and Drug Information at 1-800-729-6686.

(Excerpted from Lessons from Prevention Research, InfoFacts, found on the website of the National Institute on Drug Abuse, www.drugabuse.gov, 2003


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Free To Grow is a national program supported by the Robert Wood Johnson Foundation and the Doris Duke Charitable Foundation with direction and technical assistance provided by the Mailman School of Public Health of Columbia University.