Substance abuse prevention

Drug abuse prevention and drug use prevention is a process that attempts to prevent the onset of substance use or limit the development of problems associated with using psychoactive substances. Prevention efforts may focus on the individual or their surroundings. A concept known as "environmental prevention" focuses on changing community conditions or policies so that the availability of substances is reduced as well as the demand.

Substance abuse prevention efforts typically focus on minors – children and teens. Substances typically targeted by preventive efforts include alcohol (including binge drinking, drunkenness, and driving under the influence), tobacco (including cigarettes and various forms of smokeless tobacco), marijuana, inhalants (volatile solvents including among other things glue, gasoline, aerosols, ether, fumes from white out and marking pens), cocaine (including crack cocaine), methamphetamine, steroids, club drugs (such as Ecstacy), and opioids.

Of these, substance abuse prevention typically focuses on alcohol, tobacco, and marijuana based on gateway drug theory which proposes that these three substances are typically used first and may ultimately lead to the use of "hard drugs" like cocaine or heroin.

Protective and Risk Factors
Research has shown that there are various possible factors that could influence and increase the probability of drug use in youth. Environmental factors in the child's youth are: child abuse, exposure to drugs, lack of supervision, media influence, and peer pressure. Internal factors that are within the child or part of their personalities are self-esteem, poor social skills, attitudes about drugs, and many others.

Key risk periods for drug abuse occur during major transitions in a child's life. Some of these transitional periods that could increase the possibility of youth using drugs are puberty, moving, divorce, leaving the security of the home and entering school. School transitions such as from elementary to middle school or middle school to high school can be times that children and teenagers make new friends and are more susceptible to fall into environments where there are drugs available. Binge drinking has been shown to increase once an individual leaves the home to attend college or live on their own.

Most youth do not progress towards abusing other drugs after experimentation. The earlier the drug use, research shows, the greater possibility for continued use. Three exacerbating factors that can influence drug use to become drug abuse are social approval, lack of perceived risks, and availability of drugs in the community.

Protective Factors are important to consider in the prevention of substance abuse among youth and adolescents. A protective factor refers to anything that prevents or reduces vulnerability for the development of a disorder such as Substance Abuse Disorder. Research has generated an exhaustive list of protective factors specifically for the prevention of substance abuse in youth: Strong and positive family bonds, parental monitoring of children's activities and peers, clear rule of conduct that are consistently reinforced within the family, involvement of parents in the lives of their children, success in school performance, high self-esteem, strong bonds with institutions like schools and religious organizations, and adoption of conventional norms about drug abuse.

Community and School-Based Prevention Programs
There are numerous community-based prevention programs that have been thought to be helpful in educating children and families about the harms of substance abuse. There are mediating factors of classroom-based substance abuse that have been analyzed through research. There are specific conclusions that have been generated about effective programs. First, programs that allow the students to be interactive and learn skills such as how to refuse drugs are more effective than strictly educational or non-interactive ones. When direct influences (e.g., peers) and indirect influences (e.g., media influence) are addressed the program is better able to cover broad social influences that most programs do not consider. Programs that encourage a social commitment to abstaining from drugs show lower rates of drug use. Getting the community outside of the school to participate and also using peer leaders to facilitate the interactions tend to be an effective facet of these programs. Lastly, teaching youth and adolescents skills that increase resistance skills in social situations may increase protective factors in that population.

Life Skills Training (LST) was developed by Gilbert J. Botvin in 1996 and revised in 2000. LST is significant in giving adolescents with skills and information that are needed to resist social influences to substances, including alcohol, cigarettes, and other illicit drugs.The goal of this program is to increase personal and social competence, confidence and self-efficacy to reduce motivations to use drugs and be involved in harmful social environments. LST was structured to provide adolescents knowledge for fifteen 45-minute class periods during school for the first year. Ten booster sessions are given in the second year and then five booster class periods in the third year. The original outcome data was taken from a controlled trial of mostly white seventh grade students from various schools. A significant reduction in drug and polydrug use was found within this population with long-term effects even after three years. LST has been modified to be beneficial for minority students as well.

Project ALERT includes educational handouts, lesson plans, phone support, downloadable resources, and posters that were designed to motivate seventh and eighth grade students to not use alcohol, tobacco, or marijuana. This program's goal is to give students motivation to resist engaging in drug use by giving them assertiveness tools. Two evaluations of Project ALERT, first in the 1980s and then in 2003, showed that there were significant positive results in reducing risk factors and drug use. A study done by St. Pierre, Osgood, et al.,(2005) found no positive effects which could be influenced by implementation differences. Analysis has shown that the benefits of this program exceeds the costs.

Community programs outside of school settings that aim to prevent alcohol, tobacco, and illicit drug use have insufficient evidence that would show their effectiveness. Many of the community programs for those under age 25 are only linked to one randomized controlled trials which in most cases is not enough to conclude that they are effective. Focus of most community-based programs is on changing community policies and norms such as stricter policies on underage access to and consumption of alcohol.