The Evolution of Prevention Theory and Programming
Over the past decade, CSAP’s substance abuse prevention programs have provided direct services to tens of thousands of children, youth, families, and communities across the country. In addition, they have been a fertile proving ground for prevention research, theory, and technology. As a result of these efforts, a framework for better understanding the causes, etiology, and sequela of substance use has evolved. As noted by Johnson, Amatetti, Funkhouser, and Johnson (1988) in a review of current substance abuse prevention research and theory, “Because prevention...is an evolutionary field that is continuously growing from the thinking and experiences of researchers, planners, practitioners, and evaluators, the current knowledge base will change, expand, and emerge in new combinations, providing better tools with which to address [substance abuse] problems.” The evolving framework is constructed around two concepts—risk and protection—and their interplay.
Risk-Focused Prevention
The professional literature offers a rich body of research on risk factors for substance use and abuse among children, youth, and young adults. The major strength of this research is its predictive value: The more risk factors a child or youth experiences, the more likely it is that he or she will experience substance abuse and related problems in adolescence or young adulthood. However, risk factor research does not usually claim causative links between risks and later problems.
Many risk factors experienced by individuals in childhood are associated not just with substance abuse but with an array of health, mental health, and behavioral problems. School failure, for example, is a strong predictor of substance abuse, juvenile delinquency, and other problem behaviors (Battistich, Schaps, Watson, & Solomon, 1996). As the research on risk factors has accumulated, an increasingly vivid picture has emerged of a complex web of interrelated risks and problem behaviors. Researchers have also found that the more the risks in a child’s life can be reduced, the less vulnerable that child will be to subsequent health and social problems (Hawkins, Jenson, Catalano, & Lishner, 1988).
Grouping risk factors by domain
In one very straightforward theoretical framework of substance use, six life domains—individual, peer, family, school, community, and society—are used. It is important to note that these domains interact with the individual placed at the core of the model, and that all stimuli are processed, interpreted, and responded to based upon those characteristics that the individual brings to the situation (see Figure 1). The primary strength of this model is that it provides a framework in which to understand the interactive effects of risk and protective factors. Additionally, it provides guidance about which factors should be targeted by a diverse array of prevention programs.
This “Web of Influence” depicts the domains that affect substance use and other problem behaviors. The Web has been used as the organizing principle underlying the development of the High Risk Populations DataBank. While programs work to effect positive change in one or more of these domains, thereby increasing resiliency and enhancing protective factors, the domains are also important in understanding outcomes. Since each prevention program has as its ultimate goal to prevent, postpone, or reduce substance use, and since substance use itself is a complex product of occurrences in the other domains, it has been extracted and maintained as a separate outcome domain.
Inclusion of protective factors
Exposure to even a significant degree of risk factors in a child’s life does not necessarily mean that substance use or other problem behaviors will inevitably follow. Many children and youth growing up in presumably high-risk families and environments emerge relatively problem free. The reason for this, according to many researchers, is the presence of protective factors in these young people’s lives. Protective factors balance and buffer risk factors (Hawkins, Catalano, & Miller, 1992). In contrast to a paradigm that focuses exclusively on reducing risk, with an emphasis on negative or pathological aspects of an individual’s life, protective factor research looks at what is positive and healthy in young people. As with risk factors, protective factors can be found in each of the major domains of life experience.
A focus on resilience
One might conclude that risk factors and protective factors are opposite sides of the same coin. It is logical to assume, for example, that the opposite of a particular risk factor—e.g., success in school, as opposed to school failure—would also predict the opposite: health and personal success instead of problem behavior. Yet the correlations are not exact.
Many in the substance abuse prevention and youth development fields have argued, moreover, that an emphasis on protective factors implies a significantly different worldview from an emphasis on risk factors (Henderson, 1996; Wolin & Wolin, 1993). According to critics of risk-focused prevention, the approach concentrates on essentially negative elements in an individual’s life and environment, stressing deficits rather than strengths and blaming the victim. Wolin and Wolin (1995) label this the “Damage Model.” By contrast, some critics maintain, building on and enhancing protective factors is a more promising approach because it stresses positive elements in individuals and environments.
An important shift from risk-focused prevention theory in recent years has been a focus on resilience. As a concept in the youth development and prevention fields, the term originated in the longitudinal studies of Garmezy and Streitman (1974), Emmy Werner (1986), Michael Rutter (1979), and others who examined the developmental qualities of children and youth who prevailed and succeeded despite risk factors such as poverty, substance-abusing parents, and dysfunctional families. Garmezy has defined resilience (Hazelden, 1996) as an absence of deviant outcomes regardless of exposure to risk. Wolin and Wolin (1995) define it as successful adaptation despite risk and adversity. According to one recent review of the literature (Hazelden, 1996), factors contributing to resilience in young people include:
- A strong relationship with a parent or caring adult who provides a nurturing environment early and consistently.
- Feelings of success and a sense of mastery so young people can name something they do successfully and can build self-respect.
- Strong internal and external resources such as good physical health, self-esteem, a sense of humor, and a supportive network that includes family, school, and community.
- Social skills, including good communication and negotiating skills, and the ability to make good decisions and to refuse activities that may be dangerous.
- Problem-solving and thinking skills that help to generate alternatives and solutions to problems.
- Hope that odds can be overcome with perseverance and hard work.
- Surviving previous stressful situations—each time a young person masters a difficulty, that experience helps her or him face the next difficulty.
Developing resilience in young people and promoting specific strengths such as these within multiple domains has been and continues to be a major focus of the HRY Demonstration Grant Program.
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Last Updated: March 4, 2002
