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CSAP’s Prevention Strategies CSAP has identified six prevention strategies that, in combination, can be used to develop programs focusing on risk and protective factors for substance use (CSAP, 1993a): information dissemination, prevention education, alternatives, problem identification and referral, community-based process, and environmental approaches (CSAP, 1993b). These prevention strategies were not selected to represent the diversity of intervention efforts currently being undertaken in the substance use prevention field, but rather were seen as basic to those efforts. The importance of these six strategies, as an organizational tool, has increased recently as CSAP’s emphasis on funding prevention efforts has changed in focus from directly sponsoring innovative demonstration efforts to underwriting State-directed prevention programming. Here, funding is dependent upon a State’s adopting or developing programs employing one or more of these prevention strategies. In this vein, it should be noted that these six prevention strategies are not mutually exclusive. A specific intervention might employ one or more of these strategies in attempting to increase resilience to substance use among their targeted population. In fact, each of the eight model programs described in this report employs at least two of the six CSAP prevention strategies, again highlighting the importance of well-implemented, multifaceted programming in effecting change.

Information Dissemination

The aim of information dissemination is to increase knowledge and alter attitudes about issues related to alcohol, tobacco, and drug use and abuse. The information disseminated is information about the nature and prevalence of substance abuse and addiction and the psychological and social effects of substance abuse (CSAP, 1993b). Many information dissemination efforts involve media campaigns (e.g., the seatbelt use promotional campaign). Because the goal of these demonstration programs was not information dissemination at a large-scale level, none of the model programs launched media campaigns. Each of the model programs, however, participated in information dissemination activities by providing basic education efforts about substance use. Information dissemination techniques used included classroom-style education using lectures, discussions, role-play, videos, and books as pedagogical tools (CDP, SL, and FAN). The awareness-raising activities were conducted at multiple levels with youth, parents, teachers, and community leaders. Here, programs like GAPS and CLC sponsored public events and disseminated informational brochures to a broad audience of community members. Programs that achieved success by increasing knowledge of participants included the following:

  • Youth in the AA program increased their knowledge and perceived ability to respond appropriately to situations involving drug use compared with youth in the control group.

  • Youth in the SL program increased their knowledge about alcohol and drugs significantly more than the youth in comparison groups. In addition, these youth had less favorable attitudes toward marijuana than youth in comparison groups.

  • Parents of youth in the CLC program improved their level of substance use knowledge relative to control parents.

  • Youth in the FAN program remained constant while control group members increased in levels of perceived benefits of marijuana use. Additionally, FAN participants had clear gains in substance use knowledge relative to controls.
The increase of knowledge demonstrated in these program findings indicates that basic information dissemination is an effective educational tool to teach the dangers of substance abuse. In support of this idea, the National Institute on Drug Abuse (1997) posits that alcohol and drug education is a principal prevention strategy for both community-based and family-based prevention programs. Education about the realities of substance use and abuse is essential to any prevention program, as changing knowledge can serve as the basis for changing attitudes and behavior.

Prevention Education

The aim of this prevention strategy is to teach participants critical life and social skills (e.g., decision-making skills, refusal skills, and cultural pride; CSAP, 1993b). The goal of teaching these skills is to promote health and well-being in youth while at the same time preventing problems that may occur without these skills (Schinke & Cole, 1995). Skills deficit is a known risk factor for problem behavior and substance abuse (CSAP, 1993a). Many skills-development initiatives report substantial reductions in tobacco, alcohol, and marijuana use (Botvin, 1995; Botvin and Tortu, 1988; CSAP, 1993a; National Institute on Drug Abuse, 1997). Kumpfer (1997) reports information from a meta-analysis conducted by Stratton that revealed that programs using skills training methods were more successful than programs using lecture methods in reducing risk factors related to substance use and abuse.

Each of the programs provided some variety of life skills training; for example, RSAP’s curriculum for life skills was the Prevention Education Series. The model programs that achieved results in this area were:

  • GAPS participants showed significant increases in assertiveness and cultural pride relative to comparisons.

  • AA program participants showed increased knowledge of older people and increased knowledge of community service issues relative to controls.

  • Participating youth of the CLC reported using community services when problems arose and reported increases in bonding and communication with both mothers and fathers compared to control youth. Additionally, participating parents reported improvements in communication with their children relative to control parents.

  • Parents in the DTBY program showed significant increases in the use of appropriate control techniques and decreases in the use of harsh punishments of their children compared to control parents.

  • The FAN Club group increased its ability to refuse alcohol and ability to refuse marijuana compared with the control group.

  • Students in the CDP demonstrated improvement in their development of conflict resolution skills.
Different programs highlighted enhancing different skills based on the nature of their program and the target group included. Although the outcomes from the model programs are diverse, by increasing functioning in these areas, risk for substance abuse was reduced.

Alternatives

An “alternatives approach” to substance abuse prevention is a strategy that assumes that youth who participate in drug-free activities will have important developmental needs met through these activities and will no longer have those same needs met through drug-related activities (CSAP, 1993b). A key aspect of this strategy is the voluntary participation of youth in drug-free activities (CSAP, 1996). Alternative activities often allow youth to enhance their skills and/or knowledge, occupy their unstructured time, and involve them in community service.

In some ways, prevention programs in and of themselves can be alternatives to drug-related activities. In other words, the nature of some programs may interfere with opportunities for problem behavior development (e.g., the timing of prevention program sessions—evening sessions for CLC and after-school sessions for SL and FAN). One aspect of the GAPS program was to involve youth in art, music, and drama projects as part of the African American Heritage Project. Across Ages focused on using an “alternatives” approach to prevention as the primary intervention. The AA program provided drug-free alternative activities for participants, including time spent with mentors doing a number of recreational activities, community service activities (i.e., volunteering at local nursing homes), receiving help with school assignments, and family/mentor weekends. The alternative activities translated into positive outcomes for youth in many areas, such as improved school attendance and performance; improved well-being; and improved attitudes toward the future, school, other people, and elders. Additionally, youth with exceptionally involved mentors demonstrated gains in knowledge regarding the potential risks and consequences of alcohol, tobacco, and drug use relative to youth with average or marginally involved mentors.

It has been demonstrated that involving high-risk youth in activities with mentors improves youth’s knowledge, attitudes, and behaviors (Sipe, 1996). Many mentoring initiatives have proven successful, including Campus Partners in Learning (linking college student mentors with middle school students—Tierney & Branch, 1992); Mentoring in the Juvenile Justice System (linking community volunteer mentors with adjudicated youth—Mecartney, Styles, & Morrow, 1994); Linking Lifetimes (linking elder mentors with adolescent youth—Styles & Morrow, 1992); and Big Brothers/Big Sisters (linking community mentors with children and youth at risk for substance use—Tierney, Grossman, & Resch, 1995). Outcomes specifically related to substance use are reported in evaluations of the Big Brothers/Big Sisters program. Evaluations indicated that Little Brothers and Little Sisters were 46% less likely than controls to initiate drug use and 27% less likely than controls to initiate alcohol use throughout the time during the study (Tierney et al., 1995).

In 1996, CSAP speculated that “most people would probably agree that youth are likely to develop fewer substance abuse problems (as well as other problems) when they are surrounded by caring adults, given loving supervision, and offered age-appropriate challenges and opportunities to grow” (p. 19). Across Ages adds more rigorously evaluated findings to the literature by demonstrating that relationships with caring adults and involvement in structured activities outside of the educational arena give youth unique opportunities to develop skills and enhance knowledge.

Problem Identification and Referral

Problem identification and referral is a prevention strategy that involves recognizing youth who have already initially tried drugs or developed substance use problems and referring them to appropriate treatment options (CSAP, 1993b). This is an important aspect of prevention programs targeting high-risk youth, as many youth may already be familiar with substances. Early substance use is a first step to more serious use and abuse (Botvin & Tortu, 1988; CSAP, 1993a; Huizinga, Menard, & Elliott, 1989). None of the model programs measured substance abuse identification and referral as an outcome of interest. Two programs, however, actively worked on these issues:

  • The RSAP program served as a service to help individuals identify either their own substance abuse problems or the substance abuse problems of family members. Based on the need of the participants, individual and group sessions were provided. These services translated into reductions in substance use by RSAP’s participants.

  • The CLC program facilitated the identification of substance abuse problems of family members for participating youth and parents. These individuals were then referred to appropriate treatment or early intervention programs.
Prevention programs should be prepared to confront issues of prior use for their participants, particularly when dealing with youth at risk. In this way, programs can work to prevent further use through early intervention strategies.

Community-Based Process

This prevention strategy aims to enhance community resource involvement in substance abuse prevention (CSAP, 1993b). For example, this strategy involves building interagency coalitions and training community members and agencies in substance use education and prevention. The community in which we live serves as an important context for much of our behavior. As members of a community, we generally conform to certain rules or widely held beliefs and attitudes. If most community members do not tolerate use of substances by youth, use may be reduced.

Many of the model programs participated in community-building activities or were programs delivered through community organizations, such as CLC, SL, FAN, and DTBY. In addition, CLC participants showed increased knowledge and use of community agencies. Two programs discussed changes in the community directly related to the prevention effort:

  • The CDP attempted to create a “caring community” via many avenues. The CDP reported that teacher practices improved and were related to children’s classroom behaviors. These behaviors, in turn, were related to students’ sense of community and achievement.

  • GAPS conducted community-based programming through social policy and a community-wide prevention partnership.

  • Results from CLC demonstrated that the intervention was effective in increasing a number of resiliency factors, and that these improvements were related to substance use. More specifically relative to controls, participating parents and youth realized short-term and sustained gains in their use of community services to help resolve family and personal problems. More interestingly, the level of church community activity was found to mediate sustained reductions in alcohol use.
Improving children’s classroom behaviors and increasing their bonding with the school community is an important factor in the prevention of substance abuse. There is a large body of evidence that demonstrates that academic and interpersonal difficulties at school (e.g., Jessor & Jessor, 1977; Smith & Fogg, 1978), as well as suspension or expulsion from school (e.g., Hawkins, Lishner, & Catalano, 1985; Herjanic, Barredo, Herjanic, & Tomelleri, 1979) are associated with increased levels of substance abuse. In addition, commitment to school has been found to be a protective factor in slowing the escalation to regular or heavy marijuana use (Kandel & Davies, 1992). Similarly, improving family functioning is an important factor in effecting positive changes in substance use and related problem behaviors (cf. Kumpfer, 1997). By altering the larger community and its response to families or children in need, the CDP and CLC programs promoted healthy development opportunities for all involved.

Environmental Approach

Altering policy that can reduce risk factors and/or increase protective factors related to substance abuse is an important step in the prevention of substance abuse. Policy changes can translate into community and individual ideals related to substance abuse and adolescent health. Past research demonstrates that adolescent drug use is greater in communities where use is condoned (e.g., Coate & Grossman, 1985), in schools where use is high (e.g., Baumrind, 1985), or in families where use is accepted (e.g., Kumpfer, 1987).

Prevention programs that include this strategy involve active lobbying for policy alterations or additions that will aim to reduce risk factors and enhance protective factors for substance abuse. Examples of these policies may be community laws prohibiting alcohol and tobacco advertisements in close proximity to schools, community policies increasing the barriers youth encounter for obtaining alcohol and tobacco products, and community laws increasing punishments for driving while under the influence.

Because large-scale policy influence was not the goal of these demonstration programs, none of the eight model programs directly tackled these issues. However, the result of one program was a change in policy. The CDP program changed school policy that increased protective factors related to substance abuse. The program altered school policies regarding teacher-student relationships, curricula, cooperative learning, and discipline techniques.


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Last Updated: March 4, 2002