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, alternative drug-free activities, 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 supporting State-directed prevention programming. Here, funding is dependent on a State’s adopting or developing programs employing one or more of these prevention strategies. A specific intervention might employ one or more of these strategies in attempting to increase resilience to substance use among the targeted population. In fact, each of the eight model programs described in this report employs at least two of the six strategies, again highlighting the importance of well-implemented, multifaceted programming in effecting change.
Each of the eight model programs used information dissemination, which aims to increase knowledge and alter attitudes about issues related to alcohol, tobacco, and illicit drug use and abuse. Information is disseminated 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. Because the goal of these demonstration programs was not information dissemination on 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. The awareness-raising activities were conducted at multiple levels with youth, parents, teachers, and community leaders. Programs like CLC and GAPS sponsored public events and disseminated informational brochures to a broad audience of community members.
CDP, CLC, DTBY, GAPS, SL, and FAN focused on prevention education. The aim of this prevention strategy is to teach participants critical life and social skills (e.g., decisionmaking skills, refusal skills, and cultural pride; CSAP, 1993b) as a means of promoting health and well-being in youth, while 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).
An alternative drug-free activities approach to substance abuse prevention 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), which allow youth to enhance their skills and/or knowledge, occupy their unstructured time, and involve them in community service. AA emphasized alternative drug-free activities, in which mentored youth performed community service, modifying values and learning prosocial behaviors.
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). RSAP emphasized problem identification and referral; CLC helped identify and refer family members with substance use problems.
Both CLC and GAPS are community-based interventions that aim to enhance community resource involvement in substance abuse prevention (CSAP, 1993b). Because the community in which we live serves as an important context for much of our behavior, this strategy focuses on building interagency coalitions and training community members and agencies in substance use education and prevention. 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.
CDP worked closely with the school system using an environmental approach to change standards, policies, and attitudes that influence systemic as well as individual substance-related problems. 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), and in families where use is accepted (e.g., Kumpfer, 1987).
Did These Model Programs Demonstrate Alcohol, Tobacco, and Drug Use Prevention?
These programs have helped individuals gain skills and knowledge, fostered relationships between youth and family or community members, and enhanced community awareness of substance abuse problems. These achievements translate into reductions of risk factors and increases in protective factors (see Table 1 for specific outcomes related to risk and protective factors). While it is necessary to demonstrate these successes, the fundamental question posed to these programs has not yet been answered, and that is: “Did these model programs demonstrate alcohol, tobacco, and drug use prevention?”
Regardless of the approach used or the population served, each program was successful in postponing the onset of alcohol, tobacco, and drug use; in reducing alcohol, tobacco, and drug use; or in decreasing the risk factors known to be related to later alcohol, tobacco, and drug use. Five programs achieved success in reducing substance use:
- Youth in RSAP showed decreases in substance use: For alcohol, 81.8% of nonusers remained nonusers, while 72.2% of the users became nonusers; for marijuana, 83.3% of the nonusers remained nonusers, while 58.8% of the users became nonusers; and 78.4% of tobacco nonusers remained nonusers, while 26.9% of the users became nonusers. Comparison groups did not show these same declines.
- The SL program increased knowledge about alcohol, tobacco, and drugs and decreased favorable attitudes toward marijuana. Concomitant with those findings, the SL program participants also showed significant decreases in marijuana and tobacco use and a marginally significant decrease in alcohol use over time.
- Prevalence of alcohol use declined by an average of 11% over four years in CDP schools, compared with an increase of 2% in matched comparison schools. Prevalence of marijuana use by CDP students declined by 2%, compared with a 2% increase by comparison school students. Prevalence of cigarette use by CDP students declined by 8%, compared with a 3% decline by comparison school students.
- GAPS participants showed increases in assertiveness and cultural pride. In conjunction with those improvements, GAPS data also revealed that levels of participant alcohol, tobacco, and marijuana use decreased significantly over time.
- CLC found that participant youth experienced short-term and sustained delays in the onset of alcohol and drug use as well as decreased levels of substance use, especially as family bonding, communication, and community agency activity increased. In addition, parents of participants demonstrated short- and long-term reductions in their use of alcohol, relative to control parents.
AA, DTBY, and FAN worked with youth among whom the incidence of alcohol, tobacco, and drug use was very low. DTBY worked with parents and preschoolers. These youth were too young for involvement with substances, but the program produced dramatic positive effects on parenting skills, family management, bonding, and communication skills resulting in decreased problem behavior. DTBY was successful because it effected positive changes on one key risk factor for early onset of and sustained severe use of substances—dysfunctional family environment (Kumpfer, 1987). FAN youth also were too young to demonstrate change in substance use rates, but demonstrated prosocial changes in attitudes and perceived ability to refuse drugs and alcohol, clear indicators of inoculation. Similarly, youth in the AA program were observed at an age during which the incidence of substance use was low. However, the program did lead to significant positive changes in alcohol, tobacco, and drug knowledge; alcohol, tobacco, and drug attitudes; and school bonding and values negatively related to later substance use. AA and FAN reduced risk factors known to be related to future onset and regular use of substances (CSAP, 1993a). To the extent that the processes set in motion by these programs can be maintained, these youth, their families, and society as a whole will have been well served and better insulated against the ravages of substance use.
Conclusions
Despite the fact that prevention strategies and outcomes from the eight programs are diverse, three unifying themes are evident. First, each of the programs, in its own setting and in its own manner, promoted supportive and caring relationships between youth and members of their families, their communities, and their peer groups. Second, each of the effective programs implemented multifaceted interventions targeting the specific needs of its audiences. Third, each of the programs was successful in postponing the onset of alcohol, tobacco, and illicit drug use; reducing the frequency of alcohol, tobacco, and drug use; or reducing risk factors or enhancing protective factors related to the development of substance use.
Programs that should be promoted and broadly disseminated are those that have been shown to be efficacious via controlled studies (Hawkins et al., 1996). The eight model programs discussed here represent programs with scientifically defensible findings and demonstrate that “Prevention Works.” Because of their documented successes, these programs offer opportunities for other agencies, policymakers, and practitioners to implement effective programs in their communities.
References
Baltes, P. B. (1987). Theoretical propositions of life-span developmental psychology: On the dynamics between growth and decline. Developmental Psychology, 23 (5), 611–626.
Baumrind, D. (1985). Familial antecedents of adolescent drug use: A developmental perspective,. In C. L. Jones & R. J. Battjes (Eds.), Etiology of drug abuse: Implications for prevention (NIDA Research Monograph 56, pp. 13–44). Rockville, MD: U.S. Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse.
Botvin, G. J., & Tortu, S. (1988). Preventing adolescent substance abuse through life skills training. In R. H. Price, E. L. Cowen, R. P. Lorion, & J. Ramos-McKay (Eds.), 14 ounces of prevention (pp. 98–110). Washington, DC: American Psychological Association.
Center for Substance Abuse Prevention. (1993a). Prevention strategies based on individual risk factors for alcohol and other drug abuse. (CSAP Technical Report 7). Washington, DC: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration.
Center for Substance Abuse Prevention. (1993b). A discussion paper on preventing alcohol, tobacco, and other drug problems. Rockville, MD: U.S. Department of Health and Human Services Administration.
Center for Substance Abuse Prevention. (1996). A review of alternative activities and alternatives programs in youth-oriented prevention (CSAP Technical Report 13). Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration.
Coate, D., & Grossman, M. (1985, unpublished manuscript). Effects of alcoholic beverage prices and legal drinking ages on youth alcohol use: Results from the Second National Health and Nutrition Examination Survey. National Bureau of Economic Research.
DuPont, R. L. (Ed.). (1989). Stopping alcohol and other drug use before it starts: The future of prevention. (OSAP Prevention Monograph No. 1). Washington, DC: U.S. Department of Health and Human Services, Alcohol, Drug Abuse, and Mental Health Administration.
Hawkins, J. D., Kosterman, R., Maguin, E., Catalano, R. F., & Arthur, M. (1996). Prevention interventions: Substance use and abuse. In R. T. Ammerman & M. Hersen (Eds.), Handbook of prevention and treatment with children and adolescents: Intervention in the real world context (pp. 203–237). New York: John Wylie and Sons, Incorporated.
Huizinga, D. H., Menard, S., & Elliott, D. S. (1989). Delinquency and drug use: Temporal and developmental patterns, Justice Quarterly, 6 (3), 419–455.
Kandel, D. B. (1980). Drug and drinking behavior among youth. Annual Review of Sociology, 6, 235–285.
Kandel, D. B. (1982). Epidemiological and psychosocial perspectives on adolescent drug use. Journal of American Academic Clinical Psychiatry, 21, 328–347.
Kumpfer, K. (1987). Special populations: Etiology and prevention of vulnerability to chemical dependency in children of AOD abusers. In B. S. Brown & A. R. Mills (Eds.), Youth at risk for substance abuse (pp. 1–72). Washington, DC: U.S. Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse.
Kumpfer, K. (1997). What works in the prevention of drug abuse: Individual, school, and family approaches. In Secretary’s youth substance abuse prevention initiative: Resource papers (pp. 69–106). Washington, DC: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration.
Schinke, S., & Cole, K. (1995). Prevention in community settings. In G. J. Botvin, S. Schinke, & M. A. Orlandi (Eds.), Drug abuse prevention with multiethnic youth (pp. 215–232). Thousand Oaks, CA: Sage Publications.
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Last Updated: March 4, 2002
