Lessons from Prevention Research
In more than 20 years of drug abuse research, 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 pro-social
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 pro-social
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 that 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 school and family intervention accompany them.
- Community programs need to strengthen norms against drug use in all drug
abuse prevention settings, including the family, the school, the workplace and
- 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
- 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 rulemaking 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
- The Community Environment - Prevention programs work at the community
level with civic, religious, law enforcement, and governmental organizations
and enhance anti-drug norms and pro-social 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.
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