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                                               GUIDE TO
                                             SCIENCE-BASED
                                               PRACTICES




Principles of Substance
Abuse Prevention

Substance Abuse and Mental Health Services Administration
Center for Substance Abuse Prevention
Division of Knowledge Development and Evaluation
Acknowledgments

This document was produced under the guidance of Stephen E. Gardner, D.S.W., pro-
ject officer, and Paul J. Brounstein, Ph.D., Division of Knowledge Development and
Evaluation, Substance Abuse and Mental Health Services Administration, Center for
Substance Abuse Prevention (SAMHSA/CSAP), through contract #282-98-0023 to ROW
Sciences, Inc., Carol Winner, project director.
   Principles of Substance Abuse Prevention is based on A Guide to Science-Based
Practices in Substance Abuse Prevention, a seminal monograph developed and written
by Paul J. Brounstein, Janine M. Zweig, and Stephen E. Gardner, with substantial contri-
butions from Maria Carmona, Paul Florin, Roy Gabriel, and Kathy Stewart.
   Special thanks go to a dedicated review panel composed of Eric Einspruch, Roy
Gabriel, and Katherine Laws, RMC Research Corporation; Carol Hays, Illinois State
Incentive Grant Program; Patricia Post, Central Regional Center for the Application of
Prevention Technologies; and Mary Joyce Prudden, CSAP, who offered invaluable sug-
gestions for improving the document.
   The Department of Health and Human Services (DHHS) has reviewed and approved
policy-related information in this document but has not verified the accuracy of data or
analyses presented in the document. The opinions expressed herein are the views of the
authors and do not necessarily reflect the official position of SAMHSA or DHHS.

DHHS Publication No. (SMA)01-3507
Printed 2001




For single copies of this document, contact SAMHSA’s National Clearinghouse for
Alcohol and Drug Information (NCADI), P.O. Box 2345, Rockville, MD 20847-2345;
1-800-729-6686, 301-468-2600, or TDD 1-800-487-4889; or visit the Web site at
www.samhsa.gov.


ii Principles of Substance Abuse Prevention
Foreword

Although recent reports show a leveling or decrease in substance use among our nation’s
youth, drug abuse remains a problem in our country. There were 14.8 million current
users of illicit drugs in 1999. This figure represents 6.7 percent of the population ages 12
years and older. The 1999 National Household Survey also found increases in illicit drug
use among adults ages 18–25. Although the rates for those 26–34 years old and 35 years
and older have not changed significantly since 1994, overall statistics indicate that there
is still work to be done in preventing substance abuse.
    The Substance Abuse and Mental Health Services Administration’s (SAMHSA) Center
for Substance Abuse Prevention (CSAP) developed this series of products in response to
the ongoing substance abuse problems. The three components in this series support
CSAP’s mission to provide resources that are based on science, with measurable out-
comes, and designed to help community and state leaders formulate targeted programs.
    CSAP is committed to sponsoring, accumulating, and integrating knowledge regarding
scientifically defensible and effective prevention practices. The primary foci of each doc-
ument in this series is CSAP grantees, constituent organizations, and the communities
these groups serve.
    We are pleased to release these findings on the risk factors for substance abuse in dif-
ferent domains and successful intervention strategies to prevent substance abuse, delay
its onset, and reduce substance abuse-related behaviors. These results show that sub-
stance abuse develops in response to multiple influences, including the individual, fami-
ly, peers, school/work, community, and society/environment. These domains interact
with one another and change over time.
    The research confirms that there are a variety of proven approaches to substance
abuse prevention. The strategies highlighted in this booklet range from personal skill-
building and opportunities for family bonding to community awareness and youth-ori-
ented mass media campaigns. These findings provide an empirical knowledge base for
practitioners and a guide to State and Federal agencies, local governments, and private
foundations in their efforts to fund programs with measurable outcomes.
    This booklet is one in a series of products developed to help key stakeholders struc-
ture and assess scientifically defensible programs. It is designed to serve practitioners,
researchers, and policymakers as we all work together to develop innovative and effec-
tive methods of substance abuse prevention that respond to the unique needs of our
individual communities.

Joseph H. Autry III, M.D.                  Ruth Sanchez-Way, Ph.D.
(Acting) Administrator                     Director
Substance Abuse and Mental Health          Center for Substance Abuse Prevention
Services Administration                    Substance Abuse and Mental Health Services
                                           Administration




                                                                                          iii
Table of Contents
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ii

Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .iii

Principles of Substance Abuse Prevention . . . . . . . . . . . . . . . . . . . . . . . . .1
      Principles of Effective Substance Abuse Prevention . . . . . . . . . . . . . .1
      Why Use Scientifically Defensible Principles? . . . . . . . . . . . . . . . . .4
      Why Use This Booklet? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
      Prevention Interventions by Domain . . . . . . . . . . . . . . . . . . . . . . . .7
      Additional Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23




                                                                                                          v
Principles of Substance
                                Abuse Prevention
For more than a decade, the Substance         ples appearing in this document have
Abuse and Mental Health Services              been identified through expert or peer
Administration’s Center for Substance         consensus efforts such as consensus pan-
Abuse Prevention (CSAP) has supported         els and meta-analyses. Many have also
demonstration programs designed to iden-      been published in peer-reviewed journals.
tify interventions that work with high-risk   Appropriate use of these scientifically
populations to prevent substance abuse,       defensible principles can assist prevention
delay its onset, and reduce substance         providers in designing services that are
abuse-related behaviors. Research now         both innovative and effective, and in
confirms that interventions aimed at          modifying proven models to respond to
reducing the risk factors and increasing      the specialized needs of individual
the protective factors linked to substance    programs.
abuse and related problem behavior can
produce immediate and long-term posi-         Principles of Effective
tive results.
                                              Substance Abuse Prevention
                                              This section provides a brief listing of the
    Substance abuse prevention princi-
                                              scientifically defensible principles that
 ples are basic truths, standards, and
                                              can help service providers design and
 elements that effective interventions
                                              implement programs that work. The more
 have in common and that have been
                                              detailed descriptions of each principle
 identified through the careful evalua-
                                              within each domain are contained in the
 tion of substance abuse prevention
                                              text that follows.
 programs.
     However, principles derive from
                                              Individual Domain
 programs and must be viewed in this
 context. They are best used to modify        I-1.    Build social and personal skills.
 or adapt program core philosophy and         I-2.    Design culturally sensitive inter-
 content to specific situations or popu-              ventions.
 lations. The preventionist who con-          I-3.    Cite immediate consequences.
 structs programs directly from               I-4.    Combine information dissemina-
 principles without an eye toward con-                tion and media campaigns with
 tent may have little to show as a result.            other interventions.
                                              I-5.    Provide positive alternatives to
   Effective interventions share certain              help youth in high-risk environ-
principles that guide prevention providers            ments develop personal and
in structuring client services. The princi-           social skills in a natural and effec-
                                                      tive way.

                                                                                           1
Guide to Science-Based Practices


I-6.      Recognize that relationships exist       Peer Domain
          between substance use and a vari-
                                                   P-1.   Structure alternative activities and
          ety of other adolescent health
                                                          supervise alternative events.
          problems.
                                                   P-2.   Incorporate social and personal
I-7.      Incorporate problem identification
                                                          skills-building opportunities.
          and referral into prevention pro-
          grams.                                   P-3.   Design intensive alternative pro-
                                                          grams that include a variety of
I-8.      Provide transportation to preven-
                                                          approaches and a substantial time
          tion and treatment programs.
                                                          commitment.

Family Domain                                      P-4.   Communicate peer norms against
                                                          use of alcohol and illicit drugs.
F-1.      Target the entire family.
                                                   P-5.   Involve youth in the development
F-2.      Help develop bonds among par-                   of alternative programs.
          ents in programs; provide meals,
                                                   P-6.   Involve youth in peer-led inter-
          transportation, and small gifts;
                                                          ventions or interventions with
          sponsor family outings; and
                                                          peer-led components.
          ensure cultural sensitivity.
                                                   P-7.   Counter the effects of deviant
F-3.      Help minority families respond to
                                                          norms and behaviors by creating
          cultural and racial issues.
                                                          an environment for youth with
F-4.      Develop parenting skills.                       behavior problems to interact with
F-5.      Emphasize family bonding.                       other nonproblematic youth.
F-6.      Offer sessions where parents and
          youth learn and practice skills.         School Domain
F-7.      Train parents to both listen and         S-1.   Avoid relying solely on knowl-
          interact.                                       edge-oriented interventions
F-8.      Train parents to use positive and               designed to supply information
          consistent discipline techniques.               about negative consequences.
F-9.      Promote new skills in family com-        S-2.   Correct misconceptions about the
          munication through interactive                  prevalence of use in conjunction
          techniques.                                     with other educational approach-
F-10.     Employ strategies to overcome                   es.
          parental resistance to family-based      S-3.   Involve youth in peer-led inter-
          programs.                                       ventions or interventions with
F-11.     Improve parenting skills and child              peer-led components.
          behavior with intensive support.         S-4.   Give students opportunities to
F-12.     Improve family functioning                      practice newly acquired skills
          through family therapy when indi-               through interactive approaches.
          cated.                                   S-5.   Help youth retain skills through
F-13.     Explore alternative community                   booster sessions.
          sponsors and sites for schools.          S-6.   Involve parents in school-based
F-14.     Videotape training and education.               approaches.


2       Principles of Substance Abuse Prevention
S-7.   Communicate a commitment to           C-15. Assess progress from an outcome-
       substance abuse prevention in               based perspective and make
       school policies.                            adjustments to the plan of action
                                                   to meet goals.
Community Domain                             C-16. Involve paid coalition staff as
C-1.   Develop integrated, comprehen-              resource providers and facilitators
       sive prevention strategies rather           rather than as direct community
       than one-time community-based               organizers.
       events.
C-2.   Control the environment around        Society/Environmental Domain
       schools and other areas where         S/E-1. Develop community awareness
       youth gather.                                and media efforts.
C-3.   Provide structured time with          S/E-2. Use mass media appropriately.
       adults through mentoring.             S/E-3. Set objectives for each media
C-4.   Increase positive attitudes through          message delivered.
       community service.                    S/E-4. Avoid the use of authority figures.
C-5.   Achieve greater results with highly   S/E-5. Broadcast messages frequently
       involved mentors.                            over an extended period of time.
C-6.   Emphasize the costs to employers      S/E-6. Broadcast messages through mul-
       of workers’ substance use and                tiple channels when the target
       abuse.                                       audience is likely to be viewing or
C-7.   Communicate a clear company                  listening.
       policy on substance abuse.            S/E-7. Disseminate information about the
C-8.   Include representatives from every           hazards of a product or industry
       organization that plays a role in            that promotes it.
       fulfilling coalition objectives.      S/E-8. Promote placement of more con-
C-9.   Retain active coalition members              spicuous labels.
       by providing meaningful rewards.      S/E-9. Promote restrictions on tobacco
C-10. Define specific goals and assign              use in public places and private
      specific responsibility for their             workplaces.
      achievement to subcommittees           S/E-10. Support clean indoor air laws.
      and task forces.                       S/E-11. Combine beverage server training
C-11. Ensure planning and clear under-               with law enforcement.
      standing for coalition effective-      S/E-12. Increase beverage servers’legal
      ness.                                          liability.
C-12. Set outcome-based objectives.          S/E-13. Increase the price of alcohol and
C-13. Support a large number of preven-              tobacco through excise taxes.
      tion activities.                       S/E-14. Increase minimum purchase age
C-14. Organize at the neighborhood                   for alcohol to 21.
      level.                                 S/E-15. Limit the location and density of
                                                     retail alcohol outlets.


                                                                                         3
Guide to Science-Based Practices


S/E-16. Employ neighborhood antidrug            accountability and will simultaneously
        strategies.                             ensure that program participants receive
S/E-17. Enforce minimum purchase age            the most effective services available.
        laws using undercover buying
        operations.                             The Role of Domains
S/E-18. Use community groups to provide         Substance use is a complex problem that
        positive and negative feedback to       develops in response to multiple influ-
        merchants.                              ences. These spheres of activity—typically
S/E-19. Employ more frequent enforce-           called domains—include the individual,
        ment operations.                        family, peers, school, community, and
                                                society/environment.
S/E-20. Implement “use and lose” laws.
                                                    Characteristics and conditions that
S/E-21. Enact deterrence laws and poli-
                                                exist within each domain of activity also
        cies for impaired driving.
                                                function as risk or protective factors that
S/E-22. Enforce impaired-driving laws.          help propel individuals to or safeguard
S/E-23. Combine sobriety checkpoints            them from substance abuse. As such,
        with positive passive breath sen-       each of these domains presents an oppor-
        sors.                                   tunity for preventive action.
S/E-24. Revoke licenses for impaired dri-           Research indicates that as individuals
        ving.                                   develop, their interactions within and
S/E-25. Immobilize or impound the vehi-         across domains of activity change over
        cles of those convicted of              time. The Web of Influence model (figure
        impaired driving.                       1) illustrates that these dynamic and
                                                complicated relationships can result not
S/E-26. Target underage drivers with
                                                only in substance abuse, but also in other
        impaired-driving policies.
                                                problem behaviors such as violent crime
                                                and suicide.
Why Use Scientifically                              Risk and protective factors are drawn
Defensible Principles?                          from a large body of literature (Bry, 1983;
Prevention programs today must produce          Hansen, 1997; Hawkins, Catalano, &
tangible results. State and federal agen-       Miller, 1992; Newcomb & Felix-Ortiz,
cies, local governments, and private foun-      1992; Reynolds, Stewart, & Fisher, 1997).
dations are interested in funding programs      As applied by CSAP and depicted in the
with measurable outcomes. The new               Web of Influence, risk and protective fac-
emphasis on performance means that pre-         tors function as an interactive model. A
vention practitioners must show that the        risk factor such as delinquency, for exam-
programs they propose achieve the results       ple, can also become an outcome if an
predicted. The prevention field now has         intervention aimed at preventing or
an empirical knowledge base to assist           changing the development of that behav-
practitioners in selecting proven               ior fails to achieve its objective. In the
approaches for their programs. Using sci-       same way, if an intervention succeeds in
entifically defensible principles will help     strengthening a protective factor such as
practitioners respond to demands for



4    Principles of Substance Abuse Prevention
Figure 1
Web of Influence


     Teen                School             Substance              Teenage               Violent
  Pregnancy              Dropout               Use                 Suicide               Crime




                                             Individual
                                              Risk and
                                             Protective
                                              Factors




  Society/
                                                                                         Peer
Environment*             Family            Community**          School/Work
                                                                                      Association
Related Risk            Risk and             Risk and             Risk and
                                                                                       Risk and
     and               Protective           Protective           Protective
                                                                                       Protective
 Protective             Factors              Factors              Factors
                                                                                        Factors
  Factors

*Society/Environment: Refers to the total complex of external social, cultural, and economic conditions affecting a
community or an individual.

**Community: Refers to the specific geographic location where an individual resides and to the conditions within
that particular area.

family bonding, improved family bonding                         Prevention education to teach partici-
can become a positive outcome.                               pants important social skills such as drug
                                                             resistance and decision making;
Substance Abuse Prevention and                                  Alternatives to offer opportunities for
Treatment Block Grant Strategies                             participation in developmentally appro-
In the Substance Abuse Prevention and                        priate drug-free activities to replace,
Treatment (SAPT) block grant legislation,                    reduce, or eliminate involvement in sub-
Congress defined six strategies that pre-                    stance use-related activities;
vention programs can use to increase                            Problem identification and referral to
protective factors and reduce the impact                     recognize individuals with suspected sub-
of risk factors, as follows:                                 stance use problems and refer them for
    Information dissemination to increase                    assessment and treatment;
knowledge and change attitudes about                            Community-based processes to
substance use and abuse through activi-                      expand community resources dedicated
ties such as classroom discussions and                       to preventing substance use and abuse
media campaigns.                                             through activities such as building com-
                                                             munity coalitions; and



                                                                                                                      5
Guide to Science-Based Practices


   Environmental approaches to promote           s   Although this booklet groups principles
policy changes that reduce risk factors              by domain, planners and providers
and preserve or increase protective factors          should not feel constrained by this
such as stepped-up enforcement of legal              approach because many principles
purchase age for alcohol and tobacco                 work well in more than one domain.
products.                                        s   Principles identified in this booklet may
   To obtain funding from CSAP through               not relate to substance abuse problems
the SAPT block grant, States must identify           directly. Instead, they may influence the
the strategies that will be used in their            risk and protective factors that con-
proposed interventions.                              tribute to or guard against problems
                                                     (Hansen, 1997; Reynolds et al., 1997).
Why Use This Booklet?                            s   Although CSAP recommends a compre-
Principles of Substance Abuse Prevention             hensive approach to substance abuse
organizes scientifically defensible princi-          prevention, increasing the number of
ples by domain and links them to the pre-            principles used in a program does not
vention strategies identified in the SAPT            necessarily increase its effectiveness. It
block grant. Service providers can refer to          is important to select scientifically
it for ideas about what works, to identify           defensible principles that best meet the
proven principles in a particular domain,            needs of program participants, support
and to justify the use of one or more prin-          program objectives, and complement
ciples in a program. Because each princi-            one another.
ple is cited, it is relatively easy to locate    s   Likewise, while scientifically defensible
the full article for more detailed informa-          principles may improve some out-
tion. Grant reviewers, evaluators, and fun-          comes, they cannot compensate for or
ders may also find Principles of Substance           salvage a poorly designed or imple-
Abuse Prevention useful as a quick                   mented program.
overview of the state of the art in preven-      s   Combining a series of substance abuse
tion programming and as a tool for deter-            prevention principles does not neces-
mining whether a program is using                    sarily make for an effective prevention
scientifically defensible principles.                program. Principles are best used to
                                                     modify and enhance existing prevention
Some Caveats                                         programs and efforts, rather than create
Before one begins to use the principles              new programs from scratch.
highlighted in this booklet, it is important     s   Successful, scientifically defensible
to remember that:                                    interventions rely on strong implemen-
s   This list is not exhaustive, and it will         tation and continuous, rigorous evalua-
    grow as additional principles undergo            tion to determine if benchmarks and
    evaluation. CSAP encourages program              standards have been met and if desired
    planners and providers to build on the           outcomes have been achieved. Such
    information in this booklet to develop           implementation and evaluation are, in
    the foundation for new and innovative            themselves, important for substantiating
    approaches to substance abuse                    the scientific defensibility of prevention
    prevention.                                      principles (Morrissey et al., 1997;
                                                     Reynolds et al., 1997).

6     Principles of Substance Abuse Prevention
ties, influence attitudes, and pro-
Prevention Interventions by
                                                    mote behavior inconsistent with
Domain                                              use. These interventions usually
                                                    include information about the
Individual Domain                                   negative effects of substance use
Among the risk factors for substance                (Bell, Ellickson, & Harrison, 1993;
abuse in the individual domain are lack             Botvin, Baker, Dusenbury, Botvin,
of knowledge about the negative conse-              & Diaz, 1995; Ellickson, Bell, &
quences associated with using illegal sub-          McGuigan, 1993; Hansen, 1996;
stances, attitudes favorable toward use,            Pentz et al., 1990; Schinke &
early onset of use, biological or psycho-           Cole, 1995; Tobler, 1986, 1992).
logical dispositions, antisocial behavior,   I-2.   To be effective, interventions must
sensation seeking, and lack of adult                be culturally sensitive and consid-
supervision (Bry, 1983; Hawkins et al.,             er race, ethnicity, age, and gender
1992; Scheier & Newcomb, 1991). Most                in their designs (Botvin, Schinke,
interventions aimed at the individual are           Epstein, & Diaz, 1994; Center for
designed to change knowledge about and              Substance Abuse Prevention
attitudes toward substance abuse with the           (CSAP), 1996).
ultimate goal of influencing behavior.       I-3.   Youth tend to be more concerned
                                                    about social acceptance and the
 Linking Skills Development with                    immediate rather than long-term
 Information                                        effects of particular behaviors.
    Life Skills Training (LST) Program              Citing consequences such as
 demonstrates that linking key skills               stained teeth and bad breath has
 development with information target-               more impact than threats of lung
 ing social influences to use, and rein-            cancer, which usually develops
 forcing these strategies with booster              later in life (Flay & Sobel, 1993;
 sessions, can produce durable reduc-               Flynn et al., 1997; Paglia &
 tions in use.                                      Room, 1998).
                                             I-4.   Used alone, information dissemi-
    Research shows that whether pro-
                                                    nation and media campaigns do
 vided by trained teachers, health pro-
                                                    not play a major part in influenc-
 fessionals, or peer leaders, research
                                                    ing individual knowledge, atti-
 shows that LST can lower levels of
                                                    tudes, and beliefs, but they can be
 tobacco, alcohol, and marijuana use
                                                    effective when combined with
 among white, African American, and
                                                    other interventions (Flynn et al.,
 Hispanic/Latino youth by 59 to 75 per-
                                                    1992, 1997; Flynn, Worden,
 cent and reduce multidrug use by as
                                                    Secker-Walker, Badger, & Geller,
 much as 66 percent (Botvin et al.,
                                                    1995).
 1994, 1995).
                                             I-5.   Alternatives such as organized
                                                    sports, involvement in the arts,
Research has shown the following:
                                                    and community service provide a
I-1.   Social and personal skills-building
                                                    natural and effective way of
       can enhance individual capaci-
                                                    reaching youth in high-risk envi-

                                                                                      7
Guide to Science-Based Practices


         ronments who are not in school
         and who lack both adequate adult          Use of Incentives To Promote
         supervision and access to positive        Program Participation
         activities. Positive alternatives can
         help youth develop personal and              The Strengthening Families
         social skills inconsistent with sub-      Program, aimed at 6- to 10-year-old
         stance use (CSAP, 1996; Tobler,           children of substance abusers and their
         1986).                                    parents, used incentives such as
                                                   movie/sporting event tickets and
I-6.     Effective programs recognize that
                                                   vouchers for groceries and other
         relationships exist between sub-
                                                   household items as well as transporta-
         stance use and a variety of other
                                                   tion to engage and retain parents in the
         adolescent health problems—such
                                                   program. This approach spans cultures
         as mental disorders, family prob-
                                                   and has been successfully adapted for
         lems, pregnancy, sexually trans-
                                                   and evaluated with Hispanic/Latino,
         mitted diseases, school failure,
                                                   Asian/Pacific Islander, African
         and delinquency—and include
                                                   American, and white families (Kumpfer
         services designed to address them
                                                   & Alvarado, 1995; Kumpfer, Molgaard,
         (Compas, Hinden, & Gerhardt,
                                                   & Spoth, 1996; Kumpfer, Williams, &
         1995).
                                                   Baxley, 1997).
I-7.     Incorporating problem identifica-
         tion and referral into prevention        ture can also be a serious risk factor
         programs helps to ensure that par-       (Szapocznik et al., 1997). Research has
         ticipants who are already using          shown the following:
         drugs will receive treatment
                                                  F-1.   Interventions targeting the entire
         (Brounstein & Zweig, 1996;
                                                         family—parents as well as chil-
         Johnson et al., 1996).
                                                         dren—can be effective in prevent-
I-8.     Providing transportation to treat-              ing adolescent substance use
         ment programs can encourage                     (Dent et al., 1995; Dishion,
         youth participation (Brounstein &               Andrews, Kavanagh, & Soberman,
         Zweig, 1996).                                   1996; Hawkins et al., 1992;
                                                         Kumpfer et al., 1996; Pentz et al.,
Family Domain                                            1989; Walter, Vaughn, & Wynder,
Family domain risk factors include                       1989).
parental and sibling drug use or approval         F-2.   Retaining parents in family-based
of use, inconsistent or poor family man-                 programs can also be difficult
agement practices—including lack of                      (Botvin et al., 1995; Dent et al.,
supervision, lack of parental involvement                1995). Helping to develop bonds
in children’s lives, family conflict, sexual             among parents in a program
or physical abuse, economic instability,                 (Cohen & Linton, 1995; Creating
and lack of attachment to parents, often                 Lasting Family Connections, 1998;
called low family bonding (Hawkins &                     Resnik & Wojcicki, 1991); provid-
Catalano, 1992). For immigrant families,                 ing meals, transportation, and
problems adapting to the mainstream cul-                 small gifts; sponsoring family out-


8      Principles of Substance Abuse Prevention
ings; and ensuring that programs
         are culturally sensitive can help to    Interactive Techniques Help
         improve retention (Kumpfer &            Promote Family Communication
         Alvarado, 1995).
                                                     Creating Lasting Connections’
F-3.     Interventions that help minority        Getting Real training for parents,
         families respond to cultural and        youth, and families emphasizes role-
         racial issues can produce positive      playing to help participants identify the
         effects. Issues include the role of     responses they use most in talking with
         the extended family, influence of       family members, improve their ability
         immigration or circular migration,      to express feelings and ideas clearly,
         different language abilities within     and establish new patterns of interac-
         families, influence of religion and     tions to enrich family relationships.
         folk healers, influence of volun-       Because adults and children respond
         tary and social organizations, and      differently to interactive techniques
         stresses experienced by families as     such as role-play, the program trains
         a result of socioeconomic status        parents and youth separately. It is also
         and racism (Kumpfer & Alvarado,         careful to limit the age range with
         1995; Kumpfer et al., 1997;             youth to a three-year span (e.g., ages 9
         Szapocznik et al., 1997).               to 11) and frequently separates groups
s   Family strategies that are effective         by gender. Careful implementation
    include the following:                       ensures that activities occur in a safe
    F-4. Focus on developing parenting           place, a condition important for suc-
         skills rather than simply offering      cessful interactive interventions
         information about parenting (Bry        (Brounstein & Zweig, 1996; Creating
         & Canby, 1986; Kumpfer et al.,          Lasting Family Connections, 1998;
         1996; Szapocznik et al., 1988).         Johnson et al., 1996).
    F-5. Emphasize family bonding
                                                F-8.   Train parents to use positive and
         through opportunities for joint
                                                       consistent discipline techniques
         parent-child participation in
                                                       and to monitor and supervise their
         activities (Dishion & McMahon,
                                                       children (DeMarsh & Kumpfer,
         1998; Szapocznik et al., 1988).
                                                       1986).
    F-6. Offer sessions in which parents
                                                F-9.   Interactive techniques, including
         and youth learn and practice
                                                       modeling, coaching, rehearsal,
         skills both separately and togeth-
                                                       and role-playing, can help to pro-
         er (Brounstein et al., 1996;
                                                       mote the development of new
         DeMarsh & Kumpfer, 1986;
                                                       skills in programs aimed at
         Dishion & McMahon, 1998;
                                                       improving family communication
         Kumpfer & Baxley, 1997).
                                                       (Dishion & McMahon, 1998;
    F-7. Train parents to both listen and              Patterson & Chamberlain, 1994;
         interact in developmentally                   Szapocznik et al., 1988; Webster-
         appropriate ways with their chil-             Stratton & Herbert, 1993).
         dren (Brounstein & Zweig, 1996;
         Kumpfer et al., 1997).


                                                                                             9
Guide to Science-Based Practices


F-10.    Recruiting parents for family-         Peer Domain
         based prevention programs can be
                                                The principal risk factors associated with
         difficult. Incentives that can help
                                                the peer domain are peer use, peer norms
         overcome resistance include pro-
                                                favorable toward use, and peer activities
         viding transportation and child
                                                conducive to use. Research has shown
         care, offering rewards for partici-
                                                the following:
         pation such as cash payments,
                                                P-1.   Structured alternative activities
         and scheduling programs at times
                                                       and supervised alternative events
         most convenient for parents
                                                       (e.g., sober prom and graduation
         (Kumpfer & Alvarado, 1995).
                                                       parties) can offer peers an oppor-
F-11.    With intensive support (at least 12
                                                       tunity for social interaction in set-
         to 15 sessions of counseling and
                                                       tings antithetical to substance use
         skills-building), substance-abusing
                                                       (CSAP, 1996; Williams & Perry,
         parents can improve their parent-
                                                       1998).
         ing skills and as a result improve
                                                P-2.   Alternative activities that incorpo-
         their children’s behavior and
                                                       rate social and personal skills-
         reduce both their own and their
                                                       building opportunities can be
         children’s levels of substance use
                                                       effective with youth in high-risk
         (Bry, 1994; Kumpfer et al., 1996;
                                                       environments who may not have
         Olds, 1997).
                                                       adequate adult supervision or
F-12.    For families of juvenile offenders,
                                                       access to a variety of activities, or
         family therapy can improve family
                                                       who may have few opportunities
         functioning, increase family skills,
                                                       to develop the kinds of personal
         and reduce recidivism (DeMarsh
                                                       skills needed to avoid behavioral
         & Kumpfer, 1986; Kumpfer et al.,
                                                       problems (Tobler, 1986).
         1996).
                                                P-3.   Effective alternative programs tend
F-13.    Since schools in some communi-
                                                       to be intensive and include both a
         ties may not be highly regarded or
                                                       variety of approaches and a sub-
         accessible during nonschool
                                                       stantial commitment of time on
         hours, exploring alternative com-
                                                       the part of their participants
         munity sponsors and sites such as
                                                       (Schaps, DiBartolo, Moskowitz,
         churches and community recre-
                                                       Palley, & Churgin, 1981; Shaw,
         ation centers can enhance partici-
                                                       Rosati, Salzman, Coles, &
         pation in family-focused
                                                       McGeary, 1997; Tobler, 1986).
         interventions (Johnson et al.,
                                                P-4.   Alternative events can communi-
         1996; Kumpfer et al., 1996).
                                                       cate peer norms against use of
F-14.    Videotaped training and education
                                                       alcohol and illicit drugs and can
         can be an effective and cost-effi-
                                                       serve as community statements in
         cient tool to teach parenting skills
                                                       support of no-use norms (CSAP,
         (Webster-Stratton, 1990; Webster-
                                                       1996; Rohrbach, Johnson,
         Stratton & Herbert, 1993).
                                                       Mansergh, Fishkin, & Neumann,
                                                       1997).



10      Principles of Substance Abuse Prevention
school climate, and lenient school poli-
 Exercise Caution When Grouping               cies with regard to the use of some sub-
 Very High-Risk Youth                         stances (e.g., tobacco). Many researchers
                                              believe that student-based risk factors
    Experience with the peer compo-
                                              develop or become more pronounced
 nent of the highly regarded Adolescent
                                              when students are unable to experience
 Transitions Program (ATP) suggests
                                              some satisfaction from their academic
 some caution in applying peer-oriented
                                              efforts. For this reason, academic skills-
 principles. ATP found that when very
                                              building has become an important com-
 high-risk youth are grouped together,
                                              ponent of many after-school, alternative
 even for a supervised intervention, a
                                              activities (CSAP, 1996; LoSciuto, Rajala,
 contagion effect can occur and prob-
                                              Townsend, & Taylor, 1996; Tierney,
 lem behaviors can increase. More
                                              Grossman, & Resch, 1995). In much the
 mixed or heterogeneous environments
                                              same way, lack of attachment to school
 may be needed to counter the impact
                                              may relate to students’inability to set
 of deviant norms and behavior
                                              future-oriented goals, particularly those
 (Dishion et al., 1996; Dishion &
                                              that depend on education for their
 McMahon, 1998).
                                              achievement. Mentoring programs have
P-5.   Involving youth in the develop-        been designed, in part, to respond to that
       ment of alternative programs can       problem (CSAP, 1996; LoSciuto et al.,
       increase the appeal of the activi-     1996).
       ties offered and enhance partici-          School climate is another factor con-
       pation (Armstrong, 1992; Komro         tributing to the lack of attachment to
       et al., 1996).                         school. Together, teachers’ instructional
                                              methods, classroom management tech-
P-6.   Peer-led interventions or interven-
                                              niques, class size, student-teacher ratios,
       tions with peer-led components
                                              classroom organization, and educators’
       can be more effective than adult-
                                              attitudes toward students affect the cli-
       led approaches (Komro et al.,
                                              mate in a particular school (Battistich,
       1996; Tobler, 1986, 1992).
                                              Schaps, Watson, & Solomon, 1996; Felner
P-7.   Placing peers whose behavior is
                                              et al., 1993; Flay, 1987). Drug testing and
       deviant into the same group can
                                              the use of drug-sniffing dogs are other
       be problematic. More heteroge-
                                              practices employed by some schools.
       neous environments may be need-
                                              However, those approaches have not yet
       ed to counter the effects of
                                              been extensively evaluated to determine
       deviant norms and behavior
                                              effectiveness in countering risk factors or
       (Dishion et al., 1996; Dishion &
                                              reducing levels of substance use at school
       McMahon, 1998).
                                              (Paglia & Room, 1998).
                                                  Research has found the following:
School Domain
                                              S-1.   When used alone, knowledge-ori-
The risk factors associated with the school          ented interventions designed to
domain include lack of commitment to                 supply information about the neg-
education, poor grades or school failure,            ative consequences of substance
lack of attachment to school, negative               use do not produce measurable


                                                                                      11
Guide to Science-Based Practices


        and long-lasting changes in sub-      S-4.    Interactive approaches, such as
        stance use-related behavior or                cooperative learning, role-plays,
        attitudes and are considered                  and group exercises that give stu-
        among the least effective educa-              dents opportunities to practice
        tional strategies (Tobler, 1986).             newly acquired skills (and that are
S-2.    While interventions to correct                characteristic of social skills and
        misconceptions about the preva-               peer-led interventions), help to
        lence of use can change attitudes             engage and retain youth in pre-
        favorable toward use (Errecart et             vention education programs
        al., 1991; Hansen & Graham,                   (Botvin et al., 1994, 1995;
        1991), they are most effective in             Brounstein & Zweig, 1996; Komro
        reducing substance use when                   et al., 1996; Walter et al., 1989;
        combined with other educational               Williams & Perry, 1998).
        approaches such as fostering          S-5.    Booster sessions help youth retain
        social skills (Shope, Kloska,                 skills learned in prevention educa-
        Dielman, & Maharg, 1994).                     tion programs over time (Botvin et
S-3.    Interventions for youth that are              al., 1994, 1995).
        peer led or include peer-led com-     S-6.    School-based approaches that also
        ponents are more effective than               involve parents can be effective in
        adult- or teacher-led approaches              preventing adolescent substance
        (St. Pierre, Kaltreider, Mark, &              use (Dent et al., 1995; Dishion et
        Aitkin, 1992; Tobler, 1986, 1992).            al., 1996; Kumpfer et al., 1996;
                                                      Pentz et al., 1989; Walter et al.,
                                                      1989).
 Involving Parents in School-Based
 Programs Fosters Effectiveness               S-7.    School policies that communicate
                                                      a commitment to substance abuse
    The Child Development Project’ s                  prevention include formal no-use
 Homeside Activities give parents a                   policies for students, teachers,
 window into what their children are                  administrators, and other staff;
 learning in school. This innovative                  training for teachers and adminis-
 intervention introduces activities in the            trators; and a health education
 classroom that students complete at                  program based on validated prin-
 home with parents and then incorpo-                  ciples (Paglia & Room, 1998).
 rate into a follow-up classroom activity
 or discussion. Parents are also con-         Community Domain
 nected to the school through Family
                                              Community domain risk factors include
 Read-Aloud and other activities
                                              lack of bonding or attachment to social
 designed to create an inclusive school
                                              and community institutions, lack of com-
 environment that, in turn, helps to pre-
                                              munity awareness or acknowledgment of
 vent or delay substance abuse and oth-
                                              substance use problems, community
 er problem behaviors (e.g., involvement
                                              norms favorable to use and tolerant of
 in gangs, carrying weapons) among
                                              abuse, insufficient community resources
 young people (Battistich et al., 1996).
                                              to support prevention efforts, and inability


12     Principles of Substance Abuse Prevention
to address the problem of substance                 Skogan, 1991; Eck & Wartell, in
abuse. Community institutions such as               press; Gruenewald, Ponicki, &
churches, Boys and Girls Clubs, YMCA                Holder, 1993).
and YWCA, and Boy and Girl Scouts            C-3.   Mentoring programs that provide
often provide individuals with opportuni-           structured time with adults can
ties to develop personal capacities and             increase school attendance and
interact with prosocial peers in construc-          positive attitudes toward others,
tive endeavors (Brounstein & Zweig,                 the future, and school and can
1996; CSAP, 1996; St. Pierre et al., 1992;          reduce substance use (Brounstein
Tierney et al., 1995). Workplaces within            & Zweig, 1996; CSAP, 1996;
the community, media, and community                 LoSciuto et al., 1996).
coalitions are other vehicles for address-   C-4.   Community service can increase
ing and reducing community domain risk              positive attitudes toward others,
factors. Specifically, research has found           the future, and the community
the following:                                      and can provide youth with
C-1.   One-time community-based sub-                opportunities to give back to their
       stance abuse prevention and edu-             community (Brounstein et al.,
       cation events alone are unlikely to          1996; CSAP, 1996; LoSciuto et al.,
       affect participants’behavior, but            1996).
       they can be effective as part of an   C-5.   Highly involved mentors usually
       integrated, comprehensive pre-               achieve greater positive results
       vention strategy. In that context,           than those who are less commit-
       such events show that a commu-               ted (Brounstein et al., 1996;
       nity supports no-use norms, draw             LoSciuto et al., 1996).
       public and media attention to sub-
                                             C-6.   Emphasizing the costs to employ-
       stance use issues, and help
                                                    ers of workers’substance use and
       increase awareness and support
                                                    abuse can encourage companies
       for other important prevention
                                                    to become more active in preven-
       efforts (Paglia & Room, 1998;
                                                    tion efforts. Costs include lost pro-
       CSAP, 1996).
                                                    ductivity and increased health
C-2.   Controlling the environment                  care premiums to cover sub-
       around schools and other areas               stance-abusing employees and
       where youth gather helps to rein-            their dependents (Cook, Back, &
       force strong community norms                 Trudeau, 1996; Frankish, Johnson,
       against substance use. Controls              Ratner, & Lovato, 1997).
       include restrictions on the number
                                             C7.    Communicating a clear company
       of alcohol and tobacco outlets,
                                                    policy on substance abuse can
       required setbacks for alcohol and
                                                    help change workplace norms
       tobacco outlets, restrictions on
                                                    about substance use and abuse
       advertising near schools including
                                                    (Ames & Janes, 1987; Cook et al.,
       billboards, and the designation of
                                                    1996).
       drug-free zones that set standards
       for adult as well as youth behav-
       ior (Davis, Smith, Lurigio, &

                                                                                      13
Guide to Science-Based Practices


                                             C-8.   Community coalitions that work
 Mentoring Can Increase Positive                    include representatives from every
 Attitudes and Reduce Substance                     organization that plays a role in
 Use                                                fulfilling coalition objectives. For
                                                    example, if comprehensive service
    Across Ages: An Intergenerational
                                                    coordination is the objective,
 Approach to Drug Prevention careful-
                                                    community agency leadership
 ly matches adult mentors, ages 55 and
                                                    needs to be involved (Christenson,
 over, to sixth-grade African American,
                                                    Fendley, & Robinson, 1989;
 Asian, Latino, and white students in
                                                    Edelman & Springer, 1995;
 three Philadelphia middle schools.
                                                    Warren, Rodgers, & Evers, 1975).
 Recognizing the importance of conti-
                                                    If the objective is raising commu-
 nuity, Across Ages encouraged mentor-
                                                    nity awareness and stimulating
 ing relationships that encompassed
                                                    community action, grassroots
 parents and teachers as well as stu-
                                                    activists and community citizens
 dents and extended past the school
                                                    must be involved (Chavis &
 year and throughout the summer.
                                                    Florin, 1990; CSAP, 1997a,
 Across Ages’ multidimensional
                                                    1997b; Warren et al., 1975).
 approach to mentoring brought com-
                                                    Community linkage coalition
 munity residents into the schools and
                                                    models require a mix of both
 improved school attendance. Students
                                                    types of community members
 with deeply committed mentors
                                                    (CSAP, 1997b).
 changed their attitudes toward older
                                             C-9.   Effective coalitions retain active
 people, school, and the future and
                                                    members by providing meaningful
 developed increased capacity to resist
                                                    rewards for participation such as
 peer pressure to use drugs (Brounstein
                                                    opportunities for organizational
 & Zweig, 1996; CSAP, 1996; Johnson
                                                    leadership, distribution of
 et al., 1996; LoSciuto et al., 1996).
                                                    resources to home agencies, and
                                                    accomplishment of highly valued
                                                    personal, organizational, and
                                                    community goals (Join Together,
                                                    1996; Nistler, 1996).
                                             C-10. Effective coalitions define specific
                                                   goals and assign specific responsi-
                                                   bility for their achievement to sub-
                                                   committees and task forces, rather
                                                   than spending time on elaborating
                                                   organizational structures and pro-
                                                   cedures (Christenson, 1989; Join
                                                   Together, 1996; Rohrbach et al.,
                                                   1997).
                                             C-11. Planning is critical to coalition
                                                   effectiveness and begins with a
                                                   clear understanding, drawn from

14    Principles of Substance Abuse Prevention
validated empirical evidence, of             based perspective and make
       the substance-related problems it            adjustments to the plan of action
       seeks to change (Armstrong, 1992;            to meet their goals. Success is a
       Gabriel, 1997; Join Together,                function of strategies and activi-
       1996; Reynolds & Fisher, 1997).              ties, not a reflection of a coali-
C-12. Effective coalitions set outcome-             tion’s organizational structure or
      based objectives that are used to             design (CSAP, 1997b, 2000;
      develop specific strategies and               Forster et al., 1992; Gabriel,
      subsequent activities (Forster,               1997; Join Together, 1996; Keay,
      Hourigan, & McGovern, 1992;                   Woodruff, Wildey, & Kenney,
      Join Together, 1996; Reynolds,                1993).
      Stewart, & Fisher, 1997).              C-16. Paid coalition staff can function
C-13. Effective coalitions support a large         more effectively as resource
      number of prevention activities,             providers (such as communica-
      rather than focusing on a single             tions, coordination, and adminis-
      project (CSAP, 2000).                        trative expertise) and facilitators
C-14. Residents are more likely to par-            than as direct community organiz-
      ticipate in community partnership            ers (Join Together, 1996). It is
      activities if they are organized at          important for paid staff members
      the neighborhood level, where                to serve as catalysts for action and
      volunteers can see how they will             ensure that community partici-
      affect their own situations (CSAP,           pants receive credit for program
      2000).                                       success (CSAP, 2000).

C-15. Effective coalitions routinely
      assess progress from an outcome-
                                             Society/Environmental Domain
                                             Risk factors in the society/environmental
                                             domain include norms tolerant of use and
 Planning Is Essential to Coalition          abuse, policies enabling use and abuse,
 Effectiveness                               lack of enforcement of laws designed to
                                             prevent use and abuse, and inappropriate
     The Day One Community
                                             negative sanctions for use and abuse.
 Partnership devised the Alcohol
                                                 Since long-lasting effects should
 Sensitive Information Planning System
                                             accrue from changing school, family, and
 (ASIPS) to assess the extent to which
                                             societal norms that promote and maintain
 local criminal activity was alcohol
                                             drug abuse in youth, many prevention
 related and to provide a foundation for
                                             specialists are trying to incorporate a
 community planning activities. As one
                                             focus on both individual change and
 outgrowth of this assessment effort,
                                             changes in the systems or environmental
 Day One was able to marshal the data
                                             contexts that promote or hinder use. This
 needed to convince the city to use city
                                             expansion will have a positive impact on
 zoning to regulate retail availability of
                                             larger numbers of people than has our
 alcohol and tobacco and to conduct a
                                             reliance on more individually targeted
 decoy purchase program (Rohrbach et
                                             programs that focus more on persons with
 al., 1997).
                                             a greater likelihood of becoming problem

                                                                                     15
Guide to Science-Based Practices


Figure 2
Program Targets and Potential Impacts




abusers. The impact of this environmental            also recognize that audience per-
focus on society as a whole may be sub-              ceptions and capacities to under-
stantial, and societal/environmental sys-            stand media messages may vary
tems change efforts may form an                      based on gender, culture, and
important first line of defense in fighting          stage of cognitive development
the spread of substance abuse. (Figure 2)            (Flynn et al., 1992, 1997).
   Research has found the following:          S/E-3. Effective mass media campaigns
S/E-1. Community awareness and media                 set objectives for each message
       efforts can be effective tools for            delivered; for example, to
       increasing perceptions regarding              increase positive expectations for
       the likelihood of apprehension                nonuse or to correct assumptions
       and punishment for substance-                 about the number of youth who
       related violations and can reduce             use (Flynn et al., 1997).
       retailer noncompliance (Lewit,         S/E-4. Youth-oriented mass media cam-
       Coate, & Grossman, 1981;                      paigns that are effective with
       Schneider, Klein, & Murphy,                   youth in high-risk environments
       1981).                                        avoid the use of authority figures.
S/E-2. Appropriate use of mass media                 Instead, they use young models
       can enhance community aware-                  who appeal to the target group
       ness and influence community                  (Flynn et al., 1992).
       norms about substance use (Paglia      S/E-5. Effective campaigns broadcast
       & Room, 1998). Effective, youth-              messages frequently over an
       oriented mass media campaigns                 extended period of time. For
       identify target audiences. They               example, an effective media cam-

16    Principles of Substance Abuse Prevention
Grossman, 1996; Flynn et al.,
 Changing the Community                              1992; Wallack & DeJong, 1995).
 Environment Can Reduce                      S/E-8. The limited research on alcohol
 Underage Use of Alcohol                            warning labels suggests that while
                                                    they may affect awareness, atti-
     Responsible beverage-server train-
                                                    tudes, and intentions regarding
 ing for retail outlets and bars and com-
                                                    drinking, they do not appear to
 pliance checks of age-of-purchase laws
                                                    have a major influence on behav-
 (coordinated with local police depart-
                                                    ior (Barlow & Wogalter, 1993;
 ments and sheriffs’offices) were among
                                                    Hilton, 1993; Laughery, Young,
 the many integrated components of
                                                    Vaubel, & Brelsford, 1993).
 Project Northland, the largest random-
                                                    Studies have suggested that more
 ized community trial ever conducted
                                                    conspicuous labels would have a
 for the prevention of adolescent alco-
                                                    greater effect on awareness and
 hol use. Project Northland confirms the
                                                    behavior (Laughery et al., 1993;
 importance of applying long-term envi-
                                                    Malouff, Schutte, Wiener,
 ronmental interventions as well as
                                                    Brancazio, & Fish, 1993).
 interventions oriented to individuals to
 reduce underage alcohol use. It also        S/E-9. Restrictions on tobacco use in
 showed that it is possible to mobilize             public places and private work-
 community support for norms reinforc-              places (also known as clean
 ing the unacceptability of underage use            indoor air laws) can be effective
 (Williams & Perry, 1998).                          in curtailing cigarette sales
                                                    (Chaloupka & Saffer, 1992) and
       paign in Vermont aired 540 televi-           tobacco use among adults and
       sion broadcasts of 36 different              youth (Chaloupka, 1992;
       spots and 350 radio broadcasts of            Chaloupka & Pacula, 1997;
       17 different spots per year over             Evans, Farrelly, & Montgomery,
       four years (Flynn et al., 1997).             1996; Ohsfeldt, Boyle, &
                                                    Capilouto, 1999; Wasserman,
S/E-6. Mass media messages that are
                                                    Manning, Newhouse, & Winkler,
       effective are broadcast through
                                                    1991).
       multiple channels at times when
       members of the target audience        S/E-10. Clean indoor air laws can reduce
       are likely to be viewing or listen-           nonsmokers’exposure to cigarette
       ing (Flynn et al., 1992, 1997).               smoke and help to alter norms
                                                     regarding the social acceptability
S/E-7. Counteradvertising campaigns that
                                                     of smoking (DHHS, 1994).
       disseminate information about the
       hazards of a product or the indus-    S/E-11. Education and training programs
       try that promotes it may help                 teach beverage servers about
       reduce cigarette sales (Chaloupka             alcohol-related laws, the penalties
       & Grossman, 1996; Flay, 1987;                 for violation, the signs of intoxica-
       Flynn et al., 1992) and tobacco               tion and false identification, and
       consumption (Chaloupka &                      techniques for refusing sales.
                                                     However, when used alone, these
                                                     programs usually do not produce

                                                                                       17
Guide to Science-Based Practices


        substantial and sustained shifts                Wagenaar, 1991; Wagenaar,
        toward compliance with the law                  1993), particularly beer consump-
        (Altman, Rasenick-Douss, Foster,                tion (Berger & Snortum, 1985),
        & Tye, 1991; DiFranza & Brown,                  and in reducing alcohol-related
        1992; DiFranza, Savageau, &                     traffic crashes (General
        Aisquith, 1996; Skretny,                        Accounting Office, 1987;
        Cummings, Sciandra, & Marshall,                 National Highway Traffic Safety
        1990).                                          Administration, 1995; Safer &
S/E-11. Combining beverage-server train-                Grossman, 1987; Toomey,
        ing with enforcement of laws                    Rosenfeld, & Wagenaar, 1996;
        against service to intoxicated                  Wagenaar, 1993).
        patrons and against sales to            S/E-14. Increasing the minimum purchase
        minors is much more effective                   age for alcohol to age 21 is asso-
        than training alone in changing                 ciated with reductions in other
        selling and serving principles                  alcohol-related problems, includ-
        (Cummings & Coogan, 1992;                       ing suicide, pedestrian injuries,
        Feighery, Altman, & Saffer, 1991).              other unintentional injuries (Jones,
S/E-12. Increasing beverage servers’legal               Pieper, & Robertson, 1992), and
        liability for alcohol-related crashes           youth homicide (Parker &
        can reduce injuries and fatalities              Rebhun, 1995).
        (Wagenaar & Holder, 1991).              S/E-15. Limitations on the location and
S/E-13. Increasing the price of alcohol                 density of retail alcohol outlets
        and tobacco through excise taxes                may contribute to reductions in
        can be an effective strategy for
        reducing the prevalence of use
        and the amount consumed                  Neighborhood Antidrug Strategies
        (Chaloupka & Grossman, 1996;             Can Disrupt Illicit Drug Markets
        DHHS, 1989, 1992; Edwards et             and Reduce Alcohol and Tobacco
        al., 1994; Evans et al., 1996).          Sales to Minors
S/E-13. Price increases can reduce alco-
                                                     The Community Coalition for
        hol-related problems, including
                                                 Substance Abuse Prevention and
        motor vehicle fatalities (Cook,
                                                 Treatment in South Central Los
        1981), driving while intoxicated,
                                                 Angeles fought successfully to control
        rapes, robberies (Cook, 1981;
                                                 the rebuilding of liquor stores in neigh-
        Cook & Moore, 1993; Cook &
                                                 borhoods scarred by civil unrest. Its
        Tauchen, 1984), cirrhosis mortali-
                                                 Neighborhoods Fighting Back project
        ty (Cook & Tauchen, 1982), and
                                                 also forced absentee landlords to
        suicide and cancer death rates
                                                 board up an abandoned house used
        (Sloan, Reilly, & Schenzler, 1994).
                                                 for cocaine trafficking. Other partner-
S/E-14. Increasing the minimum purchase          ship efforts led to a new ordinance that
        age for alcohol to age 21 has            levies financial penalties on those sell-
        been effective in decreasing alco-       ing tobacco to underage youth (CSAP,
        hol use among youth (O’Malley &          2000).


18    Principles of Substance Abuse Prevention
alcohol consumption                            feedback to merchants can also
        (Gruenewald, 1993), traffic crash-             increase retailer compliance
        es (Gruenewald & Ponicki,                      (Biglan et al., 1995; Lewis,
        1995b; Scribner, MacKinnon, &                  Huebner, & Yarborough, 1996).
        Dwyer, 1995), and other alcohol-       S/E-19. More frequent enforcement opera-
        related problems, including cir-               tions can reduce retailer noncom-
        rhosis mortality (Gruenewald &                 pliance (Lewis et al., 1996;
        Ponicki, 1995a), suicide                       Preusser et al., 1994).
        (Gruenewald, Ponicki, & Mitchell,      S/E-20. “Use and lose” laws, which
        1995), and assaultive offenses                 allow suspension of the driver’s
        (Scribner et al., 1995).                       license of a person under age 21
S/E-16. Neighborhood antidrug strategies               following a conviction for any
        such as citizen surveillance and               alcohol or drug violation (e.g.,
        the use of civil remedies, particu-            use, possession, or attempt to pur-
        larly nuisance abatement pro-                  chase with or without false identi-
        grams, can be effective in                     fication), can increase compliance
        dispersing dealers, reducing the               with minimum purchase-age laws
        number and density of illicit drug             among youth (Preusser, Ulmer, &
        markets, and possibly reducing                 Preusser, 1992).
        other crimes and signs of physical     S/E-21. Deterrence laws and policies for
        disorder within small geographical             impaired driving can reduce the
        areas (Davis et al., 1991; Eck &               number of alcohol-related traffic
        Wartell, 1998; Green-Mazarolle,                crashes and fatalities among the
        Roehl, & Kadleck, in press;                    general population and particular-
        Lurigio et al., 1993; Rosenbaum &              ly among youth. Reducing the
        Lavrakas, 1993; Smith, Davis,                  legal blood-alcohol content (BAC)
        Hillenbrand, & Goretsky, 1992).                limit to 0.08 or lower can reduce
S/E-17. Enforcement of minimum pur-                    the level of impaired driving
        chase-age laws against selling                 (Kloeden & McLean, 1994) and
        alcohol and tobacco to minors by               alcohol-related crashes (Hingson,
        using undercover buying opera-                 Heeren, & Winter, 1994; Johnson,
        tions (also known as decoy or                  1995).
        sting operations) can substantially    S/E-22. Enforcement of impaired driving
        increase the proportion of retailers           laws can increase public percep-
        who comply with such laws                      tion of the risk of being caught
        (Cummings & Coogan, 1992;                      and punished for driving under
        Feighery et al., 1991; Forster et              the influence of alcohol (Voas,
        al., 1998; Jason, Billows, Schnop-             Holder, & Gruenewald, 1997).
        Wyatt, & King, 1996; Jason, Ji,
                                               S/E-23. Used alone, sobriety checkpoints
        Anes, & Birkhead, 1991; Preusser,
                                                       are not effective in detecting large
        Williams, & Weinstein, 1994).
                                                       numbers of drinking drivers
S/E-18. Undercover buying operations                   (Ferguson, Wells, & Lund, 1995;
        conducted by community groups                  Jones & Lund, 1985).
        that provide positive and negative

                                                                                        19
Guide to Science-Based Practices


S/E-23. Combining sobriety checkpoints                 Heeren, Howland, & Winter,
        with passive breath sensors that               1993; National Transportation
        allow police officers to test a dri-           Safety Board, 1993; Sweedler,
        ver’s breath without probable                  1990).
        cause can substantially increase
        the effectiveness of sobriety          Additional Resources
        checkpoints (Ferguson et al.,
                                               CSAP has developed a series of products
        1995; Jones & Lund, 1985).
                                               to assist program planners, evaluators,
S/E-24. Administrative license revocation      administrators, and policy makers in
        for impaired driving, which allows     designing and assessing scientifically
        an arresting officer to confiscate a   defensible programs. In addition to this
        driver’s license if the driver is      publication, Principles of Substance
        arrested with an illegal BAC or if     Abuse Prevention: A Domain-Based
        the driver refuses to be tested, can   Approach, products include the
        reduce the number of fatal traffic     following:
        crashes (Hingson, 1993; Klein,
                                               s   Defining Science-Based Substance
        1989; Ross & Gilliland, 1991;
                                                   Abuse Prevention: An Evaluators’
        Zador, Lund, Fields, & Weinberg,
                                                   Guide, a technical description of the
        1989) and also reduces recidivism
                                                   CSAP methodology for identifying sci-
        among driving-under-the-influ-
                                                   entifically defensible programs.
        ence (DUI) offenders (Stewart,
                                               s   Promising and Proven Substance Abuse
        Gruenewald, & Roth, 1989).
                                                   Prevention Programs, a comprehensive
S/E-25. Immobilizing or impounding the
                                                   compilation of both proven and promis-
        vehicles of those who have been
                                                   ing interventions in an easy-to-scan grid
        convicted of an impaired-driving
                                                   organized by risk factor and domain
        offense can significantly reduce
                                                   that also includes information on target
        DUI recidivism rates for multiple
                                                   age, Institute of Medicine (IOM) preven-
        DUI offenders (Voas, Tippetts, &
                                                   tion classification, program outcome,
        Taylor, 1997, 1998). Deterrence
                                                   and CSAP strategy.
        effects from marking license plates
                                                   CSAP also maintains a Web site and
        of DUI offenders have been mixed
                                               publishes materials to help prevention
        (Voas, Tippetts, & Lange, 1997).
                                               practitioners replicate proven model pro-
S/E-26. Impaired-driving policies targeting
                                               grams. The Web site includes download-
        underage drivers—particularly
                                               able versions of Promising and Proven
        zero-tolerance laws setting BAC
                                               Substance Abuse Prevention Programs,
        limits at 0.00 to 0.02 percent for
                                               one of the publications described above.
        youth and graduated driving privi-
                                               It also provides the most up-to-date infor-
        leges, in which a variety of dri-
                                               mation available about CSAP’s model
        ving restrictions are gradually
                                               programs for replication.
        lifted as the driver gains experi-
                                               s   The Web site for CSAP model pro-
        ence and maturity—can signifi-
                                                   grams is www.samhsa.gov/csap/model-
        cantly reduce traffic deaths among
                                                   programs.
        young people (Blomberg, 1993;
        Hingson et al., 1994; Hingson,

20    Principles of Substance Abuse Prevention
s   Brounstein & Zweig, 1999,                    Among the other resources available
    Understanding Substance Abuse             through the Clearinghouse to help pre-
    Prevention, Toward the 21st Century: A    vention practitioners in developing or
    Primer on Effective Programs. This        improving programs are:
    monograph, which traces the process       s   The Prevention Enhancement Protocols
    used to identify and evaluate the first       System (PEPS) guidelines on
    group of CSAP model programs, is              s   Reducing Tobacco Use Among
    available in both print and electronic            Youth: Community-Based
    versions. The electronic version is on            Approaches;
    the model programs Web site. The print
                                                  s   Preventing Substance Abuse Among
    version is available from the National
                                                      Children and Adolescents: Family-
    Clearinghouse for Alcohol and Drug
                                                      Centered Approaches;and
    Information (NCADI). See contact infor-
    mation below.                                 s   Preventing Problems Related to
                                                      Alcohol Availability: Environmental
s   CSAP (2000), Prevention Works
                                                      Approaches.
    Through Community Partnerships:
    Findings From SAMHSA/CSAP’s               s   Impaired Driving Among Youth: Trends
    National Evaluation, Rockville, MD:           and Tools for Prevention;
    CSAPDHHS Publication No. (SMA)00-         s   A Review of Alternative Activities and
    3373. This monograph, which presents          Alternative Programs in Youth-Oriented
    information on five model community           Prevention; and
    partnerships, is available from the       s   Selected Findings in Prevention: A
       SAMHSA’s National Clearinghouse            Decade of Results from the Center for
         for Alcohol and Drug Information         Substance Abuse Prevention.
       P.O. Box 2345
       Rockville, MD 20847-2345
       Toll-free tel: 1-800-729-6686
       Local tel: 301-468-2600
       Fax: 301-468-6433
       TDD (hearing impaired):
       1-800-487-4889
       www.health.org
       e-mail: info@health.org




                                                                                        21
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Ames, G. M., & Janes, C. R. (1987). Heavy       Blomberg, R. (1993). Lower BAC limits for
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  1988–89 through 1991–92. Alameda,                Botvin, E. M., & Diaz, T. (1995). Long-
  CA: Organizational Data.                         term followup results of a randomized
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  Abuse and Mental Health Services               indoor air laws and the demand for
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  tion: Lessons from experience.                 Community participation and sub-
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  Mental Health Services Administration.         concepts, and mechanisms. In
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  (1997b). Guidelines and benchmarks             vention (pp. 13–25). San Jose, CA:
  for prevention programming. Rockville,         County of Santa Clara Department of
  MD: Substance Abuse and Mental                 Health, Bureau of Drug Abuse Services,
  Health Services Administration.                Prevention Office.

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  (2000). Prevention works through com-          Robinson, J. W., Jr. (1989). Community
  munity partnerships: Findings from             development. In J. A. Christenson &
  SAMHSA/CSAP’s national evaluation              J. W. Robinson (Eds.), Community
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                                                 Inspector General.


                                                                                          25
CSA Principles of Prevention
CSA Principles of Prevention
CSA Principles of Prevention
CSA Principles of Prevention
CSA Principles of Prevention
CSA Principles of Prevention
CSA Principles of Prevention
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CSA Principles of Prevention

  • 1. 3 GUIDE TO SCIENCE-BASED PRACTICES Principles of Substance Abuse Prevention Substance Abuse and Mental Health Services Administration Center for Substance Abuse Prevention Division of Knowledge Development and Evaluation
  • 2. Acknowledgments This document was produced under the guidance of Stephen E. Gardner, D.S.W., pro- ject officer, and Paul J. Brounstein, Ph.D., Division of Knowledge Development and Evaluation, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Prevention (SAMHSA/CSAP), through contract #282-98-0023 to ROW Sciences, Inc., Carol Winner, project director. Principles of Substance Abuse Prevention is based on A Guide to Science-Based Practices in Substance Abuse Prevention, a seminal monograph developed and written by Paul J. Brounstein, Janine M. Zweig, and Stephen E. Gardner, with substantial contri- butions from Maria Carmona, Paul Florin, Roy Gabriel, and Kathy Stewart. Special thanks go to a dedicated review panel composed of Eric Einspruch, Roy Gabriel, and Katherine Laws, RMC Research Corporation; Carol Hays, Illinois State Incentive Grant Program; Patricia Post, Central Regional Center for the Application of Prevention Technologies; and Mary Joyce Prudden, CSAP, who offered invaluable sug- gestions for improving the document. The Department of Health and Human Services (DHHS) has reviewed and approved policy-related information in this document but has not verified the accuracy of data or analyses presented in the document. The opinions expressed herein are the views of the authors and do not necessarily reflect the official position of SAMHSA or DHHS. DHHS Publication No. (SMA)01-3507 Printed 2001 For single copies of this document, contact SAMHSA’s National Clearinghouse for Alcohol and Drug Information (NCADI), P.O. Box 2345, Rockville, MD 20847-2345; 1-800-729-6686, 301-468-2600, or TDD 1-800-487-4889; or visit the Web site at www.samhsa.gov. ii Principles of Substance Abuse Prevention
  • 3. Foreword Although recent reports show a leveling or decrease in substance use among our nation’s youth, drug abuse remains a problem in our country. There were 14.8 million current users of illicit drugs in 1999. This figure represents 6.7 percent of the population ages 12 years and older. The 1999 National Household Survey also found increases in illicit drug use among adults ages 18–25. Although the rates for those 26–34 years old and 35 years and older have not changed significantly since 1994, overall statistics indicate that there is still work to be done in preventing substance abuse. The Substance Abuse and Mental Health Services Administration’s (SAMHSA) Center for Substance Abuse Prevention (CSAP) developed this series of products in response to the ongoing substance abuse problems. The three components in this series support CSAP’s mission to provide resources that are based on science, with measurable out- comes, and designed to help community and state leaders formulate targeted programs. CSAP is committed to sponsoring, accumulating, and integrating knowledge regarding scientifically defensible and effective prevention practices. The primary foci of each doc- ument in this series is CSAP grantees, constituent organizations, and the communities these groups serve. We are pleased to release these findings on the risk factors for substance abuse in dif- ferent domains and successful intervention strategies to prevent substance abuse, delay its onset, and reduce substance abuse-related behaviors. These results show that sub- stance abuse develops in response to multiple influences, including the individual, fami- ly, peers, school/work, community, and society/environment. These domains interact with one another and change over time. The research confirms that there are a variety of proven approaches to substance abuse prevention. The strategies highlighted in this booklet range from personal skill- building and opportunities for family bonding to community awareness and youth-ori- ented mass media campaigns. These findings provide an empirical knowledge base for practitioners and a guide to State and Federal agencies, local governments, and private foundations in their efforts to fund programs with measurable outcomes. This booklet is one in a series of products developed to help key stakeholders struc- ture and assess scientifically defensible programs. It is designed to serve practitioners, researchers, and policymakers as we all work together to develop innovative and effec- tive methods of substance abuse prevention that respond to the unique needs of our individual communities. Joseph H. Autry III, M.D. Ruth Sanchez-Way, Ph.D. (Acting) Administrator Director Substance Abuse and Mental Health Center for Substance Abuse Prevention Services Administration Substance Abuse and Mental Health Services Administration iii
  • 4. Table of Contents Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ii Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .iii Principles of Substance Abuse Prevention . . . . . . . . . . . . . . . . . . . . . . . . .1 Principles of Effective Substance Abuse Prevention . . . . . . . . . . . . . .1 Why Use Scientifically Defensible Principles? . . . . . . . . . . . . . . . . .4 Why Use This Booklet? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 Prevention Interventions by Domain . . . . . . . . . . . . . . . . . . . . . . . .7 Additional Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23 v
  • 5. Principles of Substance Abuse Prevention For more than a decade, the Substance ples appearing in this document have Abuse and Mental Health Services been identified through expert or peer Administration’s Center for Substance consensus efforts such as consensus pan- Abuse Prevention (CSAP) has supported els and meta-analyses. Many have also demonstration programs designed to iden- been published in peer-reviewed journals. tify interventions that work with high-risk Appropriate use of these scientifically populations to prevent substance abuse, defensible principles can assist prevention delay its onset, and reduce substance providers in designing services that are abuse-related behaviors. Research now both innovative and effective, and in confirms that interventions aimed at modifying proven models to respond to reducing the risk factors and increasing the specialized needs of individual the protective factors linked to substance programs. abuse and related problem behavior can produce immediate and long-term posi- Principles of Effective tive results. Substance Abuse Prevention This section provides a brief listing of the Substance abuse prevention princi- scientifically defensible principles that ples are basic truths, standards, and can help service providers design and elements that effective interventions implement programs that work. The more have in common and that have been detailed descriptions of each principle identified through the careful evalua- within each domain are contained in the tion of substance abuse prevention text that follows. programs. However, principles derive from Individual Domain programs and must be viewed in this context. They are best used to modify I-1. Build social and personal skills. or adapt program core philosophy and I-2. Design culturally sensitive inter- content to specific situations or popu- ventions. lations. The preventionist who con- I-3. Cite immediate consequences. structs programs directly from I-4. Combine information dissemina- principles without an eye toward con- tion and media campaigns with tent may have little to show as a result. other interventions. I-5. Provide positive alternatives to Effective interventions share certain help youth in high-risk environ- principles that guide prevention providers ments develop personal and in structuring client services. The princi- social skills in a natural and effec- tive way. 1
  • 6. Guide to Science-Based Practices I-6. Recognize that relationships exist Peer Domain between substance use and a vari- P-1. Structure alternative activities and ety of other adolescent health supervise alternative events. problems. P-2. Incorporate social and personal I-7. Incorporate problem identification skills-building opportunities. and referral into prevention pro- grams. P-3. Design intensive alternative pro- grams that include a variety of I-8. Provide transportation to preven- approaches and a substantial time tion and treatment programs. commitment. Family Domain P-4. Communicate peer norms against use of alcohol and illicit drugs. F-1. Target the entire family. P-5. Involve youth in the development F-2. Help develop bonds among par- of alternative programs. ents in programs; provide meals, P-6. Involve youth in peer-led inter- transportation, and small gifts; ventions or interventions with sponsor family outings; and peer-led components. ensure cultural sensitivity. P-7. Counter the effects of deviant F-3. Help minority families respond to norms and behaviors by creating cultural and racial issues. an environment for youth with F-4. Develop parenting skills. behavior problems to interact with F-5. Emphasize family bonding. other nonproblematic youth. F-6. Offer sessions where parents and youth learn and practice skills. School Domain F-7. Train parents to both listen and S-1. Avoid relying solely on knowl- interact. edge-oriented interventions F-8. Train parents to use positive and designed to supply information consistent discipline techniques. about negative consequences. F-9. Promote new skills in family com- S-2. Correct misconceptions about the munication through interactive prevalence of use in conjunction techniques. with other educational approach- F-10. Employ strategies to overcome es. parental resistance to family-based S-3. Involve youth in peer-led inter- programs. ventions or interventions with F-11. Improve parenting skills and child peer-led components. behavior with intensive support. S-4. Give students opportunities to F-12. Improve family functioning practice newly acquired skills through family therapy when indi- through interactive approaches. cated. S-5. Help youth retain skills through F-13. Explore alternative community booster sessions. sponsors and sites for schools. S-6. Involve parents in school-based F-14. Videotape training and education. approaches. 2 Principles of Substance Abuse Prevention
  • 7. S-7. Communicate a commitment to C-15. Assess progress from an outcome- substance abuse prevention in based perspective and make school policies. adjustments to the plan of action to meet goals. Community Domain C-16. Involve paid coalition staff as C-1. Develop integrated, comprehen- resource providers and facilitators sive prevention strategies rather rather than as direct community than one-time community-based organizers. events. C-2. Control the environment around Society/Environmental Domain schools and other areas where S/E-1. Develop community awareness youth gather. and media efforts. C-3. Provide structured time with S/E-2. Use mass media appropriately. adults through mentoring. S/E-3. Set objectives for each media C-4. Increase positive attitudes through message delivered. community service. S/E-4. Avoid the use of authority figures. C-5. Achieve greater results with highly S/E-5. Broadcast messages frequently involved mentors. over an extended period of time. C-6. Emphasize the costs to employers S/E-6. Broadcast messages through mul- of workers’ substance use and tiple channels when the target abuse. audience is likely to be viewing or C-7. Communicate a clear company listening. policy on substance abuse. S/E-7. Disseminate information about the C-8. Include representatives from every hazards of a product or industry organization that plays a role in that promotes it. fulfilling coalition objectives. S/E-8. Promote placement of more con- C-9. Retain active coalition members spicuous labels. by providing meaningful rewards. S/E-9. Promote restrictions on tobacco C-10. Define specific goals and assign use in public places and private specific responsibility for their workplaces. achievement to subcommittees S/E-10. Support clean indoor air laws. and task forces. S/E-11. Combine beverage server training C-11. Ensure planning and clear under- with law enforcement. standing for coalition effective- S/E-12. Increase beverage servers’legal ness. liability. C-12. Set outcome-based objectives. S/E-13. Increase the price of alcohol and C-13. Support a large number of preven- tobacco through excise taxes. tion activities. S/E-14. Increase minimum purchase age C-14. Organize at the neighborhood for alcohol to 21. level. S/E-15. Limit the location and density of retail alcohol outlets. 3
  • 8. Guide to Science-Based Practices S/E-16. Employ neighborhood antidrug accountability and will simultaneously strategies. ensure that program participants receive S/E-17. Enforce minimum purchase age the most effective services available. laws using undercover buying operations. The Role of Domains S/E-18. Use community groups to provide Substance use is a complex problem that positive and negative feedback to develops in response to multiple influ- merchants. ences. These spheres of activity—typically S/E-19. Employ more frequent enforce- called domains—include the individual, ment operations. family, peers, school, community, and society/environment. S/E-20. Implement “use and lose” laws. Characteristics and conditions that S/E-21. Enact deterrence laws and poli- exist within each domain of activity also cies for impaired driving. function as risk or protective factors that S/E-22. Enforce impaired-driving laws. help propel individuals to or safeguard S/E-23. Combine sobriety checkpoints them from substance abuse. As such, with positive passive breath sen- each of these domains presents an oppor- sors. tunity for preventive action. S/E-24. Revoke licenses for impaired dri- Research indicates that as individuals ving. develop, their interactions within and S/E-25. Immobilize or impound the vehi- across domains of activity change over cles of those convicted of time. The Web of Influence model (figure impaired driving. 1) illustrates that these dynamic and complicated relationships can result not S/E-26. Target underage drivers with only in substance abuse, but also in other impaired-driving policies. problem behaviors such as violent crime and suicide. Why Use Scientifically Risk and protective factors are drawn Defensible Principles? from a large body of literature (Bry, 1983; Prevention programs today must produce Hansen, 1997; Hawkins, Catalano, & tangible results. State and federal agen- Miller, 1992; Newcomb & Felix-Ortiz, cies, local governments, and private foun- 1992; Reynolds, Stewart, & Fisher, 1997). dations are interested in funding programs As applied by CSAP and depicted in the with measurable outcomes. The new Web of Influence, risk and protective fac- emphasis on performance means that pre- tors function as an interactive model. A vention practitioners must show that the risk factor such as delinquency, for exam- programs they propose achieve the results ple, can also become an outcome if an predicted. The prevention field now has intervention aimed at preventing or an empirical knowledge base to assist changing the development of that behav- practitioners in selecting proven ior fails to achieve its objective. In the approaches for their programs. Using sci- same way, if an intervention succeeds in entifically defensible principles will help strengthening a protective factor such as practitioners respond to demands for 4 Principles of Substance Abuse Prevention
  • 9. Figure 1 Web of Influence Teen School Substance Teenage Violent Pregnancy Dropout Use Suicide Crime Individual Risk and Protective Factors Society/ Peer Environment* Family Community** School/Work Association Related Risk Risk and Risk and Risk and Risk and and Protective Protective Protective Protective Protective Factors Factors Factors Factors Factors *Society/Environment: Refers to the total complex of external social, cultural, and economic conditions affecting a community or an individual. **Community: Refers to the specific geographic location where an individual resides and to the conditions within that particular area. family bonding, improved family bonding Prevention education to teach partici- can become a positive outcome. pants important social skills such as drug resistance and decision making; Substance Abuse Prevention and Alternatives to offer opportunities for Treatment Block Grant Strategies participation in developmentally appro- In the Substance Abuse Prevention and priate drug-free activities to replace, Treatment (SAPT) block grant legislation, reduce, or eliminate involvement in sub- Congress defined six strategies that pre- stance use-related activities; vention programs can use to increase Problem identification and referral to protective factors and reduce the impact recognize individuals with suspected sub- of risk factors, as follows: stance use problems and refer them for Information dissemination to increase assessment and treatment; knowledge and change attitudes about Community-based processes to substance use and abuse through activi- expand community resources dedicated ties such as classroom discussions and to preventing substance use and abuse media campaigns. through activities such as building com- munity coalitions; and 5
  • 10. Guide to Science-Based Practices Environmental approaches to promote s Although this booklet groups principles policy changes that reduce risk factors by domain, planners and providers and preserve or increase protective factors should not feel constrained by this such as stepped-up enforcement of legal approach because many principles purchase age for alcohol and tobacco work well in more than one domain. products. s Principles identified in this booklet may To obtain funding from CSAP through not relate to substance abuse problems the SAPT block grant, States must identify directly. Instead, they may influence the the strategies that will be used in their risk and protective factors that con- proposed interventions. tribute to or guard against problems (Hansen, 1997; Reynolds et al., 1997). Why Use This Booklet? s Although CSAP recommends a compre- Principles of Substance Abuse Prevention hensive approach to substance abuse organizes scientifically defensible princi- prevention, increasing the number of ples by domain and links them to the pre- principles used in a program does not vention strategies identified in the SAPT necessarily increase its effectiveness. It block grant. Service providers can refer to is important to select scientifically it for ideas about what works, to identify defensible principles that best meet the proven principles in a particular domain, needs of program participants, support and to justify the use of one or more prin- program objectives, and complement ciples in a program. Because each princi- one another. ple is cited, it is relatively easy to locate s Likewise, while scientifically defensible the full article for more detailed informa- principles may improve some out- tion. Grant reviewers, evaluators, and fun- comes, they cannot compensate for or ders may also find Principles of Substance salvage a poorly designed or imple- Abuse Prevention useful as a quick mented program. overview of the state of the art in preven- s Combining a series of substance abuse tion programming and as a tool for deter- prevention principles does not neces- mining whether a program is using sarily make for an effective prevention scientifically defensible principles. program. Principles are best used to modify and enhance existing prevention Some Caveats programs and efforts, rather than create Before one begins to use the principles new programs from scratch. highlighted in this booklet, it is important s Successful, scientifically defensible to remember that: interventions rely on strong implemen- s This list is not exhaustive, and it will tation and continuous, rigorous evalua- grow as additional principles undergo tion to determine if benchmarks and evaluation. CSAP encourages program standards have been met and if desired planners and providers to build on the outcomes have been achieved. Such information in this booklet to develop implementation and evaluation are, in the foundation for new and innovative themselves, important for substantiating approaches to substance abuse the scientific defensibility of prevention prevention. principles (Morrissey et al., 1997; Reynolds et al., 1997). 6 Principles of Substance Abuse Prevention
  • 11. ties, influence attitudes, and pro- Prevention Interventions by mote behavior inconsistent with Domain use. These interventions usually include information about the Individual Domain negative effects of substance use Among the risk factors for substance (Bell, Ellickson, & Harrison, 1993; abuse in the individual domain are lack Botvin, Baker, Dusenbury, Botvin, of knowledge about the negative conse- & Diaz, 1995; Ellickson, Bell, & quences associated with using illegal sub- McGuigan, 1993; Hansen, 1996; stances, attitudes favorable toward use, Pentz et al., 1990; Schinke & early onset of use, biological or psycho- Cole, 1995; Tobler, 1986, 1992). logical dispositions, antisocial behavior, I-2. To be effective, interventions must sensation seeking, and lack of adult be culturally sensitive and consid- supervision (Bry, 1983; Hawkins et al., er race, ethnicity, age, and gender 1992; Scheier & Newcomb, 1991). Most in their designs (Botvin, Schinke, interventions aimed at the individual are Epstein, & Diaz, 1994; Center for designed to change knowledge about and Substance Abuse Prevention attitudes toward substance abuse with the (CSAP), 1996). ultimate goal of influencing behavior. I-3. Youth tend to be more concerned about social acceptance and the Linking Skills Development with immediate rather than long-term Information effects of particular behaviors. Life Skills Training (LST) Program Citing consequences such as demonstrates that linking key skills stained teeth and bad breath has development with information target- more impact than threats of lung ing social influences to use, and rein- cancer, which usually develops forcing these strategies with booster later in life (Flay & Sobel, 1993; sessions, can produce durable reduc- Flynn et al., 1997; Paglia & tions in use. Room, 1998). I-4. Used alone, information dissemi- Research shows that whether pro- nation and media campaigns do vided by trained teachers, health pro- not play a major part in influenc- fessionals, or peer leaders, research ing individual knowledge, atti- shows that LST can lower levels of tudes, and beliefs, but they can be tobacco, alcohol, and marijuana use effective when combined with among white, African American, and other interventions (Flynn et al., Hispanic/Latino youth by 59 to 75 per- 1992, 1997; Flynn, Worden, cent and reduce multidrug use by as Secker-Walker, Badger, & Geller, much as 66 percent (Botvin et al., 1995). 1994, 1995). I-5. Alternatives such as organized sports, involvement in the arts, Research has shown the following: and community service provide a I-1. Social and personal skills-building natural and effective way of can enhance individual capaci- reaching youth in high-risk envi- 7
  • 12. Guide to Science-Based Practices ronments who are not in school and who lack both adequate adult Use of Incentives To Promote supervision and access to positive Program Participation activities. Positive alternatives can help youth develop personal and The Strengthening Families social skills inconsistent with sub- Program, aimed at 6- to 10-year-old stance use (CSAP, 1996; Tobler, children of substance abusers and their 1986). parents, used incentives such as movie/sporting event tickets and I-6. Effective programs recognize that vouchers for groceries and other relationships exist between sub- household items as well as transporta- stance use and a variety of other tion to engage and retain parents in the adolescent health problems—such program. This approach spans cultures as mental disorders, family prob- and has been successfully adapted for lems, pregnancy, sexually trans- and evaluated with Hispanic/Latino, mitted diseases, school failure, Asian/Pacific Islander, African and delinquency—and include American, and white families (Kumpfer services designed to address them & Alvarado, 1995; Kumpfer, Molgaard, (Compas, Hinden, & Gerhardt, & Spoth, 1996; Kumpfer, Williams, & 1995). Baxley, 1997). I-7. Incorporating problem identifica- tion and referral into prevention ture can also be a serious risk factor programs helps to ensure that par- (Szapocznik et al., 1997). Research has ticipants who are already using shown the following: drugs will receive treatment F-1. Interventions targeting the entire (Brounstein & Zweig, 1996; family—parents as well as chil- Johnson et al., 1996). dren—can be effective in prevent- I-8. Providing transportation to treat- ing adolescent substance use ment programs can encourage (Dent et al., 1995; Dishion, youth participation (Brounstein & Andrews, Kavanagh, & Soberman, Zweig, 1996). 1996; Hawkins et al., 1992; Kumpfer et al., 1996; Pentz et al., Family Domain 1989; Walter, Vaughn, & Wynder, Family domain risk factors include 1989). parental and sibling drug use or approval F-2. Retaining parents in family-based of use, inconsistent or poor family man- programs can also be difficult agement practices—including lack of (Botvin et al., 1995; Dent et al., supervision, lack of parental involvement 1995). Helping to develop bonds in children’s lives, family conflict, sexual among parents in a program or physical abuse, economic instability, (Cohen & Linton, 1995; Creating and lack of attachment to parents, often Lasting Family Connections, 1998; called low family bonding (Hawkins & Resnik & Wojcicki, 1991); provid- Catalano, 1992). For immigrant families, ing meals, transportation, and problems adapting to the mainstream cul- small gifts; sponsoring family out- 8 Principles of Substance Abuse Prevention
  • 13. ings; and ensuring that programs are culturally sensitive can help to Interactive Techniques Help improve retention (Kumpfer & Promote Family Communication Alvarado, 1995). Creating Lasting Connections’ F-3. Interventions that help minority Getting Real training for parents, families respond to cultural and youth, and families emphasizes role- racial issues can produce positive playing to help participants identify the effects. Issues include the role of responses they use most in talking with the extended family, influence of family members, improve their ability immigration or circular migration, to express feelings and ideas clearly, different language abilities within and establish new patterns of interac- families, influence of religion and tions to enrich family relationships. folk healers, influence of volun- Because adults and children respond tary and social organizations, and differently to interactive techniques stresses experienced by families as such as role-play, the program trains a result of socioeconomic status parents and youth separately. It is also and racism (Kumpfer & Alvarado, careful to limit the age range with 1995; Kumpfer et al., 1997; youth to a three-year span (e.g., ages 9 Szapocznik et al., 1997). to 11) and frequently separates groups s Family strategies that are effective by gender. Careful implementation include the following: ensures that activities occur in a safe F-4. Focus on developing parenting place, a condition important for suc- skills rather than simply offering cessful interactive interventions information about parenting (Bry (Brounstein & Zweig, 1996; Creating & Canby, 1986; Kumpfer et al., Lasting Family Connections, 1998; 1996; Szapocznik et al., 1988). Johnson et al., 1996). F-5. Emphasize family bonding F-8. Train parents to use positive and through opportunities for joint consistent discipline techniques parent-child participation in and to monitor and supervise their activities (Dishion & McMahon, children (DeMarsh & Kumpfer, 1998; Szapocznik et al., 1988). 1986). F-6. Offer sessions in which parents F-9. Interactive techniques, including and youth learn and practice modeling, coaching, rehearsal, skills both separately and togeth- and role-playing, can help to pro- er (Brounstein et al., 1996; mote the development of new DeMarsh & Kumpfer, 1986; skills in programs aimed at Dishion & McMahon, 1998; improving family communication Kumpfer & Baxley, 1997). (Dishion & McMahon, 1998; F-7. Train parents to both listen and Patterson & Chamberlain, 1994; interact in developmentally Szapocznik et al., 1988; Webster- appropriate ways with their chil- Stratton & Herbert, 1993). dren (Brounstein & Zweig, 1996; Kumpfer et al., 1997). 9
  • 14. Guide to Science-Based Practices F-10. Recruiting parents for family- Peer Domain based prevention programs can be The principal risk factors associated with difficult. Incentives that can help the peer domain are peer use, peer norms overcome resistance include pro- favorable toward use, and peer activities viding transportation and child conducive to use. Research has shown care, offering rewards for partici- the following: pation such as cash payments, P-1. Structured alternative activities and scheduling programs at times and supervised alternative events most convenient for parents (e.g., sober prom and graduation (Kumpfer & Alvarado, 1995). parties) can offer peers an oppor- F-11. With intensive support (at least 12 tunity for social interaction in set- to 15 sessions of counseling and tings antithetical to substance use skills-building), substance-abusing (CSAP, 1996; Williams & Perry, parents can improve their parent- 1998). ing skills and as a result improve P-2. Alternative activities that incorpo- their children’s behavior and rate social and personal skills- reduce both their own and their building opportunities can be children’s levels of substance use effective with youth in high-risk (Bry, 1994; Kumpfer et al., 1996; environments who may not have Olds, 1997). adequate adult supervision or F-12. For families of juvenile offenders, access to a variety of activities, or family therapy can improve family who may have few opportunities functioning, increase family skills, to develop the kinds of personal and reduce recidivism (DeMarsh skills needed to avoid behavioral & Kumpfer, 1986; Kumpfer et al., problems (Tobler, 1986). 1996). P-3. Effective alternative programs tend F-13. Since schools in some communi- to be intensive and include both a ties may not be highly regarded or variety of approaches and a sub- accessible during nonschool stantial commitment of time on hours, exploring alternative com- the part of their participants munity sponsors and sites such as (Schaps, DiBartolo, Moskowitz, churches and community recre- Palley, & Churgin, 1981; Shaw, ation centers can enhance partici- Rosati, Salzman, Coles, & pation in family-focused McGeary, 1997; Tobler, 1986). interventions (Johnson et al., P-4. Alternative events can communi- 1996; Kumpfer et al., 1996). cate peer norms against use of F-14. Videotaped training and education alcohol and illicit drugs and can can be an effective and cost-effi- serve as community statements in cient tool to teach parenting skills support of no-use norms (CSAP, (Webster-Stratton, 1990; Webster- 1996; Rohrbach, Johnson, Stratton & Herbert, 1993). Mansergh, Fishkin, & Neumann, 1997). 10 Principles of Substance Abuse Prevention
  • 15. school climate, and lenient school poli- Exercise Caution When Grouping cies with regard to the use of some sub- Very High-Risk Youth stances (e.g., tobacco). Many researchers believe that student-based risk factors Experience with the peer compo- develop or become more pronounced nent of the highly regarded Adolescent when students are unable to experience Transitions Program (ATP) suggests some satisfaction from their academic some caution in applying peer-oriented efforts. For this reason, academic skills- principles. ATP found that when very building has become an important com- high-risk youth are grouped together, ponent of many after-school, alternative even for a supervised intervention, a activities (CSAP, 1996; LoSciuto, Rajala, contagion effect can occur and prob- Townsend, & Taylor, 1996; Tierney, lem behaviors can increase. More Grossman, & Resch, 1995). In much the mixed or heterogeneous environments same way, lack of attachment to school may be needed to counter the impact may relate to students’inability to set of deviant norms and behavior future-oriented goals, particularly those (Dishion et al., 1996; Dishion & that depend on education for their McMahon, 1998). achievement. Mentoring programs have P-5. Involving youth in the develop- been designed, in part, to respond to that ment of alternative programs can problem (CSAP, 1996; LoSciuto et al., increase the appeal of the activi- 1996). ties offered and enhance partici- School climate is another factor con- pation (Armstrong, 1992; Komro tributing to the lack of attachment to et al., 1996). school. Together, teachers’ instructional methods, classroom management tech- P-6. Peer-led interventions or interven- niques, class size, student-teacher ratios, tions with peer-led components classroom organization, and educators’ can be more effective than adult- attitudes toward students affect the cli- led approaches (Komro et al., mate in a particular school (Battistich, 1996; Tobler, 1986, 1992). Schaps, Watson, & Solomon, 1996; Felner P-7. Placing peers whose behavior is et al., 1993; Flay, 1987). Drug testing and deviant into the same group can the use of drug-sniffing dogs are other be problematic. More heteroge- practices employed by some schools. neous environments may be need- However, those approaches have not yet ed to counter the effects of been extensively evaluated to determine deviant norms and behavior effectiveness in countering risk factors or (Dishion et al., 1996; Dishion & reducing levels of substance use at school McMahon, 1998). (Paglia & Room, 1998). Research has found the following: School Domain S-1. When used alone, knowledge-ori- The risk factors associated with the school ented interventions designed to domain include lack of commitment to supply information about the neg- education, poor grades or school failure, ative consequences of substance lack of attachment to school, negative use do not produce measurable 11
  • 16. Guide to Science-Based Practices and long-lasting changes in sub- S-4. Interactive approaches, such as stance use-related behavior or cooperative learning, role-plays, attitudes and are considered and group exercises that give stu- among the least effective educa- dents opportunities to practice tional strategies (Tobler, 1986). newly acquired skills (and that are S-2. While interventions to correct characteristic of social skills and misconceptions about the preva- peer-led interventions), help to lence of use can change attitudes engage and retain youth in pre- favorable toward use (Errecart et vention education programs al., 1991; Hansen & Graham, (Botvin et al., 1994, 1995; 1991), they are most effective in Brounstein & Zweig, 1996; Komro reducing substance use when et al., 1996; Walter et al., 1989; combined with other educational Williams & Perry, 1998). approaches such as fostering S-5. Booster sessions help youth retain social skills (Shope, Kloska, skills learned in prevention educa- Dielman, & Maharg, 1994). tion programs over time (Botvin et S-3. Interventions for youth that are al., 1994, 1995). peer led or include peer-led com- S-6. School-based approaches that also ponents are more effective than involve parents can be effective in adult- or teacher-led approaches preventing adolescent substance (St. Pierre, Kaltreider, Mark, & use (Dent et al., 1995; Dishion et Aitkin, 1992; Tobler, 1986, 1992). al., 1996; Kumpfer et al., 1996; Pentz et al., 1989; Walter et al., 1989). Involving Parents in School-Based Programs Fosters Effectiveness S-7. School policies that communicate a commitment to substance abuse The Child Development Project’ s prevention include formal no-use Homeside Activities give parents a policies for students, teachers, window into what their children are administrators, and other staff; learning in school. This innovative training for teachers and adminis- intervention introduces activities in the trators; and a health education classroom that students complete at program based on validated prin- home with parents and then incorpo- ciples (Paglia & Room, 1998). rate into a follow-up classroom activity or discussion. Parents are also con- Community Domain nected to the school through Family Community domain risk factors include Read-Aloud and other activities lack of bonding or attachment to social designed to create an inclusive school and community institutions, lack of com- environment that, in turn, helps to pre- munity awareness or acknowledgment of vent or delay substance abuse and oth- substance use problems, community er problem behaviors (e.g., involvement norms favorable to use and tolerant of in gangs, carrying weapons) among abuse, insufficient community resources young people (Battistich et al., 1996). to support prevention efforts, and inability 12 Principles of Substance Abuse Prevention
  • 17. to address the problem of substance Skogan, 1991; Eck & Wartell, in abuse. Community institutions such as press; Gruenewald, Ponicki, & churches, Boys and Girls Clubs, YMCA Holder, 1993). and YWCA, and Boy and Girl Scouts C-3. Mentoring programs that provide often provide individuals with opportuni- structured time with adults can ties to develop personal capacities and increase school attendance and interact with prosocial peers in construc- positive attitudes toward others, tive endeavors (Brounstein & Zweig, the future, and school and can 1996; CSAP, 1996; St. Pierre et al., 1992; reduce substance use (Brounstein Tierney et al., 1995). Workplaces within & Zweig, 1996; CSAP, 1996; the community, media, and community LoSciuto et al., 1996). coalitions are other vehicles for address- C-4. Community service can increase ing and reducing community domain risk positive attitudes toward others, factors. Specifically, research has found the future, and the community the following: and can provide youth with C-1. One-time community-based sub- opportunities to give back to their stance abuse prevention and edu- community (Brounstein et al., cation events alone are unlikely to 1996; CSAP, 1996; LoSciuto et al., affect participants’behavior, but 1996). they can be effective as part of an C-5. Highly involved mentors usually integrated, comprehensive pre- achieve greater positive results vention strategy. In that context, than those who are less commit- such events show that a commu- ted (Brounstein et al., 1996; nity supports no-use norms, draw LoSciuto et al., 1996). public and media attention to sub- C-6. Emphasizing the costs to employ- stance use issues, and help ers of workers’substance use and increase awareness and support abuse can encourage companies for other important prevention to become more active in preven- efforts (Paglia & Room, 1998; tion efforts. Costs include lost pro- CSAP, 1996). ductivity and increased health C-2. Controlling the environment care premiums to cover sub- around schools and other areas stance-abusing employees and where youth gather helps to rein- their dependents (Cook, Back, & force strong community norms Trudeau, 1996; Frankish, Johnson, against substance use. Controls Ratner, & Lovato, 1997). include restrictions on the number C7. Communicating a clear company of alcohol and tobacco outlets, policy on substance abuse can required setbacks for alcohol and help change workplace norms tobacco outlets, restrictions on about substance use and abuse advertising near schools including (Ames & Janes, 1987; Cook et al., billboards, and the designation of 1996). drug-free zones that set standards for adult as well as youth behav- ior (Davis, Smith, Lurigio, & 13
  • 18. Guide to Science-Based Practices C-8. Community coalitions that work Mentoring Can Increase Positive include representatives from every Attitudes and Reduce Substance organization that plays a role in Use fulfilling coalition objectives. For example, if comprehensive service Across Ages: An Intergenerational coordination is the objective, Approach to Drug Prevention careful- community agency leadership ly matches adult mentors, ages 55 and needs to be involved (Christenson, over, to sixth-grade African American, Fendley, & Robinson, 1989; Asian, Latino, and white students in Edelman & Springer, 1995; three Philadelphia middle schools. Warren, Rodgers, & Evers, 1975). Recognizing the importance of conti- If the objective is raising commu- nuity, Across Ages encouraged mentor- nity awareness and stimulating ing relationships that encompassed community action, grassroots parents and teachers as well as stu- activists and community citizens dents and extended past the school must be involved (Chavis & year and throughout the summer. Florin, 1990; CSAP, 1997a, Across Ages’ multidimensional 1997b; Warren et al., 1975). approach to mentoring brought com- Community linkage coalition munity residents into the schools and models require a mix of both improved school attendance. Students types of community members with deeply committed mentors (CSAP, 1997b). changed their attitudes toward older C-9. Effective coalitions retain active people, school, and the future and members by providing meaningful developed increased capacity to resist rewards for participation such as peer pressure to use drugs (Brounstein opportunities for organizational & Zweig, 1996; CSAP, 1996; Johnson leadership, distribution of et al., 1996; LoSciuto et al., 1996). resources to home agencies, and accomplishment of highly valued personal, organizational, and community goals (Join Together, 1996; Nistler, 1996). C-10. Effective coalitions define specific goals and assign specific responsi- bility for their achievement to sub- committees and task forces, rather than spending time on elaborating organizational structures and pro- cedures (Christenson, 1989; Join Together, 1996; Rohrbach et al., 1997). C-11. Planning is critical to coalition effectiveness and begins with a clear understanding, drawn from 14 Principles of Substance Abuse Prevention
  • 19. validated empirical evidence, of based perspective and make the substance-related problems it adjustments to the plan of action seeks to change (Armstrong, 1992; to meet their goals. Success is a Gabriel, 1997; Join Together, function of strategies and activi- 1996; Reynolds & Fisher, 1997). ties, not a reflection of a coali- C-12. Effective coalitions set outcome- tion’s organizational structure or based objectives that are used to design (CSAP, 1997b, 2000; develop specific strategies and Forster et al., 1992; Gabriel, subsequent activities (Forster, 1997; Join Together, 1996; Keay, Hourigan, & McGovern, 1992; Woodruff, Wildey, & Kenney, Join Together, 1996; Reynolds, 1993). Stewart, & Fisher, 1997). C-16. Paid coalition staff can function C-13. Effective coalitions support a large more effectively as resource number of prevention activities, providers (such as communica- rather than focusing on a single tions, coordination, and adminis- project (CSAP, 2000). trative expertise) and facilitators C-14. Residents are more likely to par- than as direct community organiz- ticipate in community partnership ers (Join Together, 1996). It is activities if they are organized at important for paid staff members the neighborhood level, where to serve as catalysts for action and volunteers can see how they will ensure that community partici- affect their own situations (CSAP, pants receive credit for program 2000). success (CSAP, 2000). C-15. Effective coalitions routinely assess progress from an outcome- Society/Environmental Domain Risk factors in the society/environmental domain include norms tolerant of use and Planning Is Essential to Coalition abuse, policies enabling use and abuse, Effectiveness lack of enforcement of laws designed to prevent use and abuse, and inappropriate The Day One Community negative sanctions for use and abuse. Partnership devised the Alcohol Since long-lasting effects should Sensitive Information Planning System accrue from changing school, family, and (ASIPS) to assess the extent to which societal norms that promote and maintain local criminal activity was alcohol drug abuse in youth, many prevention related and to provide a foundation for specialists are trying to incorporate a community planning activities. As one focus on both individual change and outgrowth of this assessment effort, changes in the systems or environmental Day One was able to marshal the data contexts that promote or hinder use. This needed to convince the city to use city expansion will have a positive impact on zoning to regulate retail availability of larger numbers of people than has our alcohol and tobacco and to conduct a reliance on more individually targeted decoy purchase program (Rohrbach et programs that focus more on persons with al., 1997). a greater likelihood of becoming problem 15
  • 20. Guide to Science-Based Practices Figure 2 Program Targets and Potential Impacts abusers. The impact of this environmental also recognize that audience per- focus on society as a whole may be sub- ceptions and capacities to under- stantial, and societal/environmental sys- stand media messages may vary tems change efforts may form an based on gender, culture, and important first line of defense in fighting stage of cognitive development the spread of substance abuse. (Figure 2) (Flynn et al., 1992, 1997). Research has found the following: S/E-3. Effective mass media campaigns S/E-1. Community awareness and media set objectives for each message efforts can be effective tools for delivered; for example, to increasing perceptions regarding increase positive expectations for the likelihood of apprehension nonuse or to correct assumptions and punishment for substance- about the number of youth who related violations and can reduce use (Flynn et al., 1997). retailer noncompliance (Lewit, S/E-4. Youth-oriented mass media cam- Coate, & Grossman, 1981; paigns that are effective with Schneider, Klein, & Murphy, youth in high-risk environments 1981). avoid the use of authority figures. S/E-2. Appropriate use of mass media Instead, they use young models can enhance community aware- who appeal to the target group ness and influence community (Flynn et al., 1992). norms about substance use (Paglia S/E-5. Effective campaigns broadcast & Room, 1998). Effective, youth- messages frequently over an oriented mass media campaigns extended period of time. For identify target audiences. They example, an effective media cam- 16 Principles of Substance Abuse Prevention
  • 21. Grossman, 1996; Flynn et al., Changing the Community 1992; Wallack & DeJong, 1995). Environment Can Reduce S/E-8. The limited research on alcohol Underage Use of Alcohol warning labels suggests that while they may affect awareness, atti- Responsible beverage-server train- tudes, and intentions regarding ing for retail outlets and bars and com- drinking, they do not appear to pliance checks of age-of-purchase laws have a major influence on behav- (coordinated with local police depart- ior (Barlow & Wogalter, 1993; ments and sheriffs’offices) were among Hilton, 1993; Laughery, Young, the many integrated components of Vaubel, & Brelsford, 1993). Project Northland, the largest random- Studies have suggested that more ized community trial ever conducted conspicuous labels would have a for the prevention of adolescent alco- greater effect on awareness and hol use. Project Northland confirms the behavior (Laughery et al., 1993; importance of applying long-term envi- Malouff, Schutte, Wiener, ronmental interventions as well as Brancazio, & Fish, 1993). interventions oriented to individuals to reduce underage alcohol use. It also S/E-9. Restrictions on tobacco use in showed that it is possible to mobilize public places and private work- community support for norms reinforc- places (also known as clean ing the unacceptability of underage use indoor air laws) can be effective (Williams & Perry, 1998). in curtailing cigarette sales (Chaloupka & Saffer, 1992) and paign in Vermont aired 540 televi- tobacco use among adults and sion broadcasts of 36 different youth (Chaloupka, 1992; spots and 350 radio broadcasts of Chaloupka & Pacula, 1997; 17 different spots per year over Evans, Farrelly, & Montgomery, four years (Flynn et al., 1997). 1996; Ohsfeldt, Boyle, & Capilouto, 1999; Wasserman, S/E-6. Mass media messages that are Manning, Newhouse, & Winkler, effective are broadcast through 1991). multiple channels at times when members of the target audience S/E-10. Clean indoor air laws can reduce are likely to be viewing or listen- nonsmokers’exposure to cigarette ing (Flynn et al., 1992, 1997). smoke and help to alter norms regarding the social acceptability S/E-7. Counteradvertising campaigns that of smoking (DHHS, 1994). disseminate information about the hazards of a product or the indus- S/E-11. Education and training programs try that promotes it may help teach beverage servers about reduce cigarette sales (Chaloupka alcohol-related laws, the penalties & Grossman, 1996; Flay, 1987; for violation, the signs of intoxica- Flynn et al., 1992) and tobacco tion and false identification, and consumption (Chaloupka & techniques for refusing sales. However, when used alone, these programs usually do not produce 17
  • 22. Guide to Science-Based Practices substantial and sustained shifts Wagenaar, 1991; Wagenaar, toward compliance with the law 1993), particularly beer consump- (Altman, Rasenick-Douss, Foster, tion (Berger & Snortum, 1985), & Tye, 1991; DiFranza & Brown, and in reducing alcohol-related 1992; DiFranza, Savageau, & traffic crashes (General Aisquith, 1996; Skretny, Accounting Office, 1987; Cummings, Sciandra, & Marshall, National Highway Traffic Safety 1990). Administration, 1995; Safer & S/E-11. Combining beverage-server train- Grossman, 1987; Toomey, ing with enforcement of laws Rosenfeld, & Wagenaar, 1996; against service to intoxicated Wagenaar, 1993). patrons and against sales to S/E-14. Increasing the minimum purchase minors is much more effective age for alcohol to age 21 is asso- than training alone in changing ciated with reductions in other selling and serving principles alcohol-related problems, includ- (Cummings & Coogan, 1992; ing suicide, pedestrian injuries, Feighery, Altman, & Saffer, 1991). other unintentional injuries (Jones, S/E-12. Increasing beverage servers’legal Pieper, & Robertson, 1992), and liability for alcohol-related crashes youth homicide (Parker & can reduce injuries and fatalities Rebhun, 1995). (Wagenaar & Holder, 1991). S/E-15. Limitations on the location and S/E-13. Increasing the price of alcohol density of retail alcohol outlets and tobacco through excise taxes may contribute to reductions in can be an effective strategy for reducing the prevalence of use and the amount consumed Neighborhood Antidrug Strategies (Chaloupka & Grossman, 1996; Can Disrupt Illicit Drug Markets DHHS, 1989, 1992; Edwards et and Reduce Alcohol and Tobacco al., 1994; Evans et al., 1996). Sales to Minors S/E-13. Price increases can reduce alco- The Community Coalition for hol-related problems, including Substance Abuse Prevention and motor vehicle fatalities (Cook, Treatment in South Central Los 1981), driving while intoxicated, Angeles fought successfully to control rapes, robberies (Cook, 1981; the rebuilding of liquor stores in neigh- Cook & Moore, 1993; Cook & borhoods scarred by civil unrest. Its Tauchen, 1984), cirrhosis mortali- Neighborhoods Fighting Back project ty (Cook & Tauchen, 1982), and also forced absentee landlords to suicide and cancer death rates board up an abandoned house used (Sloan, Reilly, & Schenzler, 1994). for cocaine trafficking. Other partner- S/E-14. Increasing the minimum purchase ship efforts led to a new ordinance that age for alcohol to age 21 has levies financial penalties on those sell- been effective in decreasing alco- ing tobacco to underage youth (CSAP, hol use among youth (O’Malley & 2000). 18 Principles of Substance Abuse Prevention
  • 23. alcohol consumption feedback to merchants can also (Gruenewald, 1993), traffic crash- increase retailer compliance es (Gruenewald & Ponicki, (Biglan et al., 1995; Lewis, 1995b; Scribner, MacKinnon, & Huebner, & Yarborough, 1996). Dwyer, 1995), and other alcohol- S/E-19. More frequent enforcement opera- related problems, including cir- tions can reduce retailer noncom- rhosis mortality (Gruenewald & pliance (Lewis et al., 1996; Ponicki, 1995a), suicide Preusser et al., 1994). (Gruenewald, Ponicki, & Mitchell, S/E-20. “Use and lose” laws, which 1995), and assaultive offenses allow suspension of the driver’s (Scribner et al., 1995). license of a person under age 21 S/E-16. Neighborhood antidrug strategies following a conviction for any such as citizen surveillance and alcohol or drug violation (e.g., the use of civil remedies, particu- use, possession, or attempt to pur- larly nuisance abatement pro- chase with or without false identi- grams, can be effective in fication), can increase compliance dispersing dealers, reducing the with minimum purchase-age laws number and density of illicit drug among youth (Preusser, Ulmer, & markets, and possibly reducing Preusser, 1992). other crimes and signs of physical S/E-21. Deterrence laws and policies for disorder within small geographical impaired driving can reduce the areas (Davis et al., 1991; Eck & number of alcohol-related traffic Wartell, 1998; Green-Mazarolle, crashes and fatalities among the Roehl, & Kadleck, in press; general population and particular- Lurigio et al., 1993; Rosenbaum & ly among youth. Reducing the Lavrakas, 1993; Smith, Davis, legal blood-alcohol content (BAC) Hillenbrand, & Goretsky, 1992). limit to 0.08 or lower can reduce S/E-17. Enforcement of minimum pur- the level of impaired driving chase-age laws against selling (Kloeden & McLean, 1994) and alcohol and tobacco to minors by alcohol-related crashes (Hingson, using undercover buying opera- Heeren, & Winter, 1994; Johnson, tions (also known as decoy or 1995). sting operations) can substantially S/E-22. Enforcement of impaired driving increase the proportion of retailers laws can increase public percep- who comply with such laws tion of the risk of being caught (Cummings & Coogan, 1992; and punished for driving under Feighery et al., 1991; Forster et the influence of alcohol (Voas, al., 1998; Jason, Billows, Schnop- Holder, & Gruenewald, 1997). Wyatt, & King, 1996; Jason, Ji, S/E-23. Used alone, sobriety checkpoints Anes, & Birkhead, 1991; Preusser, are not effective in detecting large Williams, & Weinstein, 1994). numbers of drinking drivers S/E-18. Undercover buying operations (Ferguson, Wells, & Lund, 1995; conducted by community groups Jones & Lund, 1985). that provide positive and negative 19
  • 24. Guide to Science-Based Practices S/E-23. Combining sobriety checkpoints Heeren, Howland, & Winter, with passive breath sensors that 1993; National Transportation allow police officers to test a dri- Safety Board, 1993; Sweedler, ver’s breath without probable 1990). cause can substantially increase the effectiveness of sobriety Additional Resources checkpoints (Ferguson et al., CSAP has developed a series of products 1995; Jones & Lund, 1985). to assist program planners, evaluators, S/E-24. Administrative license revocation administrators, and policy makers in for impaired driving, which allows designing and assessing scientifically an arresting officer to confiscate a defensible programs. In addition to this driver’s license if the driver is publication, Principles of Substance arrested with an illegal BAC or if Abuse Prevention: A Domain-Based the driver refuses to be tested, can Approach, products include the reduce the number of fatal traffic following: crashes (Hingson, 1993; Klein, s Defining Science-Based Substance 1989; Ross & Gilliland, 1991; Abuse Prevention: An Evaluators’ Zador, Lund, Fields, & Weinberg, Guide, a technical description of the 1989) and also reduces recidivism CSAP methodology for identifying sci- among driving-under-the-influ- entifically defensible programs. ence (DUI) offenders (Stewart, s Promising and Proven Substance Abuse Gruenewald, & Roth, 1989). Prevention Programs, a comprehensive S/E-25. Immobilizing or impounding the compilation of both proven and promis- vehicles of those who have been ing interventions in an easy-to-scan grid convicted of an impaired-driving organized by risk factor and domain offense can significantly reduce that also includes information on target DUI recidivism rates for multiple age, Institute of Medicine (IOM) preven- DUI offenders (Voas, Tippetts, & tion classification, program outcome, Taylor, 1997, 1998). Deterrence and CSAP strategy. effects from marking license plates CSAP also maintains a Web site and of DUI offenders have been mixed publishes materials to help prevention (Voas, Tippetts, & Lange, 1997). practitioners replicate proven model pro- S/E-26. Impaired-driving policies targeting grams. The Web site includes download- underage drivers—particularly able versions of Promising and Proven zero-tolerance laws setting BAC Substance Abuse Prevention Programs, limits at 0.00 to 0.02 percent for one of the publications described above. youth and graduated driving privi- It also provides the most up-to-date infor- leges, in which a variety of dri- mation available about CSAP’s model ving restrictions are gradually programs for replication. lifted as the driver gains experi- s The Web site for CSAP model pro- ence and maturity—can signifi- grams is www.samhsa.gov/csap/model- cantly reduce traffic deaths among programs. young people (Blomberg, 1993; Hingson et al., 1994; Hingson, 20 Principles of Substance Abuse Prevention
  • 25. s Brounstein & Zweig, 1999, Among the other resources available Understanding Substance Abuse through the Clearinghouse to help pre- Prevention, Toward the 21st Century: A vention practitioners in developing or Primer on Effective Programs. This improving programs are: monograph, which traces the process s The Prevention Enhancement Protocols used to identify and evaluate the first System (PEPS) guidelines on group of CSAP model programs, is s Reducing Tobacco Use Among available in both print and electronic Youth: Community-Based versions. The electronic version is on Approaches; the model programs Web site. The print s Preventing Substance Abuse Among version is available from the National Children and Adolescents: Family- Clearinghouse for Alcohol and Drug Centered Approaches;and Information (NCADI). See contact infor- mation below. s Preventing Problems Related to Alcohol Availability: Environmental s CSAP (2000), Prevention Works Approaches. Through Community Partnerships: Findings From SAMHSA/CSAP’s s Impaired Driving Among Youth: Trends National Evaluation, Rockville, MD: and Tools for Prevention; CSAPDHHS Publication No. (SMA)00- s A Review of Alternative Activities and 3373. This monograph, which presents Alternative Programs in Youth-Oriented information on five model community Prevention; and partnerships, is available from the s Selected Findings in Prevention: A SAMHSA’s National Clearinghouse Decade of Results from the Center for for Alcohol and Drug Information Substance Abuse Prevention. P.O. Box 2345 Rockville, MD 20847-2345 Toll-free tel: 1-800-729-6686 Local tel: 301-468-2600 Fax: 301-468-6433 TDD (hearing impaired): 1-800-487-4889 www.health.org e-mail: info@health.org 21
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