Prevention

The use of alcohol, tobacco, and other drugs—whether legal or illegal—by various age groups and special populations continues to be a

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problem in the United States. The use of illegal drugs increased among American adolescents throughout the 1990s, and this increase caused special concern. In response, the American public has become increasingly interested in the concept of prevention. The prevention movement began in the 1970s and has gained in popularity since then. Parents have organized to address the factors that lead to substance abuse, in order to prevent drug use among young people. In many cases, youth groups have also formed to help parents prevent sub- stance abuse among young people and their peers. Supporters of the prevention movement emphasize that preventing substance abuse has a greater chance of success than helping people quit after they have become addicted. They also point out that prevention is less costly than treatment programs.

Parent groups have used several strategies to prevent their children from using drugs. One of these strategies is to change laws they see as harmful to children. For example, parent groups mounted an intensive effort to obtain laws to ban the sale of drug paraphernalia . In the early twenty-first century, nearly every state had such laws. These groups also battled with supporters of the legalization of marijuana. In general, parent groups focus on ensuring that drug- education materials convey a no-use message, rather than recommending the "responsible use" of drugs that are both illegal and harmful.

Another area of parents' concern is alcohol abuse. Families of young people killed by drunk drivers organized groups such as Mothers Against Drunk Driving (MADD), Remove Intoxicated Drivers (RID), and Students Against Drunk Driving (SADD)—now Students Against Destructive Decisions—to prevent accidents involving alcohol. As with the parent-led, drug-free movement, parents who led the anti-drunk-driving movement first raised the nation's awareness about the problem and then developed strategies to address it.

See Organizations of Interest at the back of Volume 3 for address, telephone, and URL.

Another concern of the prevention movement is the glamorization of drug use on television, in films, in song lyrics, and on the Internet—all influences on young people. Media groups have formed to address public concern about these influences. For example, the Entertainment Industries Council has developed programs to work with film makers to educate them about substance abuse and to encourage them to deglamorize drug use in movies. The National Academy of Television Arts and Sciences has taken steps to increase the industry's awareness of the impact it could have on reducing sub- stance abuse through the power and reach of the mass media. Since the mid-1980s advertising and public relations agencies have worked together in the Partnership for a Drug-Free America. These agencies volunteer their talent and time to create and produce antidrug commercials targeted at young people.

Since its origins in the 1970s, the prevention movement has spread to the military, the business community, schools, and the religious community. Ethnic and cultural groups, worried about the use of drugs by their members, have created prevention groups as a way to strengthen their communities. Local, state, and national political leaders have created policies and allocated resources to stem the flow of drugs into the country and to help people prevent substance abuse in their families and communities. The AIDS -prevention community has joined the substance-abuse prevention community in order to stop the spread of the disease among drug users.

Prevention services and policy changes have reduced the regular use of alcohol, tobacco, and other drugs in the communities they serve. These communities have benefited in several ways: fewer highway

accidents involving alcohol; improved general health because of tobacco prevention; and decreased rates of criminal activity involving illegal substance abuse. Although government policy in the United States still tends to emphasize law enforcement and treatment as a way to control substance abuse, the idea of preventing substance abuse before it starts has gained in public popularity. The prevention movement seeks to create communities in which individuals and families can live healthy lives free of drug abuse and addiction and the problems they cause.

The Principles of Prevention

Over the years, those involved in the prevention movement have developed the following guiding principles for prevention programs:

1. Reduce or eliminate so-called risk factors—factors that increase a person's risk for substance abuse. Many factors increase the chances that some individuals will become substance abusers. Prevention programs recognize the following risk factors for substance abuse:

• little commitment to school and education
• academic failure
• early antisocial behavior, aggression , and hyperactivity
• alienation, rebelliousness, and lack of social bonding to society
• antisocial behavior in early adolescence
• favorable attitudes toward drug use
• early first use of drugs
• family history of alcoholism, antisocial behavior, or criminal behavior
• parental drug use and positive attitudes toward use
• friends (peers) who use drugs

2. Promote and enhance "protective factors"—factors that help a person avoid substance abuse. These include:

• high self-esteem and self-discipline
• advanced social and problem-solving skills
• positive, optimistic outlook on life
• easy-going temperament and affectionate personality
• adequate family income
• structured and nurturing family
• promotion of learning by parents
• warm, close relationship with parents
• little marital conflict between parents
• low prevalence of neighborhood crime

3. Provide services that meet the needs of individuals as well as their families. When families receive training in relationship and parenting skills, the children in these families have fewer substance use problems. Services for individuals at risk of substance abuse or who have already become users include education, intervention, and referral to treatment when necessary. For people in high-risk substance-abuse environments, prevention programs offer further services such as health care, nutrition counseling, and prenatal care.

4. Teach people about substance abuse, guide them to the available services, and teach them how to manage their own lives. When a person becomes knowledgeable about the effects of alcohol, tobacco, and other drugs, this knowledge leads to better decision making. Prevention programs can encourage people to make good decisions and to cope with life's challenges. People with substance-abuse problems learn that they are engaging in risky behaviors, and are given accurate information about the risks of substance abuse. They acquire skills for resisting peer pressure to use drugs and learn how to resist the influence of advertising on their choices. They also learn where to turn when they need help.

One prevention program that is based on the above principles is called Life Skills Training (LST). The main goals of the LST program are: (1) to provide students with the information and skills they need to resist peer pressures to use drugs; (2) to help students develop independence, self-esteem, and self-confidence; (3) to help students cope with feelings of anxiety produced by social situations; (4) to increase students' knowledge of the negative consequences of drug

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use and of the rates of tobacco, alcohol, and marijuana use; and (5) to promote a lifestyle that excludes drug use.

5. Encourage communities to establish standards of behavior through enforcement of clear policies. Communities that establish positive standards of behavior regarding alcohol, tobacco, and other drug use have been successful in delaying the onset of use. Such communities have taken steps to decrease access to substances by children and adolescents. These steps include setting rules for the location of alcohol advertisements. Community prevention programs can also teach middle-school students how to refuse an invitation to use drugs or other substances. Parents can learn how best to supervise their children in order to prevent the negative influences of peers.

Many communities also face the growing problem of heavy drinking by college students. This problem not only affects campuses and students, but also residents living near college campuses. A 2002 study found that, on an annual basis, drinking by college students between the ages of 18 and 24 contributes to an estimated 1,400 student deaths, 500,000 injuries, and 70,000 cases of sexual assault each year. The study also found that one-fourth of college students in this age group have driven under the influence of alcohol in the past year.

The National Institute on Alcohol Abuse and Alcoholism recommends that college administrators adopt the following policies, in order to reduce excessive alcohol consumption in and around college campuses:

See Organizations of Interest at the back of Volume 3 for address, telephone, and URL.

• reinstating Friday classes and exams to reduce Thursday night partying; possibly scheduling Saturday morning classes
• offering alcohol-free, expanded late-night student activities
• eliminating keg parties on campus where underage drinking is common
• establishing alcohol-free dormitories
• employing older, salaried resident assistants or hiring adults to fulfill that role; currently, resident assistants are usually students who serve in a supervisory role in the dormitory in exchange for lower tuition
• further controlling or eliminating alcohol at sports events and prohibiting tailgating parties where heavy alcohol use is standard practice
• refusing sponsorship gifts from the alcohol industry to avoid giving any impression that underage drinking is acceptable
• banning alcohol on campus, including at official faculty and alumni events

Conclusion

Certain misunderstandings about substance abuse have slowed the progress of the prevention movement. Some people believe that sub- stance abuse cannot be prevented because it is a problem passed down through genes. Clearly, genetic and other biological factors contribute to the occurrence of substance abuse. But a person's social environment also has a great impact on whether he or she will turn to drugs. Prevention can address those influences and can play an important role in responding to the problem of drug use and abuse. Federal, state, and local governments need to ensure that the best practices in prevention and education are provided to all ages.

see also Adolescents, Drug and Alcohol Use; Binge Drinking; Media Representations of Drinking, Drug Use, and Smoking; Prevention Programs; Risk Factors for Substance Abuse; Substance Abuse and AIDS.