Prevention programs can be adapted to best help specific groups of people. In fact, there are certain populations that are more at risk for developing a substance use disorder, but the problems that each group faces cannot be generalized to everyone needing help. So, prevention programs that target the specific needs of these groups are especially important and needed!
At the simplest level, good prevention programs aim to enhance protective factors and/or decrease risk factors. Protective factors protect a person from developing a substance use disorder. Examples of protective factors are: doing good in school, having strong friendships, having good mental health, and being supervised by parents. On the other hand, risk factors are anything that puts someone more at risk of developing a substance use disorder. Examples of risk factors include: having a family history of addiction, having another mental health problem, early use, and lack of parental supervision.
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Groups At Risk for Substance Use Disorder:
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- Students in College. People ages 18-24 are already more at risk for developing a substance use disorder, but college adds another risk all together. Times of transition, like going off to college, also puts someone at risk for addiction. Because there is limited supervision in college, there are more opportunities for students to be around drugs and alcohol and more opportunities to abuse them. Also, the stress of coursework, social obligations, and the future often make students turn to drugs and alcohol as a way to cope.
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- There is so much uncertainty and unknowns when a loved one is deployed in the military. Often, family members at home have no idea how long their loved one will be gone or even where they are going. Because of this, the loved ones of those deployed have a much higher change of abusing alcohol and drugs as a way to cope. Also, even families that remain together but move around often are more at risk because of the inability for the family to truly settle into their environment.
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- Research studies have recently found that people who identify as LGBTQIA+ are more at risk for developing a substance use disorder. It is thought that this population is more at risk because they are more likely to face challenges of social stigma and discrimination. They are also more at risk of harassment and violence. Also, people in the LGBTQIA+ community are also more likely to come into treatment with a more severe substance use disorder than the general population.
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- Native Americans have the highest rates of alcohol, marijuana, cocaine, inhalant, and hallucinogen use disorders than any other ethnic group. Research points to a number of factors that increases this population’s risk of developing an addiction: historical trauma, gang violence, domestic violence, sexual assault, poverty, high levels of unemployment, discrimination, racism, lack of health insurance, and low levels of attained education. Also, research has found that rates of alcohol and marijuana misuse among Native American students are 3.4 times higher than the average.
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- African Americans are more likely to use crack than any other ethnic group in the U.S. However, research shows that African Americans are more likely to seek treatment for addiction.
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- Hispanic Americans are not at a higher risk than the general population for developing a substance use disorder. However, research shows that Hispanic Americans have significantly less access to treatment and often wait longer.
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- Addiction and mental health disorders are, unfortunately, common in the homeless population. Research has found that addiction is often a result of homelessness. The stress of living on the street, having to find food, being around violence, the lack of shelter, being away from loved ones, and struggling with their health makes them much more at risk.
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- This population actually has a lower rate of substance use disorders than the general population. However, those who need help with their addiction are often much more hesitant to get help and seek treatment.
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- This population also has lower rates of addiction than the general population, but those who need help are less likely to seek treatment.
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- Rural adults are at a much higher risk for misusing tobacco and methamphetamines, and the rate of prescription drug misuse and heroin use is growing. It is much more difficult to combat this issue in rural areas because of the limited resources. There is much less access to services, resources, and treatment facilities. Also, risk factors in this population include lower education levels, poverty, unemployment, lack of access to healthcare, and isolation.
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- Underserved Racial and Ethnic Minorities. This population has a number of stressors that puts them more at risk for developing a substance use disorder. These stressors include, but are not limited to, lack of health care, discrimination, racism, and higher rates of poverty.
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Alcohol contributes to the death of over 1,000 college students per year.
FACT! An estimated 1,519 deaths per year occur among students enrolled in college. Prevention and intervention programs are especially important for this population.
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Wine and beer are safer drink choices than liquor.
MYTH! Alcohol is alcohol. A 12-ounce beer, a shot of liquor and a 5-ounce glass of wine all have the same amount of alcohol and carry the same risks.
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Prevention of underage drinking and its consequences is possible.
FACT! The research on quality prevention programs shows that they DO work in preventing underaged individuals from drinking alcohol and having the consequences.
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If someone has already used drugs, a prevention program will not work in stopping an addiction from developing.
MYTH! There are different types of prevention and intervention strategies. An “indicated intervention” is an evidence-based strategy to help prevent individuals who have already started using drugs from addictions.
Universal interventions target the general population and are not directed at any specific group. These interventions include programs aimed at preventing or delaying the use of substances in the general population by giving information and teaching different skills. For example, in a real-world setting, an entire high school taking part in a drug education program is a universal intervention. One positive side of using universal interventions is that everyone has the opportunity to participate, but the downside is because it is not specifically targeting those more in need, those in need may not get the help they need.
Selective interventions target people with a higher risk of developing a substance use disorder. These interventions are designed based on the different risk factors for the “subgroup” that has the risk factor. So, it is not designed to target a single person; instead, the focus is on helping the entire subgroup of people that have a higher risk of substance misuse. For example, high school athletes are more likely to misuse alcohol and drugs, so a selective intervention for this population would be a drugs and alcohol education program where only the athletes had to attend. One pro of selective intervention is that because it is more specific with who receives services, it has the potential to make more of an impact. However, one con is that the subgroup may feel stigmatized which may decrease participation.
Indicated interventions target people who are already using substances or are showing high-risk behaviors for substance use disorders. These individuals do not meet the criteria of having a substance use disorder, but if they don’t change their behaviors, it is very likely that one will develop. These programs focus more on finding those people who are showing those early warning signs and getting them into the programs that can help prevent heavy misuse of substances.
Intervention is a type of prevention strategy used to both prevent and stop substance misuse by reducing risks or threats. There are categories of interventions based on level of risk.
The Center for Substance Abuse Prevention Strategies, or CSAP, works with national and local organizations to improve behavioral health by using evidenced-based prevention approaches.
CSAP uses the following 6 major prevention strategies:
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Information Dissemination
Information dissemination is the direct communication of information from the source to the intended audience. Information dissemination is “one-way” communication because the audience cannot directly ask questions back to the source. It is used to provide knowledge and awareness about substance use, substance misuse, addiction and how this effects people. Some examples of information dissemination include social media, printed materials, health fairs, prevention curriculum, media campaigns and speaking engagements.
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Prevention Education
Prevention education is the mutual communication between an educator and participants. Unlike information dissemination, prevention education is “two-way” communication because the participants can ask questions directly back to the source. The purpose of prevention educations is to improve life and social skills, like better decision making and judgement abilities. Some examples of prevention education include classroom education, youth/adult groups, and mentoring programs.
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Alternative Activities
Alternative activities are used as alternatives to replace unhealthy activities, like substance use, with healthy, constructive activities. Some examples include free and social activities, community service activities and youth/adult leadership activities.
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Community-Based Processes
Community-based processes are activities that organize, plan, and enhance prevention strategies and programs in the community through collaboration, coalition building and networking. Some examples include assessing community needs, community team activities, community and volunteer training, and systematic planning.
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Environmental Strategies
Environmental strategies focus more on the impact something will have on the community instead of its impact on a specific person. Environmental strategies exemplify the public health approach. These strategies include policies, media strategies, compliance efforts, community development and neighborhood mobilization. Some examples include compliance checks at retail stores and bars, drug sale surveillance, law enforcement education, party patrols, shoulder tap surveillance, media strategies, and policies and regulations.
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Problem Identification and Referrals
Problem identification and referrals are activities that intend to change behavior, but it is not considered therapy. It screens for whether an individual can get through primary prevention services or must be referred to treatment. Some examples include employee assistance programs, student assistance programs, and prevention screening and referral services.
Coalition building is a smart strategy that promotes coordination and collaboration and makes efficient use of limited community resources. By connecting multiple parts of the community in a comprehensive approach, community coalitions are achieving real outcomes.
Community Anti-Drug Coalitions of America (CADCA) is the leading substance misuse prevention organization. It represents over 5,000 community-based coalitions across the United States and territories and more than 30 countries around the world who work to create safe, healthy, and drug-free communities. CADCA utilizes the Strategic Prevention Framework (SPF) to assist community coalitions in developing the infrastructure needed for community‐based, public health approaches that can lead to effective and sustainable reductions in alcohol, tobacco and other drug (ATOD) use and misuse.
Coalitions
Drug-Free Communities (DFC) Coalition is a community-based program through the Centers for Disease Control and Prevention (CDC) that addresses youth substance use in local areas. The main goal of these coalitions is to build a safe, healthy, and drug-free community by working with different groups of individuals in the community. Some of these groups include parents, schools, law enforcement, religious or fraternal organizations, healthcare professionals and businesses.
Each coalition selects at least two types of substances to focus on in their communities such as alcohol, marijuana, and/or tobacco.
Coalitions in Alabama
- Alabaster: “Alabaster for Tomorrow” http://alabasterfortomorrow.com/
- Montevallo: “Impact Montevallo” http://www.impactmontevallo.com/
- Birmingham: “Safe and Healthy Homewood Coalition” https://www.facebook.com/safeHWD
- Birmingham: “Addiction Coalition” https://apcbham.org/
Steps of the SPF Model (Used by Coalitions)
Coalitions and other prevention agencies utilize the SPF model that includes five steps:
Step 1. Assessment – Collect data to define problems, resources, and readiness within a geographic area to address needs and gaps.
Step 2. Capacity – Mobilize and/or build capacity within a geographic area to address needs.
Step 3. Planning – Develop a comprehensive strategic approach that includes policies, programs, and practices creating a logical, data‐driven plan to address problems identified in the assessment.
Step 4. Implementation – Implement evidence‐based prevention strategies, programs, policies and practices.
Step 5. Evaluation – Measure the impact of the SPF and the implementation of strategies, programs, policies and practices.
Alcohol, Tobacco, and Other Drugs (ATOD)
Alcohol is the most frequently used drug. The minimum legal age to purchase, use, posses, or transport alcoholic beverages in Alabama is 21 years old. Alcohol sales are regulated by the Alabama Alcoholic Beverage Control (ABC) Board, and ABC is responsible for the distribution of alcohol, licensing of retail outlets, and enforcement of policies. Alcohol dependence during youth can lead to continued dependence in young adulthood if left untreated.
Tobacco products include cigarettes, smokeless tobacco (chewing tobacco or snuff), cigars, or pipe tobacco. Smoking is the leading preventable cause of death in the United States. Smokers are more likely than nonsmokers to develop heart disease, stroke, and lung cancer.
Vaping devices are the most commonly used form of nicotine in the United States among teens. E-Cigarettes typically include four components: a cartridge that holds the nicotine and/or flavoring, a heating element, a power source (i.e. a battery) and a mouthpiece that is used for the person to inhale. The health effects of vaping are unknown, but early research shows that teens who use e-cigarettes early on (around 9th grade) are more likely to start smoking cigarettes in the next year than their non-using peers. The Food and Drug Administration (FDA) recently sent an alert to the public about thousands of serious lung illnesses being reported by vaping users, even including dozens of death.
Illicit Drugs include marijuana, cocaine, crack, heroin, hallucinogens, inhalants, and the nonmedical use of prescription-type psychotherapeutics, including pain relievers, tranquilizers, stimulants, and sedatives.
Syringe
It is extremely important to throw out used needles in a safe and controlled way to help stop the spread of infectious diseases like Hepatitis B, Hepatitis C, and Human Immunodeficiency Virus (HIV). You should never flush your needles down the toilet and never place needles in your home or public trash bins. Instead, find a safe syringe disposal site near you or ask a pharmacist or medical professional for a FDA-cleared sharps containers.
Medication
Keeping unused or expired medications in the house is a major safety issue. It increases the risk for accidental substance use by household members. According to a National Survey on Drug Use and Health in 2019, 9.7 million people misused prescription pain relievers, 4.9 million people misused prescription stimulants and 5.9 million people misused prescription tranquilizers or sedatives that year. Most of these substances were from families and friends and taken from home medicine cabinets.
The Drug Enforcement Administration (DEA) started the program “National Takeback Day” as a safe and anonymous way to throw out prescription drugs and syringes. Take back options for medicines is the best way to safely dispose of unused or expired prescription and nonprescription medicines (ex. Over the counter meds). These collection sites are able to gather and throw out unused and expired medications in a safe and secure way. These places in your community may look like hospitals, clinic pharmacies and/or law enforcement facilities. To find a public controlled substance disposal location, check out our services directory and search prevention programs for an up-to-date list of disposal locations.
Alabama State Strategic Prevention Framework
The Office of Prevention (OOP) at the Alabama Department of Mental Health developed a strategic prevention plan in response to the Center for Substance Abuse Prevention (CSAP) Core Technical Review recommendation in 2011. The vision of the OOP is to “build emotional health, prevent or delay onset of, and mitigate symptoms and complications from substance use and mental illness through evidence-based prevention strategies which promote healthy decisions and healthier lives for individuals and families to thrive in their communities.” The purpose of this plan is to “communicate goals, action steps, distinguish responsibility, targets and metrics to guide the prevention system.”
Five main steps of the strategic prevention plan are:
- Needs Assessment
- Capacity Building
- Capacity Planning
- Implementation of Evidence-Based Prevention Programs
- Monitoring and Evaluation
