Prevent First Time Use Through Education

Introductory Paragraph

Society often promotes and glamorizes substance use. Young people may be exposed to substance use within their families or feel peer pressure from friends who are already using substances. These are powerful forces in a young person's life which need to be counteracted. Prevention education is an effective way to prevent first-time drug use and may reduce substance use disorders and the number of overdoses and drug-related fatalities within a community. Prevention education programs can - and should - start at an early age. For this reason, prevention education is often a long-term strategy.

It is important to inform young people about the consequences, dangers, and realities of using alcohol and other drugs. The main focus of a specialized educational effort is teaching individuals about substance abuse and the harmful impacts it has on people's lives. One powerful tool is hearing stories from those with lived experiences. These and other types of programs can help a person learn how to avoid, stop, or get help for addiction. Education efforts also include those that target parents and provide them with the tools needed to educate their children about the dangers of drug use. Parents are also learn warning signs which indicate their child may already be using substances. This can lead to an early intervention that often prevents the progression into a substance use disorder.

Key Information

There are multiple types of substance use education programs. Many successful approaches have been developed to target all types of populations. Programs have been developed to focus on different age groups, different racial and ethnic backgrounds, schools, families, faith-based organizations, doctors, pharmacists, and the wider community. While many programs focus on the impacts of drug use, others focus on building up the individual and helping them address risk factors like anxiety and trauma that often lead to drug use. Other prevention programs take the form of public awareness campaigns that seek to educate and warn large numbers of people.

One area of focus involves knowing the dangers of prescription medications, especially opioids and other pain medications. The "first wave" of the current epidemic started when powerful pain medications were developed, heavily marketed, and over-prescribed. The addictive nature of these medications was largely unknown, and millions of people developed substance use disorder as a result. Education strategies target both patients who are prescribed these medications and parents of children who receive pain medication prescriptions.

Providing prevention education programs to youth is critical. Effective strategies include targeting where young people are located and addressing the unseen risk factors that lead to drug use and substance use disorder. School-based prevention programs are geared towards educating youth and creating resistance to peer pressure. The core of many effective prevention strategies is an exploration of underlying trauma and other mental health challenges which impact today’s youth. Even without major trauma, an increasing number of young people are feeling stress and anxiety at high levels which lead them to seek relief by using substances. Educating youth about this reality and encouraging them to express these feelings and seek help can achieve tremendous benefits for the individual. .

Schools have been used to disseminate information about drug use because of their easy access to large populations of students. Many initial attempts at school-based drug education programs were unsuccessful due to the fact that they primarily focused on the dangers of substance use and used fear tactics to detour children. These initial attempts were not based on theory and failed to include information about developmental factors, social impacts, and biological or medical risk factors that may put individuals at a higher risk for using substances.

Prevention Education Targeting Early Onset. According to NIDA, 3.4 percent of 12- to 13-year-old children have past-month use of an illegal drug or inappropriate use of prescription drugs, 2.1 percent use alcohol, and 1.1 percent are current tobacco users. These percentages increase significantly throughout the middle and high school years -- by the time they are high school seniors, 64 percent have tried alcohol, almost half have taken an illegal drug, 31 percent have used nicotine, and 18 percent have used a prescription drug for a non-medical purpose.” This is why it is so important to place an emphasis on proper prevention education in today’s youth. If they are properly implemented, programs can help to provide real barriers to the first use and possible future abuse of substances.

A recent study by the University of Illinois found that the strongest predictor for adolescent substance use is the beliefs that youth hold about drug use, whether they find them to be abhorrent, risky, enticing, etc. As parents, school officials, and community leaders look for effective prevention tactics, they need to understand that youth attitudes and beliefs about drugs have a strong correlation with both past and present substance use. This indicates a great need for youth-centered education about the impacts of substance use. Knowing that their attitudes and beliefs are the main contributors to whether or not they participate in substance use allows the adults and community leaders the foresight to begin youth education themselves to prevent or combat existing, dangerous views about drug and alcohol use. The key takeaway: if they aren’t getting the right information, they’ll get the wrong information.

SAMHSA’s evidence-based guide to Substance Misuse Prevention for Young Adults notes that effective childhood and youth prevention programs include the following elements:

• Behavioral modification and management
• Classroom management
• Schools that provide comprehensive academic, social, and health services for students, family members, and community
• Home visiting services that foster parental education and family support
• Parenting skills education
• Social and emotional skills education
• Cognitive restructuring
• Community mobilization
• Social norms campaigns or education - focus on positive, healthy behaviors
• Environmental changes
• Policy enforcement of laws and regulations regarding substance
• Screening and brief intervention
• Wraparound services

Identification is major component of prevention. This includes assessment of current substance use and those at-risk. As the largest, natural avenue to youth, schools can play a primary role in identification and intervention. Identification can occur in teacher observation of changes in behavior, implementing youth assessment tools, and school-parent collaboration. Proper identification can lead to appropriate intervention and prevention efforts.

Implications of Teenage Substance Use

The effects of substance use are long-lasting and far-reaching. Beyond the visible surface effects, substance use in children affects all facets of life, including their biological functioning, psychological well-being, and social health. Understanding the broad spectrum of potential consequences is vital for adult caregivers to know and understand in order to better equip themselves and their children in the fight against substance use.

Potential Biological Impacts

• Increased risk of disease transmission (HIV, AIDS, Hepatitis B & C)
• Overdose
• Risky sexual behaviors (disease transmission, unplanned pregnancy, anonymous encounters)
• Impaired brain functioning - disrupts areas of the brain responsible for reward, motivation, learning, judgment, reasoning & memory
• Increased risk of traffic accidents, may result in serious bodily harm to self or others
• Long term addiction and dependence - further physical harm
• Delayed puberty
• Negative impact on the reproductive system
• Low bone mineral density
• Risk of assault, physical and/or sexual

Psychological Impacts

• Increased suicidal ideations and attempts
• Increased risk of additional mental health conditions
• Learning problems - damage to short- and long-term memory and learning process
• Substance use may mask unaddressed mental health issues (depression, anxiety, schizophrenia, etc)
• Long term addiction and dependence - further psychological harm

Social Impacts

• Delinquency
• Aggressive social behaviors - fighting and stealing
• Decreased school performance
• Poor social engagement
• Increased conflict with family and peers
• Delayed or deferred education and career opportunities

Drug Specific Impacts

• Alcohol - racing heart, insomnia, headaches, withdrawal seizures, poor bone density, dysphasia, poor physical health
• Tobacco - chronic coughing & lung infections, airway obstruction, reduced lung function, shortness of breath, higher resting heart rate, increased headaches, vision and hearing loss, risk of heart & lung diseases, risk of lung or other cancers
• Cocaine - heart attack, stroke seizures
• Ecstasy - liver and heart failure
• Inhalants - heart, lung, liver, kidney damage
• Marijuana - impairments in memory, learning, problem-solving, & concentration; later-life psychosis
• Methamphetamines - psychotic behaviors
• Opioids - respiratory distress, death from overdose

Relevant Research

The American Addiction Centers conducted a study on the most effective methods of prevention education in schools according to the students who experienced the drug education programs. This study highlighted the strengths, weaknesses, and gaps in students’ perception and knowledge, and it provided insight on how to adjust future programs in order to ensure the right information is delivered in the most effective way. Participants in school drug education programs reported that learning about the possible dangers of substance use was most impactful. Many respondents of the study reported that they did not receive any education about the dangers of commonly used substances such as methamphetamines and ecstasy. However, a larger percentage of individuals, over 84%, reported having received school-based education on alcohol use. Over 64% of respondents reported that using substances in high school was socially acceptable and considered “cool.” The study concluded that having an open and honest conversation about the dangerous consequences of using substances, even recreationally, is extremely important to young vulnerable children.

Impactful Federal, State, and Local Policies

The Substance Abuse Prevention and Treatment Block Grant (SABG) is authorized under Title XIX, Section 1921 of the Public Health Service Act to help plan, implement, and evaluate activities that prevent and treat substance abuse. The SABG program provides funds to all 50 states, the District of Columbia, and various territories and tribal entities. It is administered by SAMHSA's Center for Substance Abuse Treatment’s (CSAT) Performance Partnership Branch, in collaboration with the Center for Substance Abuse Prevention’s (CSAP) Division of State Programs. SAMHSA requires that grantees spend no less than 20% of their SABG allotment on substance abuse primary prevention strategies. These strategies are directed at individuals not identified to be in need of treatment. One of the six primary prevention strategies is prevention education, which typically includes a large portion of block grant allocations at local levels.

Available Tools and Resources

SAFE Project:

• SAFE Choices is a program within SAFE Project that focuses on fostering resiliency in youth development through collaborative and diversified approaches that reduce risk of substance addiction and mental health challenges while empowering SAFE Choices in all stages of youth development.
• "Lessons Learned: Talking to Young Children about a Loved One’s Substance Use." This article from SAFE Project discusses the importance of talking with children regarding their loved one's substance use, how these conversations can create better dialogue around substance use, and how these conversations can begin the process of breaking the addiction cycle.
• See the wiki titled "Address Risk & Protective Factors for Individuals, Families, and Communities" for more detailed information on both the risk factors and protective factors of substance use.
• See the wiki titled "Become a Trauma-Informed Community" for more detailed information on the relationship between SUD and trauma-related mental health concerns.

“Talk. They Hear You.” This is a mobile app designed by SAMHSA to support parents and caregivers. It prepares them for discussions with their children about alcohol and drug use. It provides information to assist parents to communicate effectively with their children. The app equips them with the necessary skills, confidence, and knowledge around the potential dangers of substances. The app also helps communities become proactive in supporting the needs of children and parents who may already be experiencing substance use or are at risk .

FDA Tobacco Education Resource Library provides content focused on public health education, smoking cessation, tobacco research, retailer information, tobacco regulations, and compliance — all in one place. It works to advance health equity and facilitate the reduction of tobacco-related health disparities for all people. FDA offers a Spanish-language version of the Vaping Prevention and Education Resource Center. FDA's online hub is free and science-based, and it provides standards-mapped lesson plans and materials which teachers can use to help students understand the danger of e-cigarette use and nicotine addiction.

The Hanley Foundation. It’s mission is to provide substance abuse prevention and education programs for parents, caregivers and school-age children. In addition, the foundation provides financial aid scholarships for patients who could not otherwise afford addiction treatment.

Promising Practices

Creating Lasting Family Connections (CLFC)

This promising program was given a 3.7 out of 4 from the National Registry of Evidence-based Programs and Practices for the readiness of dissemination. CLFC was designed for high-risk families in order to combat the onset of substance use and violence. The program provides education on the importance of family bonding, enhances communication skills, and promotes health beliefs and attitudes. Compared to the control groups, the families who participated in CLFC experienced less frequent alcohol use, decreased family pathology, increased use of community services, and increased parent knowledge on substance use.

Life Skills Training (LST)

LST is an evidence-based prevention program which has been proven to reduce the risk of alcohol, tobacco, drug abuse, and violence. It targets social and psychological risk factors in youth that may lead to substance use and other risky behaviors. The U.S. Department of Education and the Center for Substance Abuse Prevention have recognized LST as an exemplary prevention program that is backed by over 30 studies. LST is comprised of three domains -- drug resistance skills, personal self-management skills, and general social skills. These are taught to participants in elementary, middle, and high school students. Rather than solely focusing on the dangers of drug abuse, the LST program highlights healthy alternatives to risky behavior. It provides guidance on how to implement necessary skills to resist peer pressure, develop self-esteem and confidence, effectively cope with anxiety, increase understanding of immediate consequences of substance use, and enhance cognitive and behavioral competency. The program has been shown to be effective in diverse populations such as white middle-class students, minority students, urban, suburban, and rural populations. The curriculum is effective when implemented in a classroom, within the community, faith-based centers, and in summer or after-school settings.

Project Towards No Drug Use (Project TND)

Studies exploring the effectiveness of Project TND showed a 25% rate of reduction of hard drug use and between 7 and 12% alcohol use reduction in experimental high school groups. Results also showed a 27% reduction in cigarette use and a 22% reduction in marijuana use at one-year follow-up. This program is comprised of group discussions, games, role plays, and worksheets that focus on motivational activities, skills training, and decision making. Topics covered include attitudes, beliefs, and expectations regarding substance use, social skills, self-control, and how to make health-promoting decisions. The underlying theory of Project TND is based on the idea that students will not use drugs if they are aware of misconceptions around drug use, have adequate coping and social skills, know the negative consequences that may follow substance use, have an awareness of strategies for smoking and other drug cessation, and have adequate decision-making skills.

Project ALERT

This is a two-year program for middle school students that aids in reducing the onset of drug use among youth. Project Alert Plus is a similar program that is geared towards high school students.

Promoting Alternative Thinking Strategies (PATHS)

This program focuses on reducing behavioral problems in elementary school students while enhancing their education within the classroom. Both of these approaches help to prevent future substance use.