Before joining CEHD as a professor and researcher, I was a practicing clinical psychologist focused primarily on youth who were exhibiting problems with substance use and risky behaviors like delinquency. It was rewarding and important work, but I too often observed that the clients who were coming to see me had progressed in their symptoms to a point where it was more difficult to make progress. Often, their substance abuse was in full swing before they even came in my office. Had these clients been identified when exhibiting problems at an earlier stage, I believed I could have helped them more effectively.
These experiences motivated and informed my passion for thinking about how I could have an impact in preventing these problems before they occur.
Three Approaches to Preventing Youth Substance Abuse
In general, there are three common approaches to youth substance abuse prevention, each with their own strengths and challenges.
Universal prevention. Universal programs are one of the most common approaches to youth substance abuse prevention. They are most often school-based programs offered to all students in a school or district. D.A.R.E. is an example of a widely known school-based universal prevention program. These programs are beneficial because of their broad reach and ability to inform large groups of youth. However, because they target a broad audience of youth, they may be less effective for higher risk youth who may already be experimenting with substance use.
Selective prevention. Selective prevention is programming designed for youth coming from an already at-risk population. These could be youth who attend an alternative school related to behavioral problems, youth who regularly face substance abuse risk factors such as homelessness or parental substance abuse, or youth who have entered into the juvenile justice system.
Indicated prevention. Indicated prevention is an even more targeted prevention approach for youth who are showing early signs of developing a substance abuse problem. Often this means conducting screenings in schools or other settings for youth who may be exhibiting signs of an early substance use problem. The goal is to identify and intervene before more experimental use becomes a pattern of substance abuse.
Family and Youth-Focused Prevention Models
In general, selective and indicated prevention programming falls under two categories: youth- and family-focused models. Some programs use only one of these approaches while others may use both.
Youth-focused interventions often focus on building motivation to change, increasing awareness of certain risky behaviors, and skills like emotional regulation. We know that youth who struggle with managing negative emotions such as depression, anxiety or anger are more prone to developing substance abuse problems. By teaching them better emotional coping and regulation skills, we can often reduce their risk for future substance abuse problems. These components also help youth to identify and avoid situations that might place them at higher risk for using substances, while giving them skills for making positive choices if these situations do arise.
The family side of prevention involves increasing parental awareness of the factors that contribute to a higher risk for youth substance abuse. In some families, the parents may use substances themselves and have a lower level of concern when their children begin experimenting. Education is an important component for building more effective and positive parenting skills. Well-designed family interventions also help parents learn how to effectively set limits for their kids and improve parental monitoring and supervision skills, resulting in a healthier family culture surrounding substance use.
The Benefits of Tailored Substance Abuse Prevention Programs
Whether they are universal, indicated, or selective, prevention programs are typically delivered using a one-size-fits-all, fixed approach. This means that all youth identified for a given program tend to receive the same components and amount of programming. Because everyone receives the full program, this approach tends to be expensive and resource intensive to deliver. Many youths also end up receiving programming that they do not actually need. For example, a parent who already does an excellent job of supervising their child may have to sit unnecessarily through programming teaching him or her those skills. This may be frustrating for families, leading them to drop out of programming prematurely and not receive the content that could have been beneficial to them.
My research focuses on improving upon this fixed approach by identifying approaches to tailoring prevention programming to individual needs of youth and families. By identifying which youth and families are likely to benefit from which types and aspects of programming, we can provide just what is most likely to be helpful without the burden and expense of unnecessary services. This tailored approach allows us to offer a more carefully targeted program that is not only more likely to be effective, but may also help keep families engaged in services. Instead of giving at-risk youth every intervention that could possibly be helpful, tailored approaches identify which techniques are likely to work best in a specific case. This produces better results and uses fewer program resources, which allows the programming to be delivered more widely.
Rather than relying on subjective judgment to determine which programming might be beneficial for a particular youth and family, my research systematically evaluates who benefits from what type of programming. One of my recent studies looked at the impact of brief preventative intervention programs, consisting of only two or three sessions, given to teens identified in school as displaying some type of early substance use behavior. All the students in the study received two youth-focused sessions, and a subset of the group was given an additional family-focused session attended by their parents. We found that teens who were most at risk for impulsive decision making benefitted the most from the additional family-focused component, while youth without this tendency did not seem to derive much benefit from the single parent session. Research like this is helpful for determining which program components will help individual at-risk youth and which will not – and reaffirms the idea that tailoring to individual needs is an important factor in creating effective and efficient youth substance abuse intervention programs.
Tips for Parents: How to Minimize Your Child’s Risk for Substance Abuse
Practice Open Communication. Encourage open communication with your teen. Practice listening without reacting emotionally or judging.
Use Consistent Monitoring and Supervision. Ask where your teen will be and whom he or she will be with when going out. Limit unsupervised time with peers.
Set a Positive Example. Model healthy behaviors and attitudes. If you drink alcohol, do so responsibly and in moderation when around your teen.
Recognize Signs of a Problem. Notice changes in behavior or attitudes, including withdrawing from family life, a loss of interest in school or extracurricular activities, or changes in peer groups. Trust your gut.
Seek Additional Support if Needed. Seek an evaluation from a qualified professional if you have concerns. Your teen’s primary care provider can help evaluate your concerns and provide appropriate referrals.
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