Partners in Prevention

Written on September 29, 2023

By: CAPT Christopher Jones, Pharm.D., Dr.P.H., M.P.H., Director, Center for Substance Abuse Prevention

In October, we observe Youth Substance Use Prevention Month and Substance Misuse Prevention Month. As we kick off Prevention Month, let’s take a moment to celebrate all that we’ve accomplished together, as well as recommit ourselves to the important work that lies ahead. Everyone has a role to play in prevention.

Prevention of Substance Misuse ― Where We Are and What Lies Ahead

The substance use landscape continues to evolve with the ongoing spread of highly potent synthetic opioids (like illicit fentanyl) in counterfeit pills and the re-emergence of stimulants like methamphetamine. At the same time, we see changing state policies related to alcohol, marijuana, and hallucinogens. Vaping and tobacco products remain readily accessible to young people in many communities. And we continue to learn about the perils and potentials of social media. All of this is happening against the backdrop of rising mental health challenges, especially among young people, that are inextricably linked to substance use.

In fact, substance use has never been riskier, whether it is someone’s first time using, or a long-standing substance use disorder. The risk of overdose1,2 is now elevated with any use of an illicit drug, given the potency, lethality, and unpredictability of fentanyl and other additives (such as xylazine) in the illicit drug supply.

What remains constant is prevention science ― and the decades of community-based experience and scientific research that shows prevention works.

And while we face many challenges, we are seeing advancement. We should celebrate and build on this progress.

• Alcohol use among youth has fallen significantly since the 1970s and 1980s, and has generally trended downward over the past few decades. Alcohol remains the most widely used substance among youth, followed by marijuana and nicotine products (including e-cigarettes and other vaping devices).

• Long-term data (from the Youth Risk Behavior Survey and Monitoring the Future study) also show declines in substance use among youth for most substances over the past decade.

• The 2021 National Survey on Drug Use and Health shows that most youth (aged 12-17 years) have never used alcohol, nicotine, or illicit drugs in their lifetime.

  • 77.1 percent have never used alcohol.

  • 83.5 percent have never used nicotine products (tobacco or nicotine vaping).

  • 78.7 percent have never used illicit drugs (including marijuana or misuse of prescription medications).

Research shows that the earlier substance use begins, the more likely it will develop into a substance use disorder.3, 4, 5 That is why it is so critical that we work early with youth, to prevent initial use as well as delay the onset of use.

Prevention is not limited to youth. Prevention also focuses on adults, where we work to prevent or intervene with adult misuse in order to prevent and reduce the health and social harms of substance use, as well as the progression to substance use disorder.

Importantly, we know that substance use has no single cause and that is why prevention must focus on the spectrum of factors and root drivers of substance use. Prevention works by strengthening protective factors and reducing risk factors (PDF | 146 KB) ― at the individual, family, school, community, and society levels.

Examples of protective factors:

• Developing problem-solving and conflict resolution skills; developing emotional intelligence (including how to handle and process emotions); having positive peer, family, and community relationships; participating in healthy activities and connections (sports and recreation, arts, faith-based, cultural connections, etc.); and having opportunities for education, employment, and engagement.

Examples of risk factors:

• A low level of emotional and communication skills in the family; substance misuse in the family; trauma; exposure to abuse, neglect, or violence in the home, school, or community; community norms and policies favorable to substance use; and lack of life opportunity.

Prevention is a health equity issue ― recognizing that substance use patterns and substance use-related harms vary, based on where someone lives, their socioeconomic status, race/ethnicity, sexual orientation or gender identity, and access to services and supports.

To optimize the impact of prevention, we must address the social determinants of health; support healthy social and emotional development; prevent and address trauma; support parents and strengthen families; expand evidence-based programs in communities and schools; and improve the safety, stability, and livability of community environments.

Community engagement is a foundational part of every step of prevention planning. A participatory culture, led or co-led by members of the community of focus, is critical to the equitable scale-up of evidence-based strategies. Intentionally integrating and valuing the voices, perspectives, and experiences of youth and young adults as agents of change in prevention is critical for success; please visit Voices of Youth.

The reality is that we are facing many substance use and mental health-related challenges in our country. Rather than continuously playing catch up, prevention provides us an opportunity to get ahead of these challenges ― so that kids, families, and communities can thrive.

We’re all partners in prevention. Each of us has a role to play, in preventing substance misuse — and preventing human suffering — as individuals, among family and friends, at work and school, in our communities, and in society.

Let’s use Prevention Month as a call to action for each of us ― individually and collectively ― to redouble our efforts to advance the life-saving work of prevention in communities across our Nation.