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Implementing the Full Prevention Continuum to Prevent Opioid Use Disorder

Updated: Jul 26, 2023



Overdose deaths for adolescents and young adults remain a leading cause of preventable death nationwide. Young Americans are at a heightened risk of opioid use disorder (OUD), with approximately 3.8% of adolescents and 7.8% of young adults reporting past-year opioid misuse, creating a critical need for resources, information, and support to prevent the onset or escalation of OUD among youth and young adults.

A study published in Prevention Science underscores the need to implement the full continuum of prevention services available and highlights evidence-based programs and practices (EBPPs) available to communities to address gaps. “Prevention programs and strategies are necessary across the continuum and at multiple levels of influence to address opioid misuse before initiation and during escalation to a clinically diagnosed OUD,” lead author Dr. Jessica Cance explained.


The Prevention Continuum

The continuum of care is a framework used in the substance use disorder (SUD) and behavioral health fields to describe the different levels of care and support available to individuals based on the severity of their needs. It was first introduced by the Institute of Medicine in 1994 as a set of guiding principles for classifying an array of interventions and services across promotion, prevention, treatment, and recovery programming to ensure that individuals receive appropriate and effective treatment at each stage.

The continuum includes:

  1. Universal prevention interventions are designed to reach an entire population or large group of people to build protective factors and reduce the overall prevalence of the targeted issue.

  2. Selective prevention interventions that target individuals at higher risk of developing an SUD.

  3. Indicated prevention interventions focused on individuals showing early signs or symptoms of SUD but do not yet meet the criteria for a diagnosed condition.



HEAL Prevention Cooperative Research Spans the Full Continuum


In 2019, the Helping to End Addiction Long-Term (HEAL) Initiative, a trans-agency effort of the National Institutes of Health (NIH), launched the HEAL Prevention Cooperative (HPC) to fill a gap in prevention space by developing and offering a range of EBPPs across the prevention continuum — universal, selective and indicated approaches.


The HPC consists of a coordinating center and 10 research projects testing and developing evidence-based practices for various higher-risk segments of the U.S. youth population across the prevention continuum – universal, selective, and indicated. The HPC research is on intervention development and evaluation; risk and protective factors; social determinants of health; and dissemination, implementation, and sustainability of prevention programming. HPC research underway includes studies of universal, selective, and indicated prevention interventions.



HEAL Prevention Cooperative Research Initiatives across the Continuum


Universal Prevention Interventions

  • Cherokee Nation: School-Based Interventions and Media Campaign. Leaders from Cherokee Nation Behavioral Health have partnered with researchers at the Emory University Rollins School of Public Health to implement and rigorously evaluate a theory-based, integrated multilevel community intervention designed to prevent the onset and escalation of substance use among adolescents aged 15-20 years old living in or near the Cherokee Nation reservation within small rural communities in Oklahoma. The study focuses on universal primary prevention of rural white and American Indian/Alaska Native populations. Universal and evidence-based alcohol and drug use prevention approaches are being adapted to address the risk for opioid use onset, including screening and brief interventions with motivational interviewing delivered within schools, training for teachers and others in identifying and responding to mental health and drug use challenges, and promoting family and community preventive actions including reducing access to opioids and other drugs.


  • Traditions and Connections for Urban Native Americans. RAND and the University of California, Los Angeles, have partnered with the Sacred Path Indigenous Wellness Center (SPIWC) to test a developmentally and culturally appropriate prevention intervention among urban American Indian/Alaska Native emerging adults. Researchers conducted focus groups across California, meeting with providers, parents, and American Indian/Alaska Native emerging adults, which led to the creation of two developmentally and culturally appropriate virtual prevention interventions. Study participants will be randomized to one of two culturally appropriate interventions: Traditions and Connections for Urban Native Americans (TACUNA), which comprises three workshops and a wellness circle, or a culturally tailored opioid education workshop.


Selective Prevention Interventions

  • A Digital Intervention to Prevent the Initiation of Opioid Misuse in Adolescents in School-Based Health Centers. Researchers at the Yale Center for Health & Learning Games are developing, evaluating, and delivering in school-based health care settings a videogame intervention called PlaySMART. PlaySMART aims to prevent the initiation of opioid misuse in older adolescents through relatable storylines and skill-building activities. In the first phase, the intervention was developed with extensive input from key stakeholders (e.g., adolescents, school-based health center personnel, prevention specialists, and health providers of those diagnosed with OUD) and pilot tested among adolescents. In the second phase, 532 high-risk adolescents will enroll in a randomized controlled trial and be assigned to either the PlaySMART game or a set of attention/time control games. Working closely with the School-Based Health Alliance, the team will also partner with 15 school-based health centers across the nation to implement the video game and conduct a cost evaluation.


  • Optimized Interventions to Prevent OUD Among Adolescents and Young Adults in the Emergency Department. Researchers at the University of Michigan are using a randomized controlled trial to evaluate the efficacy of health coaching strategies delivered to emergency department (ED) patients to prevent opioid misuse among adolescents and young adults. The study will test intervention combinations among youth and young adults ages 16-30 in the ED who have screened positive for 12-month prescription or illicit opioid use, or opioid use plus at least one other substance use or mental health risk factor. The interventions incorporate motivational interviewing and cognitive behavioral therapy, including a telehealth session, post-ED visit messaging via an online participant portal, or both.


Indicated Prevention Interventions

  • Preventing Opioid Use Among Justice-Involved Youth as They Transition to Adulthood: Leveraging Safe Adults. This project is led by researchers at the Texas Christian University and will investigate the effectiveness of an intervention to prevent substance use among justice-involved youth aged 15-18 transitioning from secure residential facilities to their home environment. The program will implement an adaptation of the Trust-Based Relational Intervention® (TBRI®), which promotes youth emotional regulation by training adults in principles of connection, empowerment, and correction. In the program's first phase, dyads consisting of youth and their designated "safe adult" will receive standard community re-entry practice (SRP). In the second phase, dyads will be assigned to one of three TBRI® conditions with various coaching components, in addition to SRP.


  • Psychopathology Treatment and the Onset of OUD and Other SUDs. Investigators at Massachusetts General Hospital and Boston Medical Center are examining the impact of treating behavioral health conditions on the development or course of opioid, nicotine, and other SUDs in young people who are receiving behavioral health treatment. This longitudinal study evaluates the impact of such therapies on subsequent development of opioid, nicotine, and other SUDs and identifies possible mediating and moderating variables that may influence outcomes. Additionally, this study aims to implement a pragmatic set of OUD-based instrumentation using patient-related outcome measures linked to electronic health records.
















To read more about the prevention continuum and HPC studies, visit: https://pubmed.ncbi.nlm.nih.gov/37261635/



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