While not every SUD can be prevented, much more can be done to target risk factors and strengthen protective factors. The U.S. currently has one of the highest rates of substance use and SUD in the world.
Substance use disorders (SUDs) have significant implications for individuals, families, and communities— from human suffering to public health and safety problems, such as:
Exposure to human immunodeficiency virus/acquired immunodeficiency syndrome
Risk of other sexually transmitted diseases (STDs)
Motor vehicle accidents
While not every SUD can be prevented, much more can be done to target risk factors and strengthen protective factors. The U.S. currently has one of the highest rates of substance use and SUD in the world. Americans account for approximately 4 percent of the world's population—and 27 percent of the world's drug overdose deaths. Proven prevention programs should be implemented nationwide to reduce substance use, SUDs and overdose deaths.
Stopping the Cycle of SUD Within Families
SUDs run in families, not just because of genetics, but also because of the direct effects a family member's illness can have on those around them. Parental SUDs can put children at risk for neglect, abuse, exposure to violence, and other adverse childhood experiences (ACEs). These stressors can make children more vulnerable to initiating substance use at an early age and developing a SUD later in life. Parental substance use can also result in children losing a parent to overdose, incarceration or loss of parental rights. This trauma, as well as the economic impact on the entire family, can also increase the risk for substance use and addiction among impacted children.
When a family member has a SUD, it often means that those around them have increased access to substances—raising their risk of substance use and SUD. These factors, among others, can create a cycle of substance use and SUD within families. There are more than 9 million children in the U.S. impacted by parental SUD and millions more with siblings suffering from this illness. And while there are no available data on the number of children who lose a parent to this disease, with 192 people dying every day from drug overdose the numbers are likely to be staggering. Targeted prevention interventions can help protect the next generation from experiencing the epidemic of overdose deaths that is currently ravaging our country.
Prevention is Proven and Cost-Effective
Evidence-based prevention programs can dramatically reduce rates of substance use and SUD. Dozens of programs have been found to significantly reduce substance use, some by over 50 percent.
Prevention policies can also be effective. For example, a 10 percent increase in the cost of alcohol can reduce binge drinking by nearly 10 percent among men and over 35 percent among women. And comprehensive programs, such as Communities that Care—an evidence-based framework for community engagement and coordination that can be used to implement proven prevention programs and policies—can reduce alcohol and tobacco use by over 30 percent among middle school students.
These programs can also be highly cost-effective. Rigorous evaluations have found many prevention programs are good long term economic investments, returning more to society than they cost. While the initial investment is often made by community organizations or the education system, the return on investment comes through the health care and criminal justice systems, as well as through employee productivity. This can create challenges for finding sustainable funding for these programs.
Evidence-based prevention interventions, especially those that focus on early childhood, do more than decrease drug use; they also reduce mental health problems and crime and promote academic motivation and achievement. Thus these programs can have tremendous, long-term benefits for the children and families they serve, as well as for society as a whole.
How can we prevent addiction?
The first critical step for developing effective prevention interventions is to understand how substance use disorders (SUDs) develop. A person's risk for both substance use and SUD is associated with genetic, individual, and environmental factors.
What are risk factors?
Risk factors are biological and psychological characteristics of a child or attributes of a child's family, culture or community that make him or her more susceptible to substance use. They include a child's personality traits, such as early aggression, as well as undiagnosed mental illness. They also include factors that directly affect a child, changing their behavior, such as parental neglect, limited or poor supervision, mental or physical abuse, friendships with children misusing substances, poor or limited schooling, living in poverty, and easy access to drugs in their community. According to Substance Abuse and Mental Health Services Administration (SAMHSA), many children who are at risk have faced adverse childhood experiences including:
Intimate partner violence
Mother treated violently
Substance misuse within household
Household mental illness
Parental separation or divorce
Incarcerated household member
These risk factors, though challenging to overcome, do not on their own cause SUDs. The good news is that even with an abundance of risk factors, a child with strong, counterbalancing protective factors can emerge healthy from an at-risk childhood.
What are protective factors?
Protective factors include those qualities of children and their surrounding environments that enable them to develop the coping and adaptation skills necessary to manage challenging life situations and transitions. At the individual level, protective factors include positive self-image, self-control and good social skills. At the family, school and community level, they include external factors, such as parental involvement in their lives, positive mentoring relationships, participation in after-school activities and policies limiting substance availability in their neighborhood.
It is the balance between risk and protective factors that determine a person's risk of initiating substance use and of developing a SUD. Robust prevention programs aim to reduce risk factors and strengthen protective factors in a person's immediate environment, including his or her home, school, workplace or community. The areas that are most important to address vary with age, as exposure to substance use occurs in different environments depending on development stages. As people transition from childhood through adulthood, these programs can be modified and directed towards individuals, groups or the entire community, depending on the approach most likely to be effective.
Risk and protective factors include a constellation of genetic, individual and environmental elements. While we cannot change our genetics, having some understanding of genetic risk can be an empowering piece of information. If addiction runs in a family, it can give parents a "heads up," letting them know that their children may benefit from targeted interventions to reduce their risk factors and improve their protective factors.
Many of the genetic constellations that can make a person more likely to engage in risky behaviors, like using drugs, can, under a different set of circumstances, nudge them toward taking the kinds of risks that might make them a great public speaker or salesman, a brilliant scientist, a competitive runner, a creative entrepreneur or a deep-sea explorer. High genetic risk does not mean that a child is destined to have a SUD. Parents who recognize risks early on can direct a child's risk-taking tendencies away from self-destructive behaviors and towards more positive activities—like gymnastics, theater or science and technology competitions—helping them find an outlet for their risk-taking impulses.
The Importance of Skill Building
Unfortunately, just knowing that something can be bad for us does not stop us from doing it. Telling teenagers not to drink is analogous to telling a small child not to eat any candy before dinner. While it is important to educate children in an open, honest and accurate way, teaching them about the risks of alcohol and drugs is not the same as prevention. The most effective prevention programs focus on teaching skills both to children and child-influencers at home, in school and in community environments, empowering good choices. For example, by teaching parents and caregivers how to communicate effectively with their children during different developmental stages, encourage positive behaviors and set clear rules and expectations, the protective factors within a child's home environment can increase dramatically. Similarly, prevention programs that teach children how to regulate their emotions, control their impulses, cope with stress and effectively communicate their needs, strengthen and build their protective factors.
Education Around Norms
Most students at schools around the world do not use substances, but they often have misconceptions of how common substance use is among their peers. Teaching children about the actual behavior of their peers decreases pressure to initiate or continue substance use to "fit in." Schools can collect such substance use data from their own students or use data from a comparable school population, such as the Monitoring the Future Survey from the National Institute on Drug Abuse that collects information on substance use among 8th, 10th and 12th graders each year. Correcting students' false beliefs about alcohol and other drug use has been shown to successfully promote healthy student behaviors and attitudes.
Reducing Access to Drugs, Alcohol and Tobacco
In addition to reducing the demand for alcohol and drugs by empowering people with the knowledge and skills to delay initiation of substance use, reduce risky substance use and avoid substance use disorders, prevention interventions can also focus on reducing the availability of alcohol, drugs, and tobacco products. These efforts can include laws and policies that restrict access to alcohol and tobacco by minors, reduce overprescribing and diversion of controlled prescription medications, as well as law enforcement efforts to prevent the importation and distribution of drugs.
Delaying the Age of First Use
To prevent SUDs it is also critical to understand that the adolescent brain is more vulnerable to alcohol and drugs than the adult brain. Research shows that 90 percent of people who develop a SUD in their lifetime start using substances before they turn 18. The earlier someone starts using substances, the greater their changes of developing a SUD. People who start using alcohol or drugs before age 15 are nearly 7 times more likely to develop a SUD in their lifetime than people who delay use until they are age 21 or older. Earlier initiation of use is also linked with a greater severity of illness.
The adolescent brain is more vulnerable to alcohol and drugs because it continues to develop until the early to mid 20s, with the regions of the brain that control emotional regulation, impulse control and decision-making among the last to develop. This is one reason why adolescents are more likely to engage in risky behaviors and make impulsive decisions, such as trying drugs and alcohol. And early use of alcohol or drugs can disrupt development of the brain in ways that increase the risk of SUD.
Genetic, individual and environmental factors all interact and influence how the brain develops, which in turn affects a person's risk for substance use and SUD. For example, genes can influence the structure and function of the brain. They can also affect how we respond to or metabolize substances, as well as personality traits linked to SUDs—such as impulsivity and high reactivity to stress.
Individual factors such as age of initiation and early adverse experiences can also impact brain development. Research has shown that early substance use, while the brain is still developing, can make the brain more sensitive to alcohol and drugs, increasing the risk for a future SUD. Early exposure to alcohol or drugs can also impact the development of the prefrontal cortex--a part of the brain that directs decision-making and impulse control—increasing the long-term risk for addiction. Early adverse experiences, such as poverty, food insecurity and exposure to violence or trauma, can also affect how the brain develops and can make a child both more likely to initiate substance use and, if they do try substances, to develop a SUD.
Brain development is also impacted by environmental factors. Stressful environments early in life can change how the brain responds to stress and increase the risk for a future SUD. Early exposure to environmental toxins, such as lead, can also impact brain development; preliminary studies suggest it may impact risk for addiction.
Protecting the brain during this critical period of development is an important part of prevention. Right now, 23 percent of adolescents initiate drug use before they turn 18, 27 percent initiate alcohol use, and 11 percent develop a SUD in their teen years. Delaying the initiation of substance use, ideally until after the brain is fully developed, is critical for reducing the incidence of SUDs.