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    CSA Principles of Prevention CSA Principles of Prevention Document Transcript

    • 3 GUIDE TO SCIENCE-BASED PRACTICESPrinciples of SubstanceAbuse PreventionSubstance Abuse and Mental Health Services AdministrationCenter for Substance Abuse PreventionDivision of Knowledge Development and Evaluation
    • AcknowledgmentsThis document was produced under the guidance of Stephen E. Gardner, D.S.W., pro-ject officer, and Paul J. Brounstein, Ph.D., Division of Knowledge Development andEvaluation, Substance Abuse and Mental Health Services Administration, Center forSubstance Abuse Prevention (SAMHSA/CSAP), through contract #282-98-0023 to ROWSciences, Inc., Carol Winner, project director. Principles of Substance Abuse Prevention is based on A Guide to Science-BasedPractices in Substance Abuse Prevention, a seminal monograph developed and writtenby Paul J. Brounstein, Janine M. Zweig, and Stephen E. Gardner, with substantial contri-butions from Maria Carmona, Paul Florin, Roy Gabriel, and Kathy Stewart. Special thanks go to a dedicated review panel composed of Eric Einspruch, RoyGabriel, and Katherine Laws, RMC Research Corporation; Carol Hays, Illinois StateIncentive Grant Program; Patricia Post, Central Regional Center for the Application ofPrevention Technologies; and Mary Joyce Prudden, CSAP, who offered invaluable sug-gestions for improving the document. The Department of Health and Human Services (DHHS) has reviewed and approvedpolicy-related information in this document but has not verified the accuracy of data oranalyses presented in the document. The opinions expressed herein are the views of theauthors and do not necessarily reflect the official position of SAMHSA or DHHS.DHHS Publication No. (SMA)01-3507Printed 2001For single copies of this document, contact SAMHSA’s National Clearinghouse forAlcohol and Drug Information (NCADI), P.O. Box 2345, Rockville, MD 20847-2345;1-800-729-6686, 301-468-2600, or TDD 1-800-487-4889; or visit the Web site atwww.samhsa.gov.ii Principles of Substance Abuse Prevention
    • ForewordAlthough recent reports show a leveling or decrease in substance use among our nation’syouth, drug abuse remains a problem in our country. There were 14.8 million currentusers of illicit drugs in 1999. This figure represents 6.7 percent of the population ages 12years and older. The 1999 National Household Survey also found increases in illicit druguse among adults ages 18–25. Although the rates for those 26–34 years old and 35 yearsand older have not changed significantly since 1994, overall statistics indicate that thereis still work to be done in preventing substance abuse. The Substance Abuse and Mental Health Services Administration’s (SAMHSA) Centerfor Substance Abuse Prevention (CSAP) developed this series of products in response tothe ongoing substance abuse problems. The three components in this series supportCSAP’s mission to provide resources that are based on science, with measurable out-comes, and designed to help community and state leaders formulate targeted programs. CSAP is committed to sponsoring, accumulating, and integrating knowledge regardingscientifically defensible and effective prevention practices. The primary foci of each doc-ument in this series is CSAP grantees, constituent organizations, and the communitiesthese groups serve. We are pleased to release these findings on the risk factors for substance abuse in dif-ferent domains and successful intervention strategies to prevent substance abuse, delayits onset, and reduce substance abuse-related behaviors. These results show that sub-stance abuse develops in response to multiple influences, including the individual, fami-ly, peers, school/work, community, and society/environment. These domains interactwith one another and change over time. The research confirms that there are a variety of proven approaches to substanceabuse prevention. The strategies highlighted in this booklet range from personal skill-building and opportunities for family bonding to community awareness and youth-ori-ented mass media campaigns. These findings provide an empirical knowledge base forpractitioners and a guide to State and Federal agencies, local governments, and privatefoundations in their efforts to fund programs with measurable outcomes. This booklet is one in a series of products developed to help key stakeholders struc-ture and assess scientifically defensible programs. It is designed to serve practitioners,researchers, and policymakers as we all work together to develop innovative and effec-tive methods of substance abuse prevention that respond to the unique needs of ourindividual communities.Joseph H. Autry III, M.D. Ruth Sanchez-Way, Ph.D.(Acting) Administrator DirectorSubstance Abuse and Mental Health Center for Substance Abuse PreventionServices Administration Substance Abuse and Mental Health Services Administration iii
    • Table of ContentsAcknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .iiForeword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .iiiPrinciples of Substance Abuse Prevention . . . . . . . . . . . . . . . . . . . . . . . . .1 Principles of Effective Substance Abuse Prevention . . . . . . . . . . . . . .1 Why Use Scientifically Defensible Principles? . . . . . . . . . . . . . . . . .4 Why Use This Booklet? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 Prevention Interventions by Domain . . . . . . . . . . . . . . . . . . . . . . . .7 Additional Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23 v
    • Principles of Substance Abuse PreventionFor more than a decade, the Substance ples appearing in this document haveAbuse and Mental Health Services been identified through expert or peerAdministration’s Center for Substance consensus efforts such as consensus pan-Abuse Prevention (CSAP) has supported els and meta-analyses. Many have alsodemonstration programs designed to iden- been published in peer-reviewed journals.tify interventions that work with high-risk Appropriate use of these scientificallypopulations to prevent substance abuse, defensible principles can assist preventiondelay its onset, and reduce substance providers in designing services that areabuse-related behaviors. Research now both innovative and effective, and inconfirms that interventions aimed at modifying proven models to respond toreducing the risk factors and increasing the specialized needs of individualthe protective factors linked to substance programs.abuse and related problem behavior canproduce immediate and long-term posi- Principles of Effectivetive results. Substance Abuse Prevention This section provides a brief listing of the Substance abuse prevention princi- scientifically defensible principles that ples are basic truths, standards, and can help service providers design and elements that effective interventions implement programs that work. The more have in common and that have been detailed descriptions of each principle identified through the careful evalua- within each domain are contained in the tion of substance abuse prevention text that follows. programs. However, principles derive from Individual Domain programs and must be viewed in this context. They are best used to modify I-1. Build social and personal skills. or adapt program core philosophy and I-2. Design culturally sensitive inter- content to specific situations or popu- ventions. lations. The preventionist who con- I-3. Cite immediate consequences. structs programs directly from I-4. Combine information dissemina- principles without an eye toward con- tion and media campaigns with tent may have little to show as a result. other interventions. I-5. Provide positive alternatives to Effective interventions share certain help youth in high-risk environ-principles that guide prevention providers ments develop personal andin structuring client services. The princi- social skills in a natural and effec- tive way. 1
    • Guide to Science-Based PracticesI-6. Recognize that relationships exist Peer Domain between substance use and a vari- P-1. Structure alternative activities and ety of other adolescent health supervise alternative events. problems. P-2. Incorporate social and personalI-7. Incorporate problem identification skills-building opportunities. and referral into prevention pro- grams. P-3. Design intensive alternative pro- grams that include a variety ofI-8. Provide transportation to preven- approaches and a substantial time tion and treatment programs. commitment.Family Domain P-4. Communicate peer norms against use of alcohol and illicit drugs.F-1. Target the entire family. P-5. Involve youth in the developmentF-2. Help develop bonds among par- of alternative programs. ents in programs; provide meals, P-6. Involve youth in peer-led inter- transportation, and small gifts; ventions or interventions with sponsor family outings; and peer-led components. ensure cultural sensitivity. P-7. Counter the effects of deviantF-3. Help minority families respond to norms and behaviors by creating cultural and racial issues. an environment for youth withF-4. Develop parenting skills. behavior problems to interact withF-5. Emphasize family bonding. other nonproblematic youth.F-6. Offer sessions where parents and youth learn and practice skills. School DomainF-7. Train parents to both listen and S-1. Avoid relying solely on knowl- interact. edge-oriented interventionsF-8. Train parents to use positive and designed to supply information consistent discipline techniques. about negative consequences.F-9. Promote new skills in family com- S-2. Correct misconceptions about the munication through interactive prevalence of use in conjunction techniques. with other educational approach-F-10. Employ strategies to overcome es. parental resistance to family-based S-3. Involve youth in peer-led inter- programs. ventions or interventions withF-11. Improve parenting skills and child peer-led components. behavior with intensive support. S-4. Give students opportunities toF-12. Improve family functioning practice newly acquired skills through family therapy when indi- through interactive approaches. cated. S-5. Help youth retain skills throughF-13. Explore alternative community booster sessions. sponsors and sites for schools. S-6. Involve parents in school-basedF-14. Videotape training and education. approaches.2 Principles of Substance Abuse Prevention
    • S-7. Communicate a commitment to C-15. Assess progress from an outcome- substance abuse prevention in based perspective and make school policies. adjustments to the plan of action to meet goals.Community Domain C-16. Involve paid coalition staff asC-1. Develop integrated, comprehen- resource providers and facilitators sive prevention strategies rather rather than as direct community than one-time community-based organizers. events.C-2. Control the environment around Society/Environmental Domain schools and other areas where S/E-1. Develop community awareness youth gather. and media efforts.C-3. Provide structured time with S/E-2. Use mass media appropriately. adults through mentoring. S/E-3. Set objectives for each mediaC-4. Increase positive attitudes through message delivered. community service. S/E-4. Avoid the use of authority figures.C-5. Achieve greater results with highly S/E-5. Broadcast messages frequently involved mentors. over an extended period of time.C-6. Emphasize the costs to employers S/E-6. Broadcast messages through mul- of workers’ substance use and tiple channels when the target abuse. audience is likely to be viewing orC-7. Communicate a clear company listening. policy on substance abuse. S/E-7. Disseminate information about theC-8. Include representatives from every hazards of a product or industry organization that plays a role in that promotes it. fulfilling coalition objectives. S/E-8. Promote placement of more con-C-9. Retain active coalition members spicuous labels. by providing meaningful rewards. S/E-9. Promote restrictions on tobaccoC-10. Define specific goals and assign use in public places and private specific responsibility for their workplaces. achievement to subcommittees S/E-10. Support clean indoor air laws. and task forces. S/E-11. Combine beverage server trainingC-11. Ensure planning and clear under- with law enforcement. standing for coalition effective- S/E-12. Increase beverage servers’legal ness. liability.C-12. Set outcome-based objectives. S/E-13. Increase the price of alcohol andC-13. Support a large number of preven- tobacco through excise taxes. tion activities. S/E-14. Increase minimum purchase ageC-14. Organize at the neighborhood for alcohol to 21. level. S/E-15. Limit the location and density of retail alcohol outlets. 3
    • Guide to Science-Based PracticesS/E-16. Employ neighborhood antidrug accountability and will simultaneously strategies. ensure that program participants receiveS/E-17. Enforce minimum purchase age the most effective services available. laws using undercover buying operations. The Role of DomainsS/E-18. Use community groups to provide Substance use is a complex problem that positive and negative feedback to develops in response to multiple influ- merchants. ences. These spheres of activity—typicallyS/E-19. Employ more frequent enforce- called domains—include the individual, ment operations. family, peers, school, community, and society/environment.S/E-20. Implement “use and lose” laws. Characteristics and conditions thatS/E-21. Enact deterrence laws and poli- exist within each domain of activity also cies for impaired driving. function as risk or protective factors thatS/E-22. Enforce impaired-driving laws. help propel individuals to or safeguardS/E-23. Combine sobriety checkpoints them from substance abuse. As such, with positive passive breath sen- each of these domains presents an oppor- sors. tunity for preventive action.S/E-24. Revoke licenses for impaired dri- Research indicates that as individuals ving. develop, their interactions within andS/E-25. Immobilize or impound the vehi- across domains of activity change over cles of those convicted of time. The Web of Influence model (figure impaired driving. 1) illustrates that these dynamic and complicated relationships can result notS/E-26. Target underage drivers with only in substance abuse, but also in other impaired-driving policies. problem behaviors such as violent crime and suicide.Why Use Scientifically Risk and protective factors are drawnDefensible Principles? from a large body of literature (Bry, 1983;Prevention programs today must produce Hansen, 1997; Hawkins, Catalano, &tangible results. State and federal agen- Miller, 1992; Newcomb & Felix-Ortiz,cies, local governments, and private foun- 1992; Reynolds, Stewart, & Fisher, 1997).dations are interested in funding programs As applied by CSAP and depicted in thewith measurable outcomes. The new Web of Influence, risk and protective fac-emphasis on performance means that pre- tors function as an interactive model. Avention practitioners must show that the risk factor such as delinquency, for exam-programs they propose achieve the results ple, can also become an outcome if anpredicted. The prevention field now has intervention aimed at preventing oran empirical knowledge base to assist changing the development of that behav-practitioners in selecting proven ior fails to achieve its objective. In theapproaches for their programs. Using sci- same way, if an intervention succeeds inentifically defensible principles will help strengthening a protective factor such aspractitioners respond to demands for4 Principles of Substance Abuse Prevention
    • Figure 1Web of Influence Teen School Substance Teenage Violent Pregnancy Dropout Use Suicide Crime Individual Risk and Protective Factors Society/ PeerEnvironment* Family Community** School/Work AssociationRelated Risk Risk and Risk and Risk and Risk and and Protective Protective Protective Protective Protective Factors Factors Factors Factors Factors*Society/Environment: Refers to the total complex of external social, cultural, and economic conditions affecting acommunity or an individual.**Community: Refers to the specific geographic location where an individual resides and to the conditions withinthat particular area.family bonding, improved family bonding Prevention education to teach partici-can become a positive outcome. pants important social skills such as drug resistance and decision making;Substance Abuse Prevention and Alternatives to offer opportunities forTreatment Block Grant Strategies participation in developmentally appro-In the Substance Abuse Prevention and priate drug-free activities to replace,Treatment (SAPT) block grant legislation, reduce, or eliminate involvement in sub-Congress defined six strategies that pre- stance use-related activities;vention programs can use to increase Problem identification and referral toprotective factors and reduce the impact recognize individuals with suspected sub-of risk factors, as follows: stance use problems and refer them for Information dissemination to increase assessment and treatment;knowledge and change attitudes about Community-based processes tosubstance use and abuse through activi- expand community resources dedicatedties such as classroom discussions and to preventing substance use and abusemedia campaigns. through activities such as building com- munity coalitions; and 5
    • Guide to Science-Based Practices Environmental approaches to promote s Although this booklet groups principlespolicy changes that reduce risk factors by domain, planners and providersand preserve or increase protective factors should not feel constrained by thissuch as stepped-up enforcement of legal approach because many principlespurchase age for alcohol and tobacco work well in more than one domain.products. s Principles identified in this booklet may To obtain funding from CSAP through not relate to substance abuse problemsthe SAPT block grant, States must identify directly. Instead, they may influence thethe strategies that will be used in their risk and protective factors that con-proposed interventions. tribute to or guard against problems (Hansen, 1997; Reynolds et al., 1997).Why Use This Booklet? s Although CSAP recommends a compre-Principles of Substance Abuse Prevention hensive approach to substance abuseorganizes scientifically defensible princi- prevention, increasing the number ofples by domain and links them to the pre- principles used in a program does notvention strategies identified in the SAPT necessarily increase its effectiveness. Itblock grant. Service providers can refer to is important to select scientificallyit for ideas about what works, to identify defensible principles that best meet theproven principles in a particular domain, needs of program participants, supportand to justify the use of one or more prin- program objectives, and complementciples in a program. Because each princi- one another.ple is cited, it is relatively easy to locate s Likewise, while scientifically defensiblethe full article for more detailed informa- principles may improve some out-tion. Grant reviewers, evaluators, and fun- comes, they cannot compensate for orders may also find Principles of Substance salvage a poorly designed or imple-Abuse Prevention useful as a quick mented program.overview of the state of the art in preven- s Combining a series of substance abusetion programming and as a tool for deter- prevention principles does not neces-mining whether a program is using sarily make for an effective preventionscientifically defensible principles. program. Principles are best used to modify and enhance existing preventionSome Caveats programs and efforts, rather than createBefore one begins to use the principles new programs from scratch.highlighted in this booklet, it is important s Successful, scientifically defensibleto remember that: interventions rely on strong implemen-s This list is not exhaustive, and it will tation and continuous, rigorous evalua- grow as additional principles undergo tion to determine if benchmarks and evaluation. CSAP encourages program standards have been met and if desired planners and providers to build on the outcomes have been achieved. Such information in this booklet to develop implementation and evaluation are, in the foundation for new and innovative themselves, important for substantiating approaches to substance abuse the scientific defensibility of prevention prevention. principles (Morrissey et al., 1997; Reynolds et al., 1997).6 Principles of Substance Abuse Prevention
    • ties, influence attitudes, and pro-Prevention Interventions by mote behavior inconsistent withDomain use. These interventions usually include information about theIndividual Domain negative effects of substance useAmong the risk factors for substance (Bell, Ellickson, & Harrison, 1993;abuse in the individual domain are lack Botvin, Baker, Dusenbury, Botvin,of knowledge about the negative conse- & Diaz, 1995; Ellickson, Bell, &quences associated with using illegal sub- McGuigan, 1993; Hansen, 1996;stances, attitudes favorable toward use, Pentz et al., 1990; Schinke &early onset of use, biological or psycho- Cole, 1995; Tobler, 1986, 1992).logical dispositions, antisocial behavior, I-2. To be effective, interventions mustsensation seeking, and lack of adult be culturally sensitive and consid-supervision (Bry, 1983; Hawkins et al., er race, ethnicity, age, and gender1992; Scheier & Newcomb, 1991). Most in their designs (Botvin, Schinke,interventions aimed at the individual are Epstein, & Diaz, 1994; Center fordesigned to change knowledge about and Substance Abuse Preventionattitudes toward substance abuse with the (CSAP), 1996).ultimate goal of influencing behavior. I-3. Youth tend to be more concerned about social acceptance and the Linking Skills Development with immediate rather than long-term Information effects of particular behaviors. Life Skills Training (LST) Program Citing consequences such as demonstrates that linking key skills stained teeth and bad breath has development with information target- more impact than threats of lung ing social influences to use, and rein- cancer, which usually develops forcing these strategies with booster later in life (Flay & Sobel, 1993; sessions, can produce durable reduc- Flynn et al., 1997; Paglia & tions in use. Room, 1998). I-4. Used alone, information dissemi- Research shows that whether pro- nation and media campaigns do vided by trained teachers, health pro- not play a major part in influenc- fessionals, or peer leaders, research ing individual knowledge, atti- shows that LST can lower levels of tudes, and beliefs, but they can be tobacco, alcohol, and marijuana use effective when combined with among white, African American, and other interventions (Flynn et al., Hispanic/Latino youth by 59 to 75 per- 1992, 1997; Flynn, Worden, cent and reduce multidrug use by as Secker-Walker, Badger, & Geller, much as 66 percent (Botvin et al., 1995). 1994, 1995). I-5. Alternatives such as organized sports, involvement in the arts,Research has shown the following: and community service provide aI-1. Social and personal skills-building natural and effective way of can enhance individual capaci- reaching youth in high-risk envi- 7
    • Guide to Science-Based Practices ronments who are not in school and who lack both adequate adult Use of Incentives To Promote supervision and access to positive Program Participation activities. Positive alternatives can help youth develop personal and The Strengthening Families social skills inconsistent with sub- Program, aimed at 6- to 10-year-old stance use (CSAP, 1996; Tobler, children of substance abusers and their 1986). parents, used incentives such as movie/sporting event tickets andI-6. Effective programs recognize that vouchers for groceries and other relationships exist between sub- household items as well as transporta- stance use and a variety of other tion to engage and retain parents in the adolescent health problems—such program. This approach spans cultures as mental disorders, family prob- and has been successfully adapted for lems, pregnancy, sexually trans- and evaluated with Hispanic/Latino, mitted diseases, school failure, Asian/Pacific Islander, African and delinquency—and include American, and white families (Kumpfer services designed to address them & Alvarado, 1995; Kumpfer, Molgaard, (Compas, Hinden, & Gerhardt, & Spoth, 1996; Kumpfer, Williams, & 1995). Baxley, 1997).I-7. Incorporating problem identifica- tion and referral into prevention ture can also be a serious risk factor programs helps to ensure that par- (Szapocznik et al., 1997). Research has ticipants who are already using shown the following: drugs will receive treatment F-1. Interventions targeting the entire (Brounstein & Zweig, 1996; family—parents as well as chil- Johnson et al., 1996). dren—can be effective in prevent-I-8. Providing transportation to treat- ing adolescent substance use ment programs can encourage (Dent et al., 1995; Dishion, youth participation (Brounstein & Andrews, Kavanagh, & Soberman, Zweig, 1996). 1996; Hawkins et al., 1992; Kumpfer et al., 1996; Pentz et al.,Family Domain 1989; Walter, Vaughn, & Wynder,Family domain risk factors include 1989).parental and sibling drug use or approval F-2. Retaining parents in family-basedof use, inconsistent or poor family man- programs can also be difficultagement practices—including lack of (Botvin et al., 1995; Dent et al.,supervision, lack of parental involvement 1995). Helping to develop bondsin children’s lives, family conflict, sexual among parents in a programor physical abuse, economic instability, (Cohen & Linton, 1995; Creatingand lack of attachment to parents, often Lasting Family Connections, 1998;called low family bonding (Hawkins & Resnik & Wojcicki, 1991); provid-Catalano, 1992). For immigrant families, ing meals, transportation, andproblems adapting to the mainstream cul- small gifts; sponsoring family out-8 Principles of Substance Abuse Prevention
    • ings; and ensuring that programs are culturally sensitive can help to Interactive Techniques Help improve retention (Kumpfer & Promote Family Communication Alvarado, 1995). Creating Lasting Connections’F-3. Interventions that help minority Getting Real training for parents, families respond to cultural and youth, and families emphasizes role- racial issues can produce positive playing to help participants identify the effects. Issues include the role of responses they use most in talking with the extended family, influence of family members, improve their ability immigration or circular migration, to express feelings and ideas clearly, different language abilities within and establish new patterns of interac- families, influence of religion and tions to enrich family relationships. folk healers, influence of volun- Because adults and children respond tary and social organizations, and differently to interactive techniques stresses experienced by families as such as role-play, the program trains a result of socioeconomic status parents and youth separately. It is also and racism (Kumpfer & Alvarado, careful to limit the age range with 1995; Kumpfer et al., 1997; youth to a three-year span (e.g., ages 9 Szapocznik et al., 1997). to 11) and frequently separates groupss Family strategies that are effective by gender. Careful implementation include the following: ensures that activities occur in a safe F-4. Focus on developing parenting place, a condition important for suc- skills rather than simply offering cessful interactive interventions information about parenting (Bry (Brounstein & Zweig, 1996; Creating & Canby, 1986; Kumpfer et al., Lasting Family Connections, 1998; 1996; Szapocznik et al., 1988). Johnson et al., 1996). F-5. Emphasize family bonding F-8. Train parents to use positive and through opportunities for joint consistent discipline techniques parent-child participation in and to monitor and supervise their activities (Dishion & McMahon, children (DeMarsh & Kumpfer, 1998; Szapocznik et al., 1988). 1986). F-6. Offer sessions in which parents F-9. Interactive techniques, including and youth learn and practice modeling, coaching, rehearsal, skills both separately and togeth- and role-playing, can help to pro- er (Brounstein et al., 1996; mote the development of new DeMarsh & Kumpfer, 1986; skills in programs aimed at Dishion & McMahon, 1998; improving family communication Kumpfer & Baxley, 1997). (Dishion & McMahon, 1998; F-7. Train parents to both listen and Patterson & Chamberlain, 1994; interact in developmentally Szapocznik et al., 1988; Webster- appropriate ways with their chil- Stratton & Herbert, 1993). dren (Brounstein & Zweig, 1996; Kumpfer et al., 1997). 9
    • Guide to Science-Based PracticesF-10. Recruiting parents for family- Peer Domain based prevention programs can be The principal risk factors associated with difficult. Incentives that can help the peer domain are peer use, peer norms overcome resistance include pro- favorable toward use, and peer activities viding transportation and child conducive to use. Research has shown care, offering rewards for partici- the following: pation such as cash payments, P-1. Structured alternative activities and scheduling programs at times and supervised alternative events most convenient for parents (e.g., sober prom and graduation (Kumpfer & Alvarado, 1995). parties) can offer peers an oppor-F-11. With intensive support (at least 12 tunity for social interaction in set- to 15 sessions of counseling and tings antithetical to substance use skills-building), substance-abusing (CSAP, 1996; Williams & Perry, parents can improve their parent- 1998). ing skills and as a result improve P-2. Alternative activities that incorpo- their children’s behavior and rate social and personal skills- reduce both their own and their building opportunities can be children’s levels of substance use effective with youth in high-risk (Bry, 1994; Kumpfer et al., 1996; environments who may not have Olds, 1997). adequate adult supervision orF-12. For families of juvenile offenders, access to a variety of activities, or family therapy can improve family who may have few opportunities functioning, increase family skills, to develop the kinds of personal and reduce recidivism (DeMarsh skills needed to avoid behavioral & Kumpfer, 1986; Kumpfer et al., problems (Tobler, 1986). 1996). P-3. Effective alternative programs tendF-13. Since schools in some communi- to be intensive and include both a ties may not be highly regarded or variety of approaches and a sub- accessible during nonschool stantial commitment of time on hours, exploring alternative com- the part of their participants munity sponsors and sites such as (Schaps, DiBartolo, Moskowitz, churches and community recre- Palley, & Churgin, 1981; Shaw, ation centers can enhance partici- Rosati, Salzman, Coles, & pation in family-focused McGeary, 1997; Tobler, 1986). interventions (Johnson et al., P-4. Alternative events can communi- 1996; Kumpfer et al., 1996). cate peer norms against use ofF-14. Videotaped training and education alcohol and illicit drugs and can can be an effective and cost-effi- serve as community statements in cient tool to teach parenting skills support of no-use norms (CSAP, (Webster-Stratton, 1990; Webster- 1996; Rohrbach, Johnson, Stratton & Herbert, 1993). Mansergh, Fishkin, & Neumann, 1997).10 Principles of Substance Abuse Prevention
    • school climate, and lenient school poli- Exercise Caution When Grouping cies with regard to the use of some sub- Very High-Risk Youth stances (e.g., tobacco). Many researchers believe that student-based risk factors Experience with the peer compo- develop or become more pronounced nent of the highly regarded Adolescent when students are unable to experience Transitions Program (ATP) suggests some satisfaction from their academic some caution in applying peer-oriented efforts. For this reason, academic skills- principles. ATP found that when very building has become an important com- high-risk youth are grouped together, ponent of many after-school, alternative even for a supervised intervention, a activities (CSAP, 1996; LoSciuto, Rajala, contagion effect can occur and prob- Townsend, & Taylor, 1996; Tierney, lem behaviors can increase. More Grossman, & Resch, 1995). In much the mixed or heterogeneous environments same way, lack of attachment to school may be needed to counter the impact may relate to students’inability to set of deviant norms and behavior future-oriented goals, particularly those (Dishion et al., 1996; Dishion & that depend on education for their McMahon, 1998). achievement. Mentoring programs haveP-5. Involving youth in the develop- been designed, in part, to respond to that ment of alternative programs can problem (CSAP, 1996; LoSciuto et al., increase the appeal of the activi- 1996). ties offered and enhance partici- School climate is another factor con- pation (Armstrong, 1992; Komro tributing to the lack of attachment to et al., 1996). school. Together, teachers’ instructional methods, classroom management tech-P-6. Peer-led interventions or interven- niques, class size, student-teacher ratios, tions with peer-led components classroom organization, and educators’ can be more effective than adult- attitudes toward students affect the cli- led approaches (Komro et al., mate in a particular school (Battistich, 1996; Tobler, 1986, 1992). Schaps, Watson, & Solomon, 1996; FelnerP-7. Placing peers whose behavior is et al., 1993; Flay, 1987). Drug testing and deviant into the same group can the use of drug-sniffing dogs are other be problematic. More heteroge- practices employed by some schools. neous environments may be need- However, those approaches have not yet ed to counter the effects of been extensively evaluated to determine deviant norms and behavior effectiveness in countering risk factors or (Dishion et al., 1996; Dishion & reducing levels of substance use at school McMahon, 1998). (Paglia & Room, 1998). Research has found the following:School Domain S-1. When used alone, knowledge-ori-The risk factors associated with the school ented interventions designed todomain include lack of commitment to supply information about the neg-education, poor grades or school failure, ative consequences of substancelack of attachment to school, negative use do not produce measurable 11
    • Guide to Science-Based Practices and long-lasting changes in sub- S-4. Interactive approaches, such as stance use-related behavior or cooperative learning, role-plays, attitudes and are considered and group exercises that give stu- among the least effective educa- dents opportunities to practice tional strategies (Tobler, 1986). newly acquired skills (and that areS-2. While interventions to correct characteristic of social skills and misconceptions about the preva- peer-led interventions), help to lence of use can change attitudes engage and retain youth in pre- favorable toward use (Errecart et vention education programs al., 1991; Hansen & Graham, (Botvin et al., 1994, 1995; 1991), they are most effective in Brounstein & Zweig, 1996; Komro reducing substance use when et al., 1996; Walter et al., 1989; combined with other educational Williams & Perry, 1998). approaches such as fostering S-5. Booster sessions help youth retain social skills (Shope, Kloska, skills learned in prevention educa- Dielman, & Maharg, 1994). tion programs over time (Botvin etS-3. Interventions for youth that are al., 1994, 1995). peer led or include peer-led com- S-6. School-based approaches that also ponents are more effective than involve parents can be effective in adult- or teacher-led approaches preventing adolescent substance (St. Pierre, Kaltreider, Mark, & use (Dent et al., 1995; Dishion et Aitkin, 1992; Tobler, 1986, 1992). al., 1996; Kumpfer et al., 1996; Pentz et al., 1989; Walter et al., 1989). Involving Parents in School-Based Programs Fosters Effectiveness S-7. School policies that communicate a commitment to substance abuse The Child Development Project’ s prevention include formal no-use Homeside Activities give parents a policies for students, teachers, window into what their children are administrators, and other staff; learning in school. This innovative training for teachers and adminis- intervention introduces activities in the trators; and a health education classroom that students complete at program based on validated prin- home with parents and then incorpo- ciples (Paglia & Room, 1998). rate into a follow-up classroom activity or discussion. Parents are also con- Community Domain nected to the school through Family Community domain risk factors include Read-Aloud and other activities lack of bonding or attachment to social designed to create an inclusive school and community institutions, lack of com- environment that, in turn, helps to pre- munity awareness or acknowledgment of vent or delay substance abuse and oth- substance use problems, community er problem behaviors (e.g., involvement norms favorable to use and tolerant of in gangs, carrying weapons) among abuse, insufficient community resources young people (Battistich et al., 1996). to support prevention efforts, and inability12 Principles of Substance Abuse Prevention
    • to address the problem of substance Skogan, 1991; Eck & Wartell, inabuse. Community institutions such as press; Gruenewald, Ponicki, &churches, Boys and Girls Clubs, YMCA Holder, 1993).and YWCA, and Boy and Girl Scouts C-3. Mentoring programs that provideoften provide individuals with opportuni- structured time with adults canties to develop personal capacities and increase school attendance andinteract with prosocial peers in construc- positive attitudes toward others,tive endeavors (Brounstein & Zweig, the future, and school and can1996; CSAP, 1996; St. Pierre et al., 1992; reduce substance use (BrounsteinTierney et al., 1995). Workplaces within & Zweig, 1996; CSAP, 1996;the community, media, and community LoSciuto et al., 1996).coalitions are other vehicles for address- C-4. Community service can increaseing and reducing community domain risk positive attitudes toward others,factors. Specifically, research has found the future, and the communitythe following: and can provide youth withC-1. One-time community-based sub- opportunities to give back to their stance abuse prevention and edu- community (Brounstein et al., cation events alone are unlikely to 1996; CSAP, 1996; LoSciuto et al., affect participants’behavior, but 1996). they can be effective as part of an C-5. Highly involved mentors usually integrated, comprehensive pre- achieve greater positive results vention strategy. In that context, than those who are less commit- such events show that a commu- ted (Brounstein et al., 1996; nity supports no-use norms, draw LoSciuto et al., 1996). public and media attention to sub- C-6. Emphasizing the costs to employ- stance use issues, and help ers of workers’substance use and increase awareness and support abuse can encourage companies for other important prevention to become more active in preven- efforts (Paglia & Room, 1998; tion efforts. Costs include lost pro- CSAP, 1996). ductivity and increased healthC-2. Controlling the environment care premiums to cover sub- around schools and other areas stance-abusing employees and where youth gather helps to rein- their dependents (Cook, Back, & force strong community norms Trudeau, 1996; Frankish, Johnson, against substance use. Controls Ratner, & Lovato, 1997). include restrictions on the number C7. Communicating a clear company of alcohol and tobacco outlets, policy on substance abuse can required setbacks for alcohol and help change workplace norms tobacco outlets, restrictions on about substance use and abuse advertising near schools including (Ames & Janes, 1987; Cook et al., billboards, and the designation of 1996). drug-free zones that set standards for adult as well as youth behav- ior (Davis, Smith, Lurigio, & 13
    • Guide to Science-Based Practices C-8. Community coalitions that work Mentoring Can Increase Positive include representatives from every Attitudes and Reduce Substance organization that plays a role in Use fulfilling coalition objectives. For example, if comprehensive service Across Ages: An Intergenerational coordination is the objective, Approach to Drug Prevention careful- community agency leadership ly matches adult mentors, ages 55 and needs to be involved (Christenson, over, to sixth-grade African American, Fendley, & Robinson, 1989; Asian, Latino, and white students in Edelman & Springer, 1995; three Philadelphia middle schools. Warren, Rodgers, & Evers, 1975). Recognizing the importance of conti- If the objective is raising commu- nuity, Across Ages encouraged mentor- nity awareness and stimulating ing relationships that encompassed community action, grassroots parents and teachers as well as stu- activists and community citizens dents and extended past the school must be involved (Chavis & year and throughout the summer. Florin, 1990; CSAP, 1997a, Across Ages’ multidimensional 1997b; Warren et al., 1975). approach to mentoring brought com- Community linkage coalition munity residents into the schools and models require a mix of both improved school attendance. Students types of community members with deeply committed mentors (CSAP, 1997b). changed their attitudes toward older C-9. Effective coalitions retain active people, school, and the future and members by providing meaningful developed increased capacity to resist rewards for participation such as peer pressure to use drugs (Brounstein opportunities for organizational & Zweig, 1996; CSAP, 1996; Johnson leadership, distribution of et al., 1996; LoSciuto et al., 1996). resources to home agencies, and accomplishment of highly valued personal, organizational, and community goals (Join Together, 1996; Nistler, 1996). C-10. Effective coalitions define specific goals and assign specific responsi- bility for their achievement to sub- committees and task forces, rather than spending time on elaborating organizational structures and pro- cedures (Christenson, 1989; Join Together, 1996; Rohrbach et al., 1997). C-11. Planning is critical to coalition effectiveness and begins with a clear understanding, drawn from14 Principles of Substance Abuse Prevention
    • validated empirical evidence, of based perspective and make the substance-related problems it adjustments to the plan of action seeks to change (Armstrong, 1992; to meet their goals. Success is a Gabriel, 1997; Join Together, function of strategies and activi- 1996; Reynolds & Fisher, 1997). ties, not a reflection of a coali-C-12. Effective coalitions set outcome- tion’s organizational structure or based objectives that are used to design (CSAP, 1997b, 2000; develop specific strategies and Forster et al., 1992; Gabriel, subsequent activities (Forster, 1997; Join Together, 1996; Keay, Hourigan, & McGovern, 1992; Woodruff, Wildey, & Kenney, Join Together, 1996; Reynolds, 1993). Stewart, & Fisher, 1997). C-16. Paid coalition staff can functionC-13. Effective coalitions support a large more effectively as resource number of prevention activities, providers (such as communica- rather than focusing on a single tions, coordination, and adminis- project (CSAP, 2000). trative expertise) and facilitatorsC-14. Residents are more likely to par- than as direct community organiz- ticipate in community partnership ers (Join Together, 1996). It is activities if they are organized at important for paid staff members the neighborhood level, where to serve as catalysts for action and volunteers can see how they will ensure that community partici- affect their own situations (CSAP, pants receive credit for program 2000). success (CSAP, 2000).C-15. Effective coalitions routinely assess progress from an outcome- Society/Environmental Domain Risk factors in the society/environmental domain include norms tolerant of use and Planning Is Essential to Coalition abuse, policies enabling use and abuse, Effectiveness lack of enforcement of laws designed to prevent use and abuse, and inappropriate The Day One Community negative sanctions for use and abuse. Partnership devised the Alcohol Since long-lasting effects should Sensitive Information Planning System accrue from changing school, family, and (ASIPS) to assess the extent to which societal norms that promote and maintain local criminal activity was alcohol drug abuse in youth, many prevention related and to provide a foundation for specialists are trying to incorporate a community planning activities. As one focus on both individual change and outgrowth of this assessment effort, changes in the systems or environmental Day One was able to marshal the data contexts that promote or hinder use. This needed to convince the city to use city expansion will have a positive impact on zoning to regulate retail availability of larger numbers of people than has our alcohol and tobacco and to conduct a reliance on more individually targeted decoy purchase program (Rohrbach et programs that focus more on persons with al., 1997). a greater likelihood of becoming problem 15
    • Guide to Science-Based PracticesFigure 2Program Targets and Potential Impactsabusers. The impact of this environmental also recognize that audience per-focus on society as a whole may be sub- ceptions and capacities to under-stantial, and societal/environmental sys- stand media messages may varytems change efforts may form an based on gender, culture, andimportant first line of defense in fighting stage of cognitive developmentthe spread of substance abuse. (Figure 2) (Flynn et al., 1992, 1997). Research has found the following: S/E-3. Effective mass media campaignsS/E-1. Community awareness and media set objectives for each message efforts can be effective tools for delivered; for example, to increasing perceptions regarding increase positive expectations for the likelihood of apprehension nonuse or to correct assumptions and punishment for substance- about the number of youth who related violations and can reduce use (Flynn et al., 1997). retailer noncompliance (Lewit, S/E-4. Youth-oriented mass media cam- Coate, & Grossman, 1981; paigns that are effective with Schneider, Klein, & Murphy, youth in high-risk environments 1981). avoid the use of authority figures.S/E-2. Appropriate use of mass media Instead, they use young models can enhance community aware- who appeal to the target group ness and influence community (Flynn et al., 1992). norms about substance use (Paglia S/E-5. Effective campaigns broadcast & Room, 1998). Effective, youth- messages frequently over an oriented mass media campaigns extended period of time. For identify target audiences. They example, an effective media cam-16 Principles of Substance Abuse Prevention
    • Grossman, 1996; Flynn et al., Changing the Community 1992; Wallack & DeJong, 1995). Environment Can Reduce S/E-8. The limited research on alcohol Underage Use of Alcohol warning labels suggests that while they may affect awareness, atti- Responsible beverage-server train- tudes, and intentions regarding ing for retail outlets and bars and com- drinking, they do not appear to pliance checks of age-of-purchase laws have a major influence on behav- (coordinated with local police depart- ior (Barlow & Wogalter, 1993; ments and sheriffs’offices) were among Hilton, 1993; Laughery, Young, the many integrated components of Vaubel, & Brelsford, 1993). Project Northland, the largest random- Studies have suggested that more ized community trial ever conducted conspicuous labels would have a for the prevention of adolescent alco- greater effect on awareness and hol use. Project Northland confirms the behavior (Laughery et al., 1993; importance of applying long-term envi- Malouff, Schutte, Wiener, ronmental interventions as well as Brancazio, & Fish, 1993). interventions oriented to individuals to reduce underage alcohol use. It also S/E-9. Restrictions on tobacco use in showed that it is possible to mobilize public places and private work- community support for norms reinforc- places (also known as clean ing the unacceptability of underage use indoor air laws) can be effective (Williams & Perry, 1998). in curtailing cigarette sales (Chaloupka & Saffer, 1992) and paign in Vermont aired 540 televi- tobacco use among adults and sion broadcasts of 36 different youth (Chaloupka, 1992; spots and 350 radio broadcasts of Chaloupka & Pacula, 1997; 17 different spots per year over Evans, Farrelly, & Montgomery, four years (Flynn et al., 1997). 1996; Ohsfeldt, Boyle, & Capilouto, 1999; Wasserman,S/E-6. Mass media messages that are Manning, Newhouse, & Winkler, effective are broadcast through 1991). multiple channels at times when members of the target audience S/E-10. Clean indoor air laws can reduce are likely to be viewing or listen- nonsmokers’exposure to cigarette ing (Flynn et al., 1992, 1997). smoke and help to alter norms regarding the social acceptabilityS/E-7. Counteradvertising campaigns that of smoking (DHHS, 1994). disseminate information about the hazards of a product or the indus- S/E-11. Education and training programs try that promotes it may help teach beverage servers about reduce cigarette sales (Chaloupka alcohol-related laws, the penalties & Grossman, 1996; Flay, 1987; for violation, the signs of intoxica- Flynn et al., 1992) and tobacco tion and false identification, and consumption (Chaloupka & techniques for refusing sales. However, when used alone, these programs usually do not produce 17
    • Guide to Science-Based Practices substantial and sustained shifts Wagenaar, 1991; Wagenaar, toward compliance with the law 1993), particularly beer consump- (Altman, Rasenick-Douss, Foster, tion (Berger & Snortum, 1985), & Tye, 1991; DiFranza & Brown, and in reducing alcohol-related 1992; DiFranza, Savageau, & traffic crashes (General Aisquith, 1996; Skretny, Accounting Office, 1987; Cummings, Sciandra, & Marshall, National Highway Traffic Safety 1990). Administration, 1995; Safer &S/E-11. Combining beverage-server train- Grossman, 1987; Toomey, ing with enforcement of laws Rosenfeld, & Wagenaar, 1996; against service to intoxicated Wagenaar, 1993). patrons and against sales to S/E-14. Increasing the minimum purchase minors is much more effective age for alcohol to age 21 is asso- than training alone in changing ciated with reductions in other selling and serving principles alcohol-related problems, includ- (Cummings & Coogan, 1992; ing suicide, pedestrian injuries, Feighery, Altman, & Saffer, 1991). other unintentional injuries (Jones,S/E-12. Increasing beverage servers’legal Pieper, & Robertson, 1992), and liability for alcohol-related crashes youth homicide (Parker & can reduce injuries and fatalities Rebhun, 1995). (Wagenaar & Holder, 1991). S/E-15. Limitations on the location andS/E-13. Increasing the price of alcohol density of retail alcohol outlets and tobacco through excise taxes may contribute to reductions in can be an effective strategy for reducing the prevalence of use and the amount consumed Neighborhood Antidrug Strategies (Chaloupka & Grossman, 1996; Can Disrupt Illicit Drug Markets DHHS, 1989, 1992; Edwards et and Reduce Alcohol and Tobacco al., 1994; Evans et al., 1996). Sales to MinorsS/E-13. Price increases can reduce alco- The Community Coalition for hol-related problems, including Substance Abuse Prevention and motor vehicle fatalities (Cook, Treatment in South Central Los 1981), driving while intoxicated, Angeles fought successfully to control rapes, robberies (Cook, 1981; the rebuilding of liquor stores in neigh- Cook & Moore, 1993; Cook & borhoods scarred by civil unrest. Its Tauchen, 1984), cirrhosis mortali- Neighborhoods Fighting Back project ty (Cook & Tauchen, 1982), and also forced absentee landlords to suicide and cancer death rates board up an abandoned house used (Sloan, Reilly, & Schenzler, 1994). for cocaine trafficking. Other partner-S/E-14. Increasing the minimum purchase ship efforts led to a new ordinance that age for alcohol to age 21 has levies financial penalties on those sell- been effective in decreasing alco- ing tobacco to underage youth (CSAP, hol use among youth (O’Malley & 2000).18 Principles of Substance Abuse Prevention
    • alcohol consumption feedback to merchants can also (Gruenewald, 1993), traffic crash- increase retailer compliance es (Gruenewald & Ponicki, (Biglan et al., 1995; Lewis, 1995b; Scribner, MacKinnon, & Huebner, & Yarborough, 1996). Dwyer, 1995), and other alcohol- S/E-19. More frequent enforcement opera- related problems, including cir- tions can reduce retailer noncom- rhosis mortality (Gruenewald & pliance (Lewis et al., 1996; Ponicki, 1995a), suicide Preusser et al., 1994). (Gruenewald, Ponicki, & Mitchell, S/E-20. “Use and lose” laws, which 1995), and assaultive offenses allow suspension of the driver’s (Scribner et al., 1995). license of a person under age 21S/E-16. Neighborhood antidrug strategies following a conviction for any such as citizen surveillance and alcohol or drug violation (e.g., the use of civil remedies, particu- use, possession, or attempt to pur- larly nuisance abatement pro- chase with or without false identi- grams, can be effective in fication), can increase compliance dispersing dealers, reducing the with minimum purchase-age laws number and density of illicit drug among youth (Preusser, Ulmer, & markets, and possibly reducing Preusser, 1992). other crimes and signs of physical S/E-21. Deterrence laws and policies for disorder within small geographical impaired driving can reduce the areas (Davis et al., 1991; Eck & number of alcohol-related traffic Wartell, 1998; Green-Mazarolle, crashes and fatalities among the Roehl, & Kadleck, in press; general population and particular- Lurigio et al., 1993; Rosenbaum & ly among youth. Reducing the Lavrakas, 1993; Smith, Davis, legal blood-alcohol content (BAC) Hillenbrand, & Goretsky, 1992). limit to 0.08 or lower can reduceS/E-17. Enforcement of minimum pur- the level of impaired driving chase-age laws against selling (Kloeden & McLean, 1994) and alcohol and tobacco to minors by alcohol-related crashes (Hingson, using undercover buying opera- Heeren, & Winter, 1994; Johnson, tions (also known as decoy or 1995). sting operations) can substantially S/E-22. Enforcement of impaired driving increase the proportion of retailers laws can increase public percep- who comply with such laws tion of the risk of being caught (Cummings & Coogan, 1992; and punished for driving under Feighery et al., 1991; Forster et the influence of alcohol (Voas, al., 1998; Jason, Billows, Schnop- Holder, & Gruenewald, 1997). Wyatt, & King, 1996; Jason, Ji, S/E-23. Used alone, sobriety checkpoints Anes, & Birkhead, 1991; Preusser, are not effective in detecting large Williams, & Weinstein, 1994). numbers of drinking driversS/E-18. Undercover buying operations (Ferguson, Wells, & Lund, 1995; conducted by community groups Jones & Lund, 1985). that provide positive and negative 19
    • Guide to Science-Based PracticesS/E-23. Combining sobriety checkpoints Heeren, Howland, & Winter, with passive breath sensors that 1993; National Transportation allow police officers to test a dri- Safety Board, 1993; Sweedler, ver’s breath without probable 1990). cause can substantially increase the effectiveness of sobriety Additional Resources checkpoints (Ferguson et al., CSAP has developed a series of products 1995; Jones & Lund, 1985). to assist program planners, evaluators,S/E-24. Administrative license revocation administrators, and policy makers in for impaired driving, which allows designing and assessing scientifically an arresting officer to confiscate a defensible programs. In addition to this driver’s license if the driver is publication, Principles of Substance arrested with an illegal BAC or if Abuse Prevention: A Domain-Based the driver refuses to be tested, can Approach, products include the reduce the number of fatal traffic following: crashes (Hingson, 1993; Klein, s Defining Science-Based Substance 1989; Ross & Gilliland, 1991; Abuse Prevention: An Evaluators’ Zador, Lund, Fields, & Weinberg, Guide, a technical description of the 1989) and also reduces recidivism CSAP methodology for identifying sci- among driving-under-the-influ- entifically defensible programs. ence (DUI) offenders (Stewart, s Promising and Proven Substance Abuse Gruenewald, & Roth, 1989). Prevention Programs, a comprehensiveS/E-25. Immobilizing or impounding the compilation of both proven and promis- vehicles of those who have been ing interventions in an easy-to-scan grid convicted of an impaired-driving organized by risk factor and domain offense can significantly reduce that also includes information on target DUI recidivism rates for multiple age, Institute of Medicine (IOM) preven- DUI offenders (Voas, Tippetts, & tion classification, program outcome, Taylor, 1997, 1998). Deterrence and CSAP strategy. effects from marking license plates CSAP also maintains a Web site and of DUI offenders have been mixed publishes materials to help prevention (Voas, Tippetts, & Lange, 1997). practitioners replicate proven model pro-S/E-26. Impaired-driving policies targeting grams. The Web site includes download- underage drivers—particularly able versions of Promising and Proven zero-tolerance laws setting BAC Substance Abuse Prevention Programs, limits at 0.00 to 0.02 percent for one of the publications described above. youth and graduated driving privi- It also provides the most up-to-date infor- leges, in which a variety of dri- mation available about CSAP’s model ving restrictions are gradually programs for replication. lifted as the driver gains experi- s The Web site for CSAP model pro- ence and maturity—can signifi- grams is www.samhsa.gov/csap/model- cantly reduce traffic deaths among programs. young people (Blomberg, 1993; Hingson et al., 1994; Hingson,20 Principles of Substance Abuse Prevention
    • s Brounstein & Zweig, 1999, Among the other resources available Understanding Substance Abuse through the Clearinghouse to help pre- Prevention, Toward the 21st Century: A vention practitioners in developing or Primer on Effective Programs. This improving programs are: monograph, which traces the process s The Prevention Enhancement Protocols used to identify and evaluate the first System (PEPS) guidelines on group of CSAP model programs, is s Reducing Tobacco Use Among available in both print and electronic Youth: Community-Based versions. The electronic version is on Approaches; the model programs Web site. The print s Preventing Substance Abuse Among version is available from the National Children and Adolescents: Family- Clearinghouse for Alcohol and Drug Centered Approaches;and Information (NCADI). See contact infor- mation below. s Preventing Problems Related to Alcohol Availability: Environmentals CSAP (2000), Prevention Works Approaches. Through Community Partnerships: Findings From SAMHSA/CSAP’s s Impaired Driving Among Youth: Trends National Evaluation, Rockville, MD: and Tools for Prevention; CSAPDHHS Publication No. (SMA)00- s A Review of Alternative Activities and 3373. This monograph, which presents Alternative Programs in Youth-Oriented information on five model community Prevention; and partnerships, is available from the s Selected Findings in Prevention: A SAMHSA’s National Clearinghouse Decade of Results from the Center for for Alcohol and Drug Information Substance Abuse Prevention. P.O. Box 2345 Rockville, MD 20847-2345 Toll-free tel: 1-800-729-6686 Local tel: 301-468-2600 Fax: 301-468-6433 TDD (hearing impaired): 1-800-487-4889 www.health.org e-mail: info@health.org 21
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