National data reveal that many youth engage in substance use by the time they graduate high school, but most desist and do not develop a SUD. Substance use and overdose rates vary across substances (e.g., nicotine, cocaine, opioids) and states. While rates have changed over time, accidental overdose rates among youth have risen[1].

As a primary setting for youth development, schools can play a key role in substance misuse prevention. From school contexts (e.g., in the classroom, after school programs) to facilitators (e.g., teachers, nurses, peer mentors), there are strategies policymakers can consider to maximize youth access to and participation in school-based substance misuse prevention programs.

Key Features of Effective Substance Misuse Prevention Programs for Youth

Prevention strategies can improve youth awareness, knowledge, and attitudes related to substance misuse. These strategies can also build individual, interpersonal, family, and community skills, as well as promote resilience. Effective prevention has extensive, cross-cutting effects on different types of substance use and other areas of behavioral health.

Effective prevention programs include the following key features:

• Utilize evidence-based content and delivery. Evidence-based prevention content targets social influences and comprehensive life and academic skills through structured activities. Evidence-based delivery prioritizes interactive teaching and skills-building rather than passive information dissemination.
• Use effective universal, targeted (selective), and indicated approaches. Universal prevention strategies are delivered to youth at a population level and can therefore be implemented efficiently without individual tailoring (e.g., cooperative/peer learning, fostering a positive school climate). Given the complexities in addressing substance use, there are also opportunities to tailor approaches to the needs of well-defined, at-risk subgroups through age-appropriate targeted/selective or indicated strategies[2].
  • Multi-level systems of support that involve community resources, schools, and families are the most comprehensive programs.
  • Increased efforts may be needed to adapt programs and reach youth from minority and low-income families, as well as those in rural communities.
• Involve the community, school, and family systems. Programs that integrate the efforts of the community, school, and family in some capacity are critical for all prevention programs and promoting prosocial youth development. Programs may engage others to strengthen protective factors and weaken risk factors.
  • Community efforts (e.g., substance misuse prevention media campaigns) may be supplemented by partnerships between schools, parents, and community organizations.
  • School connectedness can decrease substance misuse, and cooperative/peer learning can promote positive relationships while reducing substance use.
  • Known family protective factors include strong relationships, effective parent behavior management, and high family functioning, among others. The strengths of these protective factors can vary by age.
• Use strengths-based and empowerment approaches. Strengths-based programs build on youth’s strengths rather than focusing solely on negative risks, including their desires to explore and collaborate with adults. These approaches empower youth to make healthy decisions and have been shown to reduce substance misuse among youth of color.

Considerations for Policymakers

The motivations, patterns, and risk factors of substance use are diverse, as are approaches to prevent substance use. Supporting the widespread, sustainable scale-up of established, evidence-based prevention programs that are culturally-tailored and developmentally-appropriate holds promise for improving youth engagement and health outcomes while reducing health disparities.

Strategies to strengthen school-based prevention programs include:

• Expand the delivery of effective evidence-based prevention programs in schools. Participation in these programs has been declining due to decreases in funding and availability of school- and community-based programs, despite research suggesting they are cost-effective. With hundreds of existing programs, it is important to prioritize those that are evidence-based and can be implemented with high fidelity.
• Support substance misuse prevention research across populations. Translational research is needed to understand what works best for whom and under what circumstances. Few evidence-based substance use prevention programs have been developed with health equity in mind.
• Establish school district prevention leaders. School district substance use prevention coordinators and district-level coalitions play a large role in the adoption and implementation of effective programs. Information, training, and resources about evidence-based prevention programs should be disseminated to these local leaders.
• Train prevention professionals in schools. Fostering competencies among school professionals and providing certifications can help ensure personnel are appropriately trained in substance misuse prevention. This might include helping teachers identify signs/symptoms of youth using substances, situations that expose students to substances, and other factors that heighten risk of substance use.
• Promote collaborations between schools and other organizations. School-based prevention programs combined with community programs can promote sustained positive youth development. Assistance (e.g., community mobilization models) may be needed to support community organizations in partnering with schools and implementing effective programs with fidelity, as these partners are often unaware of best practices for adapting programs[3]. Bringing in graduate students[4] could help bridge gaps in funding, services, and exposure to evidence-based prevention strategies.

Glossary of Terms

• Substance: Something that when ingested affects mental processes (e.g., cognition or affect). Includes substances that are legal and illicit.
• SUD: A generic term for diseases of “various conditions and illnesses associated with the use of any psychoactive drug. It includes both problematic and dependent drug use.”
• Misuse: The “use of a substance for a purpose not consistent with legal or medical guidelines, as in the non-medical use of prescription medications.” The term is preferred by some to “abuse,” as it is less stigmatizing. It may also refer to high-risk use, e.g., excessive use of alcohol in situations where drinking is not illegal.
• SUD prevention: Broadly, “an intervention designed to change the social and environmental determinants of drug and alcohol abuse, including discouraging the initiation of drug use and preventing the progression to more frequent or regular use among at-risk populations.”

[1] Although opioid prescription rates are decreasing (e.g., fentanyl and oxycodone), the availability of these drugs in homes can increase risk of exposure and harms to youth, including accidental or intentional use, overdose, and death.

[2] Targeted prevention approaches can be used for individuals with risk factors that increase their chances of developing a SUD (e.g., truancy, failing academic grades, juvenile depression, suicidal ideation), and indicated prevention approaches can be used for individuals showing early signs of substance use.

[3] Some academic units (e.g., Penn State EPIS and project ECHO, Colorado State University Prevention Research Center, among others), the SAMHSA Prevention Technology Transfer Centers, and local training and technical assistance providers provide a wide range of such supports.

[4] This could include students studying counseling, psychology, social work, public health, and prevention science who can collaborate with other professionals (e.g., educators, law enforcement) on interventions that mobilize local prevention resources.