ENGAGE: Evidence-Based Strategies to Prevent Youth Substance Use Overdose Prevention

Interestingly, the TAU condition used a problem-solving approach and focused on directive counseling, whereas the ABP approach was less directive and focused on emotional support. An analysis of the content of the therapies found that the supportive, exploratory aspects of the ABP treatment were more important than the content of the ABP itself (Berg, Sandahl, & Clinton, 2008). Other treatment models have been developed, although they have little empirical support.

In an emergency? Need treatment?

• People experiencing SUDs have trouble controlling their drug use even though they know drugs are harmful.
• Similarly, women who smoke have a greater risk than men of tobacco‐related heart disease, lung disease, and other health problems335.
• Cannabinoids can provide some relief of neuropathic and cancer‐related pain, but their effects are small and tend to diminish over time, and they can have significant side effects300.
• The effectiveness of its immediate‐release formulation as a treatment for opioid use disorder has been limited by poor adherence193, but its extended‐release (3‐4 weeks) formulation, XR‐NTX, significantly improves treatment retention194.
• Treatmentof early onset mental disorders, screening for substance use with their patientsand providing advice can help reduce the burden of the problem.

Substance use and SUDs are multidetermined, with the different risk factors playing varying roles at different life stages, from the prenatal period and childhood to early and late adulthood78, 79, 164. The goal of SUD prevention is avoiding the use of psychoactive substances, in order to foster healthy development and ensure that young people are best able to realize their potential and engage positively with their families, schools and communities273. Brief interventions are for individuals whose substance use causes mild to moderate interference, but who do not meet criteria for a moderate or severe SUD (pre‐addiction). The US Preventive Services Task Force considers the evidence insufficient for other substances247.

Risk Factors

All over the world, mental health needs are high but responses are insufficient and inadequate…. Read more about how NIDA is advancing the science on effective prevention strategies. It is important to give any treatment plan a chance to work before deciding whether it is right for you.

Substance use disorder (SUD) is a condition where someone struggles to control their use of alcohol, drugs, or other substances, even when it’s clearly causing problems in their life. Substance use disorders can be caused by multiple risk factors, including environmental influences, other mental health disorders, or childhood trauma and genetics 4. Leveraging a socioecological approach empowers leaders to champion prevention strategies that address health equity and amend the nation’s historically unjust practices, some of which persist today. With health equity in mind, the authors encourage US leaders to sharpen their attention toward macro-level solutions for prevention; these hold the greatest potential for sustainably improving health for all citizens across a broad set of health outcomes. Figure 1 illustrates the nested levels of factors considered in a socioecological framework, which have been highly simplified for the purpose of organizing the current argument. Macro-level factors, such as policies and practices, can have direct impacts on individuals’ health by subjecting them to stigma, trauma, and discrimination stemming from these broader influences.

Treatment for co-occurring disorders

Upregulation of CRF in the amygdala in turn plays a role in negative emotional states during drug withdrawal51. In the addicted state, there is a diminished sensitivity to the drug’s rewarding properties, such that increasingly higher doses are needed to produce the desired effect. Over time, this leads to seeking the drug not for its pleasurable effects, but instead to escape the aversive state of withdrawal. The emergence of withdrawal symptoms upon drug discontinuation, which is particularly severe from opioids, alcohol and nicotine, contributes to perpetuating drug‐taking.

Exploring Prevention Programs for Substance Abuse

• The longer the pattern continues, the more mood, judgment, and behavior are altered, leading to the development of SUD.
• Several types of treatment settings, including inpatient and outpatient settings, as well as short-term care and long-term therapeutic communities, are available.
• Addressing mental health issues such as anxiety and depression plays a vital role, as these conditions can increase the likelihood of substance abuse.
• Dentists, although typically less involved in treating SUD, are well-positioned to recognize oral signs of substance use and refer patients to appropriate care—but they, too, face gaps in training and systemic support.
• “Teens may use alcohol and other substances to help them cope with stress, anxiety, and depression,” said Dr. Allison Arwady, director of the CDC’s National Center for Injury Prevention and Control, in a press release.

Race, often treated in biomedical perspectives as biologically defined (Ioannidis, Powe, and Yancy, 2021), is recognized as a socially constructed factor that is not biologically determined but does create differences in biological outcomes (Krieger, Dorling, and McCartney, 2012; Roberts, 2012). Among those in the United States who died of overdose, the racial inequity that existed before the pandemic was amplified by the heavier economic, social, and health burdens carried by non-Hispanic Black individuals during the pandemic. This group had the greatest annual increase in drug-related overdose deaths in 2020 (Mistler et al., 2021; SAMHSA, 2020a).

Sheidow, McCart, Zajac, and Davis (2012) report that 36% to 40% of young adults with a serious mental health condition or young adults seeking treatment meet criteria for a SUD. Among adolescents in treatment studies, more than 60% have comorbid substance use and non-SUD with more than 50% having a conduct disorder and 15% having major depression or attention-deficit/hyperactivity disorder (ADHD; Grella, Hser, Joshi, & Rounds-Bryant et al., 2001). It is logical that the presence of comorbid disorders indicates a need for the simultaneous treatment of both conditions, sometimes referred to as integrated treatment of dual disorders.

What are some prevention programs for substance abuse?

The National Association of Addiction Treatment Providers recognizes addiction as a disease with psychological and social components, not a lack of willpower or an acute, behaviorally-centered condition. Become educated about drugs of abuse and the statistics surrounding them, and learn how to tell when someone may have a Substance Use Disorder. Like other chronic conditions, substance use disorder often requires ongoing care and adjustments in treatment plans. Yes, substance use disorder is the clinical term for what’s commonly called addiction. Both describe a condition where the person continues using drugs or alcohol even when it harms their well-being. By targeting emotional triggers and behavior patterns, therapy helps change how someone responds to stress.

Some people use the term to describe some substance use disorders, especially more serious presentations. One of the most impactful models demonstrating effectiveness in preventing substance use among adolescents is the Icelandic Prevention Model (IPM). This model operates within the community, concentrating on tackling the underlying environmental and social factors that contribute to substance use Figure 2. For an adult, a divorce, loss of a job or death of a loved one may increase the risk of substance use. It’s important to turn to healthy coping mechanisms during these times of change, like exercising, meditating or learning a new hobby. Consider seeing a mental health professional if you’re having difficulty managing stress.

SUD medications

This differs from the UK, where e‐cigarettes are encouraged as smoking‐cessation aids181. Consequently, we recently proposed the new term “pre‐addiction” to identify the early stages of a SUD (mild SUD, as per DSM‐5) as a focus of attention in screening for problematic drug use15. The term and strategy were inspired by the introduction of the term “pre‐diabetes” to bring attention to the early stages of a condition amenable to intervention, in order to halt the progression to the full‐blown disease. This resulted in policies in health care that now reimburse for early screening and intervention in pre‐diabetes and also incentivize education of health providers in its recognition and management.

A strong genetic predisposition exists along with environmental risks for the development of comorbid disorders (Kessler, 2004). For example, the idea that drug use is a deviant behavior engaged in by undesirable elements in society and, more broadly, stigmatization and discrimination against individuals who use substances, create resistance against policies that promote decriminalization. Chronic pain is significantly more prevalent among people with SUDs than in the general population, and this is a factor that can contribute to drug‐taking292, 293. Managing patients with co‐occurring chronic pain and SUD – particularly opioid use disorder – presents unique challenges294, 295, including sometimes lack of trust between patients and clinicians regarding symptoms of pain and patterns of opioid use. Patients may fear that clinicians are unwilling to continue prescribing opioids or are going to reduce the amount prescribed. Clinicians may be concerned that patients deny or minimize aberrant patterns of opioid use or other symptoms of opioid use disorder, or that they may obtain medication through doctor shopping or from the illicit market.

Many people with substance use disorders also experience other mental disorders like depression, anxiety, or bipolar disorder. Similarly, people with mental disorders are at a higher risk of developing substance use problems. Prevention research over the years has emphasized that working in an isolated fashion with individuals, families, or schools is insufficient to make meaningful reductions in adverse mental health outcomes, such as substance use at the population level. This has led to the adoption of community-based prevention models in many parts of the world, which focus not only on reducing problem behaviors but also prevention of substance use and mental disorders enhance a sense of well-being and ownership among communities.

Accurate diagnosis is key for treating co-occurring substance use and mental disorders, since symptoms may overlap. Health care providers with experience in both substance use disorders and mental disorders can use comprehensive assessment tools to reduce the chance of a missed diagnosis and create an effective treatment plan. Our Risk of Bias review revealed significant methodological weaknesses that need to be remedied in future research.