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We define prevention as an ongoing process of promoting the individual's, the family's, and the community's full personal growth and potential in order to reduce the likelihood of problems related to alcohol and/or drug abuse. Prevention efforts are effective only in the degree to which they address and involve all aspects of the emotional, interpersonal and social milieus in which underage or excessive drinking or drug abuse occurs. Alcohol consumption and drug abuse are pervasive in society; any effort to prevent it must be operate on an equally comprehensive basis. To accomplish this goal, our basic approach is to provide the indirect services (consultation, training, and technical assistance) which support citizen and institutional involvement in prevention activities through education, voluntary action and community organization.

Prevention activities may take a two-pronged approach: (1) a deliberate and constructive process designed to promote growth of individuals and communities toward full human potential, (2) the counteraction of harmful circumstances such as health and safety hazards, family stresses, job pressures, isolation, violence, economic hardship and inadequate housing, medical services, or child care. Every segment of the community has a special role to play in prevention. Parents and schools are particularly important.

A key question is, "What, exactly, do we mean by prevention?" Within the alcohol and drug field, there are two major schools of thought regarding prevention, and these lead to two very different categories of activities. The first group of activities may be called "educationally oriented" prevention strategies. The second, newer set of activities is referred to as "environmentally focused" or "public policy oriented" prevention.

Educationally oriented prevention is what most people mean when they talk about "prevention." This refers to activities such as classroom curricula to educate school children about the effects of alcohol and other drugs and media campaigns to teach the public the early warning signs of alcoholism and other addictions. This category of prevention activities is based on these assumptions which have not proven valid:

A newer, more creative set of ideas regarding prevention of alcohol problems focuses on altering the environment in which these problems occur. This approach is both constructed upon and necessitated by the fact that alcohol (the drug ethanol) is legal and widely available.

Advocates of this approach emphasize two important ideas. First, we must deal with a broad range of alcohol-related problems, not just "alcoholism". Alcohol is involved in much violent crime and household injuries, for example, but not all the people involved are "alcoholics". A second concept important to this approach is that the environments or settings in which consumption of alcohol occurs are an important piece of the puzzle. Drinking, in and of itself, may not necessarily be a problem. Drinking just before driving a car on the freeway is a problem.

We can create environments which reduce the risks associated with alcoholconsumption through State and local laws. Private businesses can implement policies to do the same thing.

Thus, laws which curtail the sale of alcohol to minors reduce the risk of teenage traffic crashes, Banning sales of alcohol during the last segment of a professional sporting event reduces the likelihood that spectators will drive away from the stadium under the influence of alcohol, thus reducing the risk of drunk driving traffic accidents. By banning alcohol consumption on worksites during the lunch hour, a construction company can reduce the injury rate and increase productivity. These are all examples of policies designed to prevent alcohol problems, and they cost little or nothing to implement.

Public policy oriented prevention has two advantages over educationally oriented prevention. For one thing, it costs a lot less. For another, it works better. A recent study by the RAND Corporation determined that school-based educational programs have almost no effect in reducing alcohol problems among teenagers. On the other hand, simply changing the law to raise the legal drinking age from 18 to 21 in several states has significantly reduced deaths associated with drinking and driving among teenagers.

Conducting school based educational programs is fun to do and makes people feel good, However, changing public policies is a cheaper and more effective way to reduce alcohol problems.

Prevention strategies targeting youth have evolved over the past 20 years as evaluation research reveals more about what works. Several strategies are used effectively, especially in combination:

Information dissemination. This strategy provides awareness and knowledge of the nature and extent of alcohol, tobacco, and other drug use, abuse, and addiction and their effects on individuals, families, and communities, as well as information to increase perceptions of risk. It also provides knowledge and awareness of prevention policies, programs, and services. It helps set and reinforce norms (for example, underage drinking and drug dealers will not be tolerated in this neighborhood).

Prevention education. This strategy aims to affect critical life and social skills, including decision making, refusal skills, critical analysis (for example, of media messages), and systematic and judgmental abilities.

Alternatives. This strategy provides for the participation of targeted populations in activities that exclude alcohol, tobacco, and other drug use by youth. Constructive and healthy activities offset the attraction to, or otherwise meet the needs usually filled by, alcohol, tobacco, and other drug use.

Problem identification and referral. This strategy calls for identification, education, and counseling for those youth who have indulged in age-inappropriate use of tobacco products or alcohol, or who have indulged in the first use of illicit drugs. Activities under this strategy would include screening for tendencies toward substance abuse and referral for preventive treatment for curbing such tendencies.

Community-based process. This strategy aims to enhance the ability of the community to provide prevention and treatment services to alcohol, tobacco, and other drug use disorders more effectively. Activities include organizing, planning, enhancing efficiency and effectiveness of services implementation, interagency collaboration, coalition building, and networking. Building healthy communities encourages healthy lifestyle choices.

Environmental approach. This strategy sets up or changes written and unwritten community standards, codes, and attitudes--influencing incidence and prevalence of alcohol, tobacco, and other drug use problems in the general population. Included are laws to restrict availability and access, price increases, and community-wide actions.

1. The Future by Design: A Community Framework for Preventing Alcohol and Other Drug Problems Through a Systems Approach (1991) BK189
2. Frequently Asked Questions about Preventing Alcohol, Tobacco, and Other Drug Problems (1993) Center for Substance Abuse Prevention

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