We have come to an historic time when several key events are coming together that underscore the importance of building infrastructures to support the integration of prevention programming at all population levels from small rural towns to large metropolitan areas. What are these events?
1. Non-communicable diseases (i.e., health problems associated with behaviors such as psychoactive substance use, poor dietary practices, risky sexual behaviors, mental health issues, and violence) are the major causes of world-wide morbidity and mortality. (WHO, 2020)
2. Not only are these non-communicable diseases burdening health care systems, but they are also contributing to increases in the number of productive years lost due to ill-health, disability or early death (disability-adjusted life year -DALY) (Eisenberg & Neighbors, 2007)
3. The application of prevention science to:
a. Understanding the etiology of health-risk behaviors
b. Development of evidence-based interventions and strategies
c. Building community-based implementation systems to support multiple, integrated prevention interventions and policies
4. Recognition that evidence-based prevention interventions not only have strong short-term outcomes related to the development of prosocial attitudes and behaviors, and intermediate-term outcomes related to positive developmental outcomes such as academic performance and school and family bonding but also long-term outcomes such as reductions in substance use and substance abuse disorders, and delinquency and criminal behaviors (BluePrints for Health Youth Development; Steiner et al., 2019). For instance,
a. LifeSkills Training is an evidence-based school universal prevention curriculum that has undergone several rigorous evaluations including those that extended into early adulthood of those adolescents who participated in the original studies. These outcomes included: reductions in alcohol, tobacco and illicit substance use; emotional regulation; delinquency/criminal behavior; violence; sexual risk behaviors; and sexually transmitted infections.
b. Project Toward No Drug Use is an evidence-based school selective prevention curriculum that also has undergone several rigorous evaluations and has been found to not only address substance use but also sexual risk behaviors and violence.
c. Nurse-Family Partnership is an evidence-based indicated prevention program that targets first-time pregnant women who are substance users. This program not only has positive outcomes for the mothers but also for the babies. These outcomes are derived from several rigorous evaluations and for the mother include reductions in substance use, healthy gestation and births, employment, improvement in physical health and well-being, and child maltreatment. For the children, the outcomes include cognitive development, preschool communication and language skills, externalizing behaviors, and academic performance.
Dollar Costs of NOT Providing Evidence-Based Prevention Programming (examples)
The last report delineating the social and economic costs of drug abuse are over 20 years old (Harwood et al., 1998; United Nations International Drug Control Programme Bulletin on Narcotics, 2000) their findings remain even more relevant today in terms of the high costs of substance use and substance use disorders to all countries. These reports highlight direct costs in terms of treatment, health, crime and violence as well as the indirect costs on national productivity and social and health services. Examples of immediate costs to society that can be directly tied to substance use that are addressed by evidence-based prevention programming include:
1. School Dropouts
“The social and economic costs of high school dropouts are staggering. Not only do dropouts earn significantly less (over the course of a lifetime, a high school dropout earns, on average, about $260,000 less than a high school graduate), but they also contribute to billions of dollars of expenditures in uninsured health care costs and crime-related costs. According to the Alliance for Excellent Education, dropouts from the Class of 2009 will cost the nation over $330 billion in lost wages, taxes, and productivity over their lifetimes.” (National Conference of State Legislatures: https://www.ncsl.org/research/education/at-risk-students-dropout-prevention-and-recovery.aspx -retrieved February 4, 2021)
2. Juvenile Delinquency and Crime
In a report, Sticker Price-The Cost of Youth Incarceration, released by the Justice Policy Institute (http://www.justicepolicy.org/research/12928) it was estimated that the average costs of the most expensive confinement option throughout the 46 states it surveyed is $407 a day, or $148,767 per year. The range of costs were from $46,662 to $352,663 a year per offender.
3. Substance Use Treatment for Adolescents
The Substance Abuse and Mental Health Administration in its Advisory, Screening and Treatment of Substance Use Disorders, reports that “…according to the 2019 National Survey on Drug Use and Health, 17.2 percent of adolescents aged 12 to 17 used illicit drugs in the past year, with 4.5 percent having a SUD… Adolescents with untreated or under-treated SUDs are at risk for experiencing adverse outcomes into adulthood, including criminal involvement (Racz et al., 2016), sexually transmitted infections (Dembo et al., 2009), unintended pregnancy (Chapman & Wu, 2013), and co-occurring mental disorders (National Institute on Drug Abuse, 2020a). Adolescent substance use is associated with violence and unintentional injury—two of the leading causes of death for this population (The National Center on Addiction and Substance Abuse, 2011). This report indicates that alcohol detoxification and treatment costs for young people in 2007 were estimated to be $2.4 billion, but in that same year fewer than eight percent of teens in need of treatment actually received it.
However, these dollar costs mostly reflect direct services to individuals and do not address the dollar costs to families of these children nor do they reflect the intangible costs of the lost potentials that each of these individuals could have achieved. Figures of cost savings as an outcome of prevention in terms of treatment range from $5 to $18 for every $1 spent on prevention (Miller and Hendrie, 2008; National Institute on Drug Abuse, 2003).
References:
Blueprints for Healthy Youth Development. blueprints@colorado.edu (retrieved February 4, 2021).
Chapman, S. L. C., & Wu, L.-T. (2013). Substance use among adolescent mothers: A review.
Children and youth services review, 35(5), 806-815.
Dembo, R., Belenko, S., Childs, K., & Wareham, J. (2009). Drug use and sexually transmitted diseases among female and male arrested youths. Journal of behavioral medicine, 32(2), 129-
141.
Eisenberg, D., and Neighbors, K. (2007). Economics of Preventing Mental Disorders and Substance Abuse Among Young People. Paper commissioned by the Committee on Prevention of Mental Disorders and Substance Abuse Among Children, Youth, and Young
Adults: Research Advances and Promising Interventions, Board on Children, Youth, and Families, National Research Council and Institute of Medicine, Washington, DC. P.246.
Harwood, H., Fountain, D., & Livermore, G. (1998).The economic costs of alcohol and drug abuse in the United States, 1992. Rockville, MD: National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism.
Miller, T. and Hendrie, D. Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis, DHHS Pub. No. (SMA) 07-4298. Rockville, MD: Center for Substance Abuse Prevention, Substance Abuse and Mental Health Services Administration, 2008.
National Institute on Drug Abuse. (2003). Preventing Drug Abuse Among Children and Adolescents: A Research-Based Guide.
National Institute on Drug Abuse. (2020a). Common Comorbidities with Substance Use Disorders Research Report. Part 1: The Connection Between Substance Use Disorders and Mental Illness.
Racz, S. J., Saha, S., Trent, M., Adger, H., Bradshaw, C. P., Goldweber, A., & Cauffman, E. (2016).
Polysubstance use among minority adolescent males incarcerated for serious offenses. Child & youth care forum, 45, 205-220.
Steiner RJ, Sheremenko G, Lesesne C, et al. (2019). Adolescent Connectedness and Adult Health Outcomes. Pediatrics, 144(1) e20183766.
Substance Abuse and Mental Health Services Administration. (2021). Screening and Treatment of Substance Use Disorders among Adolescents. Advisory.
The National Center on Addiction and Substance Abuse. (2011). Adolescent Substance Use:
America’s #1 Public Health Problem. https://files.eric.ed.gov/fulltext/ED521379.pdf
United Nations International Drug Control Programme Bulletin on Narcotics. (2000). Economic and Social Costs of Substance Abuse. Volume LII, Nos. 1 and 2.