Normalization of Prevention Principles and Practices to Reduce Substance Use Disorders
Normalization of science-based prevention practices, what do we mean? Over the past 30 years, we have seen some remarkable research breakthroughs in the field of substance use prevention that have helped us understand ways to prevent the use of substances, particularly among youth, and the impact of the consequences of use among those who have already initiated. At the same time, we have seen the development and testing of multiple approaches to effective interventions in the family, school, and community settings. So, normalization of practices would involve the transfer of such knowledge and skills to those who work with youth in the prevention and related health and social service fields.
Specifically, in the knowledge area, we would like to see a broader understanding of (1) the pharmacological effects of psychoactive substances on the central and peripheral nervous systems and the health and social consequences of such use , particularly for children and adolescents; (2) the processes that increase vulnerability to or protection from initiation of substance use and progression to substance use disorders (SUDs) and (3) the effective strategies and practices that have been developed to prevent the initiation and escalation of substance use.
So, how can we “normalize” what we have learned from this research so that it is:
incorporated into the work of prevention professionals who are on the front lines and involved in supporting, planning, and delivering prevention programming to populations around the world;
integrated into health and social service systems by reaching health and social service professionals working with families and youth; and,
communicated to policy makers and the general population (parents, educators, policy makers, law enforcement, and others who influence the lives of young people) to help shape public policies and everyday behaviors.
Reaching Prevention Professionals
Until recently, there has not been a universal movement to train prevention practitioners or students in professional schools in the field of prevention science and its application to implementing evidence-based prevention programming in communities. Since the turn of the century, however, new efforts have been initiated to address the issue of uniform training including our own work at APSI (Applied Prevention Science International https://www.apsintl.org) with the development of the international curricula, Universal Prevention Curriculum for Coordinators and Implementers, and here in the U.S., Foundations of Prevention Science and Practice.
In addition, several universities have either degree programs in the field of prevention science or offer certificates (Pavlovská et al., 2019). In addition, the Substance Abuse and Mental Health Services Administration has established the Prevention Technology Transfer Centers, (https://pttcnetwork.org/) that have embraced the issue of training the prevention workforce to professionalize the field, and provide extensive technical resources and networking opportunities to people working in the field. Furthermore, through the International Certification and Reciprocity Consortium’s (IC&RC) Prevention Think Tank, the field now has a code of ethics that is comparable to other professional groups.
Normalization of science-based prevention practice requires at least three additional steps:
Acceptance and recognition that prevention professionals are part of public health and school-based health teams addressing youth behavioral problems;
Development and universal approval of guidelines that fully articulate and define the duties encompassed by prevention professionals that can be used for training, credentialling and licensing;
Adequate and continuous funding to support the implementation of evidence-based prevention programming to address the needs of communities.
Reaching Other Service Professionals Who Deliver Prevention Programming
Many professionals in the health and social service fields are involved in implementing preventive interventions, but do not identify themselves as prevention professionals. They may be educators in schools or social workers working with families or public health staff working at the community level. So, a different dissemination approach might be needed to reach these professionals with the latest science and in a means that can be more easily transferred. Preventive interventions that are determined to be EBIs are often complex and may prove challenging to implement in settings that may not be receptive institutionally or structurally. Their structure, content and delivery style are based on strong theories of human behavior and their successful outcomes are heavily dependent on maintaining fidelity to their design. These approaches may not ‘fit’ within the training or delivery experiences of these service professionals.
Next Steps for Other Professionals
For the workforce that is not specialized in prevention but who work with children and families, normalization requires concrete, simple interventions and activities. There has been a shift from the development and evaluation of complex, multi-component interventions toward work that will lead to understanding the key drivers of intervention success (Collins et al., 2007; (Bose, 1947; Collins et al., 2007; Gunst & Mason, 2009; https://grants.nih.gov/grants/guide/pa-files/par-20-103.html). Risk screening tools are now available for health care and education professionals to use to address risk in those they work with.
Reaching the General Population (Parents, Educators, Policy Makers, Law Enforcement, and Others Who Influence the Lives of Young People)
The greatest challenge for professionals is 1) to convince the public that prevention is important and effective and they can do something about intervening—whether it’s in their own family, or their child’s school, or more widely at the community level; 2) to translate the key ‘ingredients’ of evidence-based preventive interventions and policies for the general population to reinforce positive attitudes, beliefs, norms, and behaviors and to change them when they are neutral or negative; and 3) to advocate for preventive policies and effective strategies such as community-wide actions like tobacco/alcohol pricing and age restrictions that can make a difference in preventing youth access, and currently might be adapted for the changing legal status of cannabis.
Next Steps for the General Population
Achieving our goals in ‘normalizing’ effective prevention practices with prevention professionals and educators and health and social service professionals should go a long way to ‘normalizing’ these practices with the general public. And, as they get engaged in advocacy and public interaction, would be exposing the general population to effective science-based parenting skills to enhance family bonding and build resilience in children and teaching skills to create supportive and safe learning environments where children can feel they have opportunities to live happily and to be productive citizens in their communities.
Five decades of epidemiologic and prevention research has provided us not only a framework for understanding the issue of vulnerability to engage in risky behaviors such as substance use but also the tools derived from theories of human behavior, of effective communications, and of supportive learning strategies. The field of prevention is now challenged with the daunting tasks of integrating these practices into the everyday lives of the general public so they achieve their personal goals and also enhance the lives of others in their communities. Moving forward with the recommendations presented here requires not only the work of prevention professionals around the world but also the engagement of key organizations that have prevention as part of their mandate to develop strategies to advance the normalization of evidence-based prevention practices that would have the most positive impact on community members.
Bose, R. C. (1947). Mathematical theory of the symmetrical factorial design. Sankhyā: The Indian Journal of Statistics, 107–166.
Collins, L. M., Murphy, S. A., & Strecher, V. (2007). The multiphase optimization strategy (MOST) and the sequential multiple assignment randomized trial (SMART): New methods for more potent eHealth interventions. American Journal of Preventive Medicine, 32(5), S112–S118.
Gunst, R. F., & Mason, R. L. (2009). Fractional factorial design. Wiley Interdisciplinary Reviews: Computational Statistics, 1(2), 234–244.
Pavlovská, A., Peters, R. H., Gabrhelík, R., Miovský, M., Sloboda, Z., & Babor, T. F. (2019). Overview of the university-based addic- tion studies programmes in the United States. Journal of Sub- stance Use, 24(1), 55–60.
Sloboda, Z., Johnson, K.A., Fishbein, D.H., Brown, C.H., Coatsworth, J.D., Fixsen, D.L., Kandel, D., Paschall, M.J., Silva, F.S., Sumnall, H., & Vanyukov, M. (2023). Normalization of Prevention Principles and Practices to Reduce Substance Use Disorders Through an Integrated Dissemination and Implementation Framework. Prevention Science doi: 10.1007/s11121-023-01532-2. Epub ahead of print. PMID: 37052866.