The Prevention Path Forward: What We Have Learned and What Is Next

Part 4 - What Is Next in Prevention: Research,

Practice and Action^[1]

^[1] Part 1- How Treatment Shaped the Prevention Landscape; Part 2- The Rise of Prevention Science; Part 4- Rethinking Risk: The Evolution of Harm Reduction

Parts 1-3 of this Nugget Series summarized the history of progress made in the prevention and treatment of substance use and in harm reduction strategies for substance users through rigorous research affording practitioners with the most effective tools available to address vulnerabilities to substance use and, in many cases, other problem behaviors and to help those impacted by substance use through treatment and other support social, behavioral, and health services.  Although significantly more research is needed in these focus areas, for prevention there are four major areas that warrant ongoing research studies as well as data monitoring systems to support both research and practice particularly at the community level.  The following outlines these areas with suggested avenues of research to inform evidence-based practice.

1.  Epidemiology

• Ongoing surveillance and monitoring systems to:

  • Determine new patterns of substance use including:

    • New psychoactive substances: including those emanating from medical/health research and street seizures

    • New means of administration of substances, e.g., inhaling, subcutaneous injection, imbibing, etc.

    • New groups involved in substance use, particularly children and adolescents but also occupational groups, urban/rural, males/females etc.

  • Etiologic studies informed by prior neurobiological and etiological studies that follow cohorts of children and adolescents into adulthood determine not only determinants associated with the initiation of psychoactive substance use but also of progression AND non-continuation.

    
    

NIAAA, 2003

Such systems need to be designed not only to improve our understanding of the issue of psychoactive substance use and other health challenges, but also to include notification systems for prevention, treatment, and harm reduction professionals that include information that will inform how they should best respond in their service delivery.

2.  Prevention Interventions

• Much of existing research on the effectiveness of prevention interventions was conducted in the late 1980s into the late 1990s.  This research should be rereviewed and a plan developed to conduct updated evaluations taking into consideration the changing culture of children and adolescents

  • Symbols: Anything that carries a particular meaning recognized by people who share a culture;

  • Language: A system of symbols that allows people to communicate with one another;

  • Values: Culturally defined standards of what is good or bad, right or wrong;

  • Norms: Rules and expectations by which a society guides the behavior of its members;

  • Artifacts: Material objects that reflect a culture

  
  

UNODC 2018

The United Nations on Drugs and Crime and the World Health Organization published a summary of the findings from both multiple of studies of specific interventions (by name) or meta-analyses of interventions by risk status (universal, selective, indicated), by age group and setting (family, school, community, workplace).  The publication identified areas warranting further research: sports and other leisure time activities, preventing the non-medical use of prescription drugs, and interventions and policies targeting children and youth particularly at risk and the prevention of the use of new psychoactive substances not controlled under the Conventions.  It is recommended that the document, The International Standards for Drug Use Prevention (2013/2018) be reviewed by a panel of researchers and practitioners to identify further areas warranting a research focus.

To the extent possible, the development of a forward-thinking research agenda should include representatives of the practitioner community.

3.  Research to Practice

Three key issues warranting further research are intervention selection, implementation fidelity and adaptation.

• Intervention Selection

  • Matching the intervention to participants’ needs involves a multi-faceted approach. Having information regarding the extent of the substance use problem in the community—both quantitative and qualitative—helps guide the prevention professional’s selection of the most appropriate prevention strategies in terms of outcomes desired (short-, intermediate-, and long-term), the age composition of the participants, and the best setting to reach the participants (family, school, workplace, community).

  • Selecting an evidence-based prevention strategy is key to not only achieve the best outcomes but also DOES NO HARM.  Several registries are available to assist in the selection process (See Prevention Nuggets June 25 and 27, 2025). These strategies are considered evidence-based as through rigorous research they have been found to be effective.  However, it is important to understand that evidence-based prevention strategies are developed based on a foundation of extensive research and theories of human development, learning, and behavior change.  These elements are key to good outcomes.  Think of these elements as baking a cake…ingredients, measurements, the process of adding and mixing, baking temperature and timing all are important to an excellent final product.  This is the same for evidence-based prevention!

  • Intervention Delivery and Adaptation

  • A pilot “run” of the prevention strategy with a small group representative of those who will ultimately participate to gather feedback on terminology, practice activities, length of sessions, materials used all serve to determine if the strategy is appropriate. 

  • If adaptation is needed, only…

    • Update and/or customize statistics and other factual content.

    • Customize role play scenarios (e.g., using scenarios or wording more reflective of the participants and their communities).

    • Make activities more interactive, appealing to different learning styles.

    • Tailoring aspects of instructional approaches or activities to participants’ culture, age, or lived experiences (https://www.csun.edu/sites/default/files/FindingBalance1.pdf).

    • Monitoring the short-term outcomes of the evidence-based prevention strategy when delivered.

    • For manualized programs, these outcomes will be identified and, in many cased, pre/post-tests are available. 

    • For other prevention strategies such as policies related to availability and accessibility short-term outcomes, monitoring may be more challenging.

Foundations of Prevention Science and Practice APSI 2025

Clear and easy to follow guidelines and trainings need to be prepared for prevention practitioners who deliver evidence-based prevention interventions and courses given in prevention science should include material and exercises for those who want to practice prevention as well as for those who want to become prevention researchers. And, as above, to the extent possible, the development of a forward-thinking research agenda should include representatives of the practitioner community.