Theories are the key to understanding the bases for risky behaviors, identifying those at greatest risk, and how to develop prevention interventions to prevent initiation and progression of these behaviors that lead to harmful outcomes. Theories provide the foundation for the content of an intervention and how it should be structured and delivered to enhance the intervention’s effectiveness. So, knowing the types of theories that are important to prevention is fundamental for prevention professionals.
Whether we are talking about effective school-based prevention interventions and policies, family interventions, media campaigns, or policies such as those regulating access to tobacco and alcohol, theories help us understand prevention processes and explain why evidence-based interventions work the way they do.
Theories have several important characteristics:
• They present a systematic way of understanding events, behaviors and/or situations. Many theories are based on scientific evidence that explain not only why something happened but also how it happened.
• They also specify the factors or mediators involved in order to reach a particular outcome of interest, as well as,
• The sequencing of these factors over time leading to the desired change of behavior and outcomes.
Types of Theories*
Etiology theories explain the causes of problem behaviors. For example, they describe the initiation and progression of substance use from infrequent to frequent use or abuse and ultimately to dependence or addiction. The Etiology Model, Nugget #4, presents the factors that interact to place individuals at risk for substance use, or those that protect them from initiating use. These theories:
• Help identify the processes that could benefit from targeted prevention interventions and policies, such as parent skills training and workplace policies related to substance use;
• Specify intervention points where evidence-based prevention can be implemented;
• Serve as a model for monitoring and evaluation of the delivery of an evidence-based prevention intervention or policy.
Human development theories help to explain normal and dysfunctional development relating to problem behaviors such as substance use. These theories were developed by conducting studies that observed and tested large numbers of children, adolescents and adults. In addition, with the improvement of brain imaging, it has been possible to monitor brain development over the lifespan. One of the most important discoveries through brain imaging revealed that the brains of adolescents do not fully mature until they are in their early 20s which may help to explain their risky decisions in regard to behaviors such as substance use.
Theories of human behavior that inform prevention include learning theories and behavior and behavior change theories. Learning theories help us structure the strategies and methods teaching youth skills to make good decisions and avoid the use of substances in various situations. Theories of behavior and behavior change provide guidance to prevention interventions on the factors that are central to good decision-making, resisting the offers of substances, and how these relate to preventing substance use behaviors.
Lastly, implementation theories involve the most effective ways to spread the use of interventions beyond the initial research-sponsored effort. It describes how to undertake, manage, and sustain preventive interventions, most often in ‘real-world’ settings.
All these sets of theories are important as they help us understand what types of interventions are needed for each developmental period from infancy through middle and old age, how to intervene to promote positive healthy development and where to intervene to achieve the most impact.
*Examples presented focus on substance use