Prevention

• A range of prevention and intervention measures are available. As with any health problem, intervention may aim to prevent a problem, provide early intervention and treatment; or provide treatment or harm reduction in a well-established disorder. 
• We are here concerned with practical ways in which doctors and health care professionals can diagnose the various forms of substance use disorders and provide practical assistance and treatment to people for helping them recover or at least reduce the risk of harmful consequences. However, we should note that at a societal level, the most effective strategy to reduce substance-related harm derives from population level approaches, such as legal controls on availability, random testing and public policies such as no smoking zones, supported by public and school-based education. In Australia and elsewhere, random breath testing has significantly reduced alcohol-related road traffic accidents and mortality.
• Other population-based strategies have specifically targeted blood borne viral infections, e.g., HIV/AIDS and, in more recent years, hepatitis C and B infections. Many countries have in recent years established campaigns and programs to reduce the harm caused by substance use at a population level. These include the Australian National Campaign against Drug Abuse and the UK 10-year drug strategy. An important role of doctors and health care practitioners is to support these broad community-based measures within their own spheres of influence, while recognizing that the bulk of their work will be concerned with the practical issues of assessment, diagnosis, and treatment of their patients. Doctors and other health professionals also have an important role to play in early intervention for non-dependent substance use disorders.
• Prevention (primary intervention) Aims to prevent substance use in the general population, e.g., by controls on availability (supply reduction), media, or school education campaigns (demand reduction), work place policies and addressing underlying risk factors, such as social disadvantage or psychiatric disorders, or by enhancing protective factors such as establishing links with family or community. In terms of practical health care, primary intervention can also be taken as intervention by a general practitioner or health care worker at the point of first contact with a patient who is using substances hazardously.
• Substance use disorder is a chronic relapsing disorder and long-term goals include sustaining social functioning, and optimizing physical and mental health. Treatment goals include abstinence and relapse prevention, so prevention is also important in maintenance phase of change.
• A range of preventive measures have been successfully employed to reduce the risk of substance use disorders. Community-wide efforts such as mass media campaigns and school education campaigns have varying levels of success, and public policy needs to be regularly reviewed and informed by the evidence base. More recently, preventive initiatives have examined the effectiveness of increasing a young person’s sense of connectedness with family, school or another group. Health professionals have an important role in preventing substance use harms by informing their patients about risks of substance use, and providing brief screening and, where necessary, intervention for all their patients.
• Prevention programs should address all forms of drug abuse, alone or in combination, including the underage use of legal drugs (e.g., tobacco or alcohol); the use of illegal drugs (e.g., marijuana or heroin); and the inappropriate use of legally obtained substances (e.g., inhalants), prescription medications, or over-the-counter drugs.
• Prevention programs should address the type of drug abuse problem in the local community, target modifiable risk factors, and strengthen identified protective factors.

Prevention in different substances:

Although cannabis is considered a ‘soft’ drug, people (particularly young people), with a past history, or family history, of schizophrenia, psychosis, anxiety or depression should be warned about the potential neuropsychiatric complications of cannabis use. People using cannabis should be advised about the risks of driving while under the influence of cannabis, particularly if it is used in combination with alcohol.

Control supply (policing, importation restrictions, and restrictions to purchase of precursors) has been the measure most widely used to prevent illicit opioid use. There is evidence that when supply of heroin is reduced (whether by international factors or local controls) that rates of heroin overdose decrease. However, some users will switch to use of other illicit or licit substances when heroin is less available. Community education methods are used to attempt to reduce demand for heroin, but evidence for the effectiveness of these is limited.

• The Disposal of Unused Medicines.
• Substance Abuse Prevention for Early Childhood.
• Preventing Drug Use among Children and Adolescents.
• Substance Misuse Prevention for Young Adults.

Early intervention with risk factors (e.g., aggressive behavior and poor self-control) often has a greater impact than later intervention by changing a child's life path away from problems and toward positive behaviors.

Prevention programs for elementary school children should target improving academic and social-emotional learning to address risk factors for drug abuse, such as early aggression, academic failure, and school dropout. Education should focus on the following skills:

• self-control
• emotional awareness
• communication
• social problem-solving and
• academic support, especially in reading

Prevention programs for middle or junior high and high school students should increase academic and social competence with the following skills:

• study habits and academic support
• communication
• peer relationships
• self-efficacy and assertiveness
• drug resistance skills
• reinforcement of anti-drug attitudes
• strengthening of personal commitments against drug abuse

Prevention of substance use disorders in adolescence: Resilience in adolescence can help protect against substance use. There is evidence that resilience can be promoted by increasing a sense of connectedness of the adolescent, e.g., to family, school, or to sporting, religious or cultural groups.

Family-based prevention programs should enhance family bonding and relationships and include parenting skills; practice in developing, discussing, and enforcing family policies on substance abuse; and training in drug education and information.

Family-focused interventions for the general population can positively change specific parenting behavior that can reduce later risks of drug abuse

Prevention of substance misuse related to disadvantage clearly government and other agency attempts to reduce disadvantage, and increase access to employment, quality education, support services, and safe and appropriate housing and environment for all citizens are important.

Connectedness to society has been shown to be important in providing resilience against substance misuse. Studies of methods to increase connectedness, for example, among young people, have shown promise in reducing the prevalence of substance misuse.

Providing early childhood support or other intervention can improve the outcome for children in troubled families, and is likely to reduce the Trans-generational transmission of substance use disorders.

Ensuring access to quality mental health services is also important to reduce substance misuse among those with mental health disorders and their offspring.

Community prevention programs that combine two or more effective programs, such as family-based and school-based programs, can be more effective than a single program alone.

Community prevention programs reaching populations in multiple settings—for example, schools, clubs, faith-based organizations, and the media—are most effective when they present consistent, community-wide messages in each setting.