Chapter 35. Prevention of Substance Use Disorders

Abstract

Substance use continues to pose substantial public health problems worldwide, despite significant advances in prevention science over the past 20 years. In the United States, an estimated 19.7 million people age 12 years or older had a substance use disorder in 2017. Of these, 14.5 million people had an alcohol use disorder and 7.5 million people had an illicit drug use disorder, with the most common illicit drug use disorder being for marijuana (4.1 million people) (Substance Abuse and Mental Health Services Administration 2018). Concerted prevention efforts are needed to minimize the devastating effects of substance use disorders on individuals, families, and communities and to reduce the substantial associated burden of disease and social and economic costs. Indeed, a considerable proportion of global disease, disability, and mortality can be attributed to the use of alcohol and other drugs. Globally, in 2016, 99.2 million disability-adjusted life years (DALYs)—or 4.2% of all DALYs—were attributable to alcohol use, and 31.8 million DALYs—or 1.3% of all DALYs—were attributable to illicit drug use (Degenhardt et al. 2018). The burden of disease attributed to alcohol and other drugs is great among young people ages 15–24 years (Mokdad et al. 2016), which corresponds with the typical period of onset of substance-related problems. Although effective prevention provides an opportunity to avert the substantial burden associated with substance use disorders and related harms, further research is needed to strengthen the evidence base and to improve the implementation, scalability, and sustainability of substance use prevention efforts. In this chapter we attempt to summarize the current state of the evidence in relation to substance use prevention, including when and where prevention efforts should be deployed. The evidence base for substance use prevention delivered outside of school settings is not as strong as that for preventive measures delivered within schools, largely due to a lack of high-quality evaluations and gold-standard randomized controlled trials (RCTs) examining prevention programs in nonschool settings. The focus of this chapter is therefore on school-based prevention, although other important approaches, such as community, family, and mass media interventions, are also discussed. The potential of new approaches, such as web-based and mobile health interventions, is also highlighted.

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