Prevention of alcohol and drug abuse: what works?

There is no single "best" prevention program, and no one program or approach will stop all drug use. There are many effective research-based programs; the best approach for any particular population requires selecting the best intervention for the target population on the basis of a knowledge of the risk and protective factors in that population. Unfortunately, the most highly marketed school or family programs are generally not those programs with the best outcomes. The best approach to prevention is to begin early to reduce emerging behavioral and emotional problems in youth. Longer-lasting effects should accrue from changing school, community, and family environmental conditions that promote and maintain drug problems in youth. More and more prevention specialists are considering moving from a focus on the individual to changes in total systems or the environmental contexts that promote or hinder drug use. On the basis of economic considerations, the "whole family" systems-change approach of family skills training classes is becoming popular even in the managed care environment. The greatest challenge facing the drug abuse prevention field is to get information out to practitioners and communities about the best prevention programs, approaches, and principles of effectiveness. Researchers and funding agencies must learn how to effectively market the most successful programs to bridge the gap between research and practice. We must become as effective at marketing drug prevention programs as drug dealers are at promoting and selling drugs. Communities need health care professionals who are knowledgeable about substance abuse prevention and who can advocate the implementation and ongoing improvement of prevention programs with known effectiveness.