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    Rethinking Substance Use Prevention: An Earlier and Broader Approach

    Published: January 2022

    Substance use prevention, along with treatment and recovery support, is a key component of the public health approach needed to transform how our nation addresses addiction. A growing body of research on the effects of adverse and positive childhood experiences and on the importance of social and structural determinants of health have made it increasingly clear that an earlier and broader approach to prevention is necessary.


    Recent research in the fields of substance use and early childhood development shows that experiences in early and middle childhood, coupled with biological vulnerabilities, set the stage for how children will fare as they grow older. This means that most current prevention strategies are necessary, but not sufficient to effectively prevent substance use risk among youth. That’s because they primarily target the individual child, rather than parents, families, and communities. They typically begin in late middle school or high school, rather than in early childhood when the seeds of risk and resilience are planted. They focus mostly on risk reduction, rather than on promoting health and resilience. And they address only a small portion of individual factors associated with substance use, rather than the broader social determinants of risk and protection that are essential for achieving significant, equitable, and sustainable outcomes.

    Many of the risk factors commonly targeted in substance use prevention programs have roots in early childhood, sometimes as early as infancy. While some of these – such as poverty, trauma, or illness – may seem too difficult for a prevention program to address or reverse, research shows that even small interventions can successfully shift the course of risk for a young child. By intervening earlier and more broadly, we can better prevent substance use in adolescence and the countless unhealthy and damaging consequences associated with it.

    This report calls for a broader and earlier approach to protecting youth from substance use and addiction. It presents a compelling, research-based case for integrating what is known from the fields of early childhood development and healthy youth development into substance use prevention. It offers a historical perspective on prevention and describes who is and who should be responsible for being involved in prevention efforts. It argues for shifting prevention efforts earlier and for broadening its scope by breaking down silos to enhance collaboration between related fields. It describes barriers to change and offers concrete recommendations for policymakers, caregivers, educators, health care providers, and researchers to enact an earlier, broader, and more effective approach to substance use prevention and youth health promotion.