Drug prevention programs are an incredibly important part of drug treatment because drug addiction is a powerful and harmful disease. We already know that drug abuse and addiction take a toll on health, ruins relationships, destroy careers, and do irreparable damage to lives. Worse still, addiction is a chronic problem. It can be treated and managed, but on some level, it’s always one wrong turn away from coming right back in force. Knowing all this, the best possible treatment for drug addiction is prevention. The symptoms and problems associated with drug addiction are so difficult to deal with, the only way to keep yourself truly free from them is to never subject yourself to them in the first place. As with any disease, prevention is the best medicine. Millions of dollars a year are spent on drug education and prevention programs for this exact reason. The Center for Substance Abuse Prevention works tirelessly to develop evidence-based methods to prevent the abuse and misuse of alcohol and drugs. Initiatives and organizations across the country are united in this goal, and yet addiction continues to spread. This raises the question: If all these addiction programs are in place, how effective can they really be if they’re not effectively stemming the tide of this epidemic? Do they even do the job they’re put in place to do? The answer isn’t a simple one. Some of the most well-known programs for drug prevention are some of the least effective at doing what they set out to do. Despite this, there are still a number of programs out there working to prevent drug abuse through a number of evidence-based approaches. Let’s talk about what works, what doesn’t, and where the all-important drug prevention step goes from here. But first, let’s talk about the basis of drug prevention. 
What is a Drug Prevention Program?
It sounds simple, and at its core, it is. A drug prevention program is about stopping people from misusing drugs and alcohol before they start. That much should be obvious, and there is no resistance to this desired outcome. Where things get messy is where we start talking about the how and why of things. How do these programs actually go about preventing drug abuse, and what drives the way they do things? Much like drug treatment, drug prevention is a constantly moving target that continues to evolve as we analyze prevention research about works and what doesn’t. But generally speaking, the crux of what these programs are trying to do is change people’s behavior in a way that makes them less likely to use or abuse drugs in the future. The theories used in these programs are heavily rooted in psychology and behavioral science and are generally tied to a specific setting. They may take place in schools, churches, communities or at home, and the information is generally adapted for use in each of those individual settings, for whatever the target audience is expected to be. As with drug treatment, a “one-size-fits-all” approach to drug prevention isn’t effective. The ideal prevention program is extremely local, with the circumstances and needs of the individual regarded as some of the most important Problem is, this tenet of drug treatment and prevention wasn’t always as accepted and widespread as it is now. Drug prevention programs of the past had focuses that were ineffective at best and misleading at worst. The 1936 film Reefer Madness, while not a program in and of itself, is a representative piece of classic anti-drug media that used misinformation and fear to send a message about drug use. Today, we know better, and Reefer Madness is seen as not just ineffective, but an unintentional parody of the message it’s trying to convey. That said, there are many higher-profile examples of what not to do in drug prevention. 
Addiction Prevention Programs in the United States
It shouldn’t be surprising to learn that many addiction prevention programs are targeted toward students. This is because addiction largely begins during late childhood and into the teenage years. Over the years, there have been many programs implemented, and some have been more successful than others. Just some of the programs that have been developed include:
- Programs from the Office of Safe and Drug-Free Schools
- Various University-led programs
- Programs from the CDC
- Programs from the National Institute on Drug Abuse
- National Institute of Mental Health implemented programs
More often than not individual school districts will set their own programs into place. This allows them to pay close attention to the needs of their own students. Their needs may differ from those in other parts of the United States. The Bureau of International Narcotics and Law Enforcement Affairs (INL) is directly involved. Over the last three decades, this department has sponsored several different programs. They report that their programs and services have saved countless number of lives. Their goals are:
- To delay the onset of drug use
- To decrease drug use overall
- To reduce the number of deaths caused by drugs
- The reduce criminal behaviors and reduce violence
- The diminish the presence of gangs
- To establish self-sustained drug education, prevention, and programs in other countries
The problem is that the effectiveness of many programs is in question. Let’s take a look at one of the more popular programs most people are familiar with. 
What We Can Learn From D. A. R. E.: The Popular but Ineffective Drug Prevention Program
It’s very likely that D. A. R. E., or Drug Abuse Resistance Education, is the very first thing you thought of upon reading the words “drug prevention program.” That’s no surprise. D. A. R. E. was an extremely successful program, at least in its ability to grow and gain notoriety. At its peak, it saw hundreds of millions of dollars in public funding and had a presence in 75% of all public schools in the United States. They had a recognizable logo that showed up on countless t-shirts, bumper stickers, and all over schools. They were instrumental in popularizing Nancy Reagan’s famous phrase, “Just Say No.” The organization was a veritable superstar of the anti-drug movement, and the larger “War on Drugs.” There’s just one little problem with their approach. “Just Say No” doesn’t work, and neither did most of the other pillars of their approach to drug prevention. The “War on Drugs” is broadly considered to have been disastrously misguided at best, and only now are we even considering changing tactics on the way we handle drug use. D. A. R. E.’s approach was based on psychological research, but it was incomplete research that the social scientists themselves eventually debunked. It was primarily a one-size-fits-all approach that made broad assumptions about why young people start using drugs. The approach was rooted in explaining the drawbacks of drug abuse and reinforcing self-esteem. The assumption was that most middle and high school students come by substance abuse via peer pressure, and addressed that by attempting to reinforce the belief that abstaining from drugs was the “cool” thing to do. The program, which involved bringing uniformed police officers to schools to speak about the dangers of using drugs, was well-received by students, teachers, parents, administrators, politicians, and law enforcement agencies alike. It gave everybody the feeling that they were doing something about a recognized problem. The only people who didn’t like it were those tasked with measuring D. A. R. E.’s effectiveness. Researchers and social scientists completed the study after study showing absolutely no correlation between D. A. R. E. program completion and a reduction in drug use. Some well-regarded studies actually found the opposite – that people who had gone through a D. A. R. E. program was actually more likely to experiment with drugs and underage drinking than those who hadn’t. Several studies have shown that D. A. R. E. was literally less effective at preventing drug abuse than doing nothing at all. But as researchers continued to protest, public opinion on the program continued to improve. Politicians, responding to that public opinion, continued to funnel money into the program. Decades passed with the nation’s flagship drug prevention program proving ineffective at best, and counterproductive at worst. It wasn’t until the early 2000’s that the Surgeon General and Government Accountability Office each performed independent studies on the effectiveness of D. A. R. E., the results of which dried up their funding. Only then did the organization begin pursuing evidence-based methods, and consulting with scientists to develop a treatment model that works. Programs like D. A. R. E. is a big reason why we talk about “evidence-based” treatment models today. There is so much misinformation about drug abuse and the treatment thereof, it has been historically very easy for people and organizations to act on flawed anecdotal information rather than scientifically backed and properly researched evidence. Of course, just because of D. A. R. E. was a high-profile failure doesn’t mean drug prevention programs aren’t effective, or that they aren’t important. It is a cautionary tale about listening to science, evidence, and research, and taking the time to formulate a program that works.
Drug Abuse and Mental Illness Prevention
Sometimes people don’t realize that substance abuse and mental illness often go hand in hand. The problem is that people will frequently fail to realize that they have a mental illness. They may be aware of their symptoms, but they’re not sure what’s wrong. Eventually, they find out that abusing substances helps them feel better; at least for a short time. SAMHSA has done extensive research on the impact of mental health and substance abuse disorders. They’ve found that:
- In 2014, about 9.8 million adults had a mental illness.
- Of these individuals, 1.7 million of them were between the ages of 18 to 25.
- During that same year, 22.5 million Americans who were age 12 and older needed treatment for substance abuse.
- 8 million adults admitted to needing mental health treatment in the last year.
- These issues carry a high disease burden in our country.
Furthermore, it is estimated that by 2020, mental health and substance abuse disorders will skyrocket. In fact, they will be more prevalent than physical diseases. They may also be a major reason for disability all over the world. 
Drug Use Disorders and Mental Illnesses: Why are They Co-Occurring?
While the fact that these disorders often occur together is interesting, it doesn’t mean one causes the other. However, for so many people, that is definitely the case. It can be difficult to determine which one came first. There are typically three different scenarios that are examined: When drug abuse comes first: When someone abuses drugs, this can lead to mental illnesses. This is because of the way drugs and alcohol result in changes within the brain’s structure. When mental illness comes first: People with mental illnesses largely go untreated. In many cases, people will look for alternative ways to treat themselves rather than getting medical help. It stands to reason that many would try substances to get relief. Unfortunately, this form of self-medication can work for a little while. However, the results typically don’t last for very long. Eventually, the substance abuse will exacerbate the mental health condition. When both conditions are caused in another way: Occasionally, there are other reasons behind both conditions. These can include genetic issues, trauma, stress or brain deficits. This is probably the rarest scenario, but it can occur. When people are being treated, it doesn’t really matter which condition came first. The key is to treat them both co-occurring disorders at the same time. This is the only way to help the individual heal. Of course, prevention is the key to both accounts. Mental illnesses can be prevented, even if it’s solely by early detection. Developing more programs to aid in this would be extremely beneficial. Both mental illnesses and substance abuse typically emerge during adolescence. This is why so much energy is placed in this particular age group. With appropriate programs, it’s possible to raise awareness. This is why schools continue to implement their programs. 
What Are the Features of Effective Drug Prevention Programs?
The National Institute on Drug Abuse is always working to improve every aspect of drug treatment, from prevention to aftercare. The government is investing huge amounts of money into stopping the drug epidemic, including research funding. As a result, long-term studies have been analyzed to identify 16 lessons from prevention research. Those lessons help point us in the direction of more effective drug prevention methods, including:
- Addressing all forms of substance abuse (prescription, alcohol, illicit, underage substance abuse)
- Tailoring programs to address local problems and understanding localized risk factors based on location or demographics
- Enhancing family bonding and communication
- Focusing on academic support and social competence skills in-school prevention programs
- Maintaining a clear, consistent message across multiple channels in a community
- Repeating prevention techniques long-term, regularly reinforcing prevention goals
- Employing techniques that include interactivity, open communication, and exploration of unique circumstances
This is but a sampling of the findings of what makes an effective drug prevention program. But any successful program boils down to how you shape three main elements: structure, content, and delivery. The structure of the program involves the nuts and bolts of how it all works. Who is this prevention program targeting? How will you reach them? Where will these interventions take place? School-based prevention programs have some of the easiest structures to understand. They target children, they take place in schools, and it’s simple to reach them because the children are already there. Content is the next aspect to consider. Once you have your audience and your delivery method, what are you saying to them and how? What information are you sharing? Are you focusing on enforcing an anti-drug attitude, or taking a more neutral, informative stance on the effects of drugs and addiction? The type of content presented and the style of that presentation will differ based on the circumstances. A successful drug prevention program needs to address both children and their parents to inform them about the best ways to recognize and resist drug abuse. But they obviously won’t address parents in the same way they addressed children. Finally, there’s the delivery. This refers to shaping and adapting a general program to fit specific community needs. If you’re addressing a community with a high rate of opioid abuse, make sure the program reflects the risk factors for opioid abuse. If there are unique pressures or risk factors in the community, or a need that isn’t being filled, address those. We’ve said it many times before, but just like with drug treatment, drug prevention must be tailored to the individual. Evidence shows again and again that simply putting people through a generic treatment plan does them no good. A truly effective treatment – or prevention – plan hones in on specific issues and addresses those in such a way that substance abuse becomes unnecessary or undesirable.
Where Does Drug Prevention Go From Here?
Prevention is always going to be the most effective way to stop addiction. More programs are adapting evidence-based approaches and accepting the reality that preaching abstinence without context is ineffective. We’re starting to see prevention programs take more nuanced, realistic approaches to prevention, acknowledging the effects of temptation and curiosity. They’re still trying to reinforce anti-drug attitudes, but through informative and cognitive ways that encourage rational decision-making skills. This has allowed many prevention programs to address something that was previously neglected – preventing experimental drug use from becoming regular or habitual. After all, not all drug use becomes an addiction. If people can recognize the warning signs of a substance becoming a problem, they are more likely to stop before it takes complete control of them. This is a huge change from the culture of fear and shame that surrounded previous anti-drug programs. Even D. A. R. E. has reinvented itself with a new evidence-based initiative that has drawn praise from the Surgeon General. The next step forward is simply to stay on this course. Beating drug addiction is a long-term battle on every front. Just as addicts can’t beat their vices overnight, prevention isn’t as simple as just showing up once and telling people to “Just Say No.” It takes time, patience, and consistency. Have you experienced a drug prevention program before? Did you find it effective? Did it have a lasting impact on you? Or did you find it completely laughable? Tell us your story in the comments below.