Preventing Drug Use Among Children And Adolescents (redbook)

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Acknowledgments
NIDA wishes to thank the following individuals for their guidance and comments during the development
and review of this publication:
Karen L. Bierman, Ph.D.

Hyman Hops, Ph.D.

Pennsylvania State University
Oregon Research Institute
C. Hendricks Brown, Ph.D.

Eugene R. Oetting, Ph.D.

University of South Florida

Colorado State University
Richard R. Clayton, Ph.D.

Zili Sloboda, Sc.D.

University of Kentucky
University of Akron
Thomas J. Dishion, Ph.D.

Richard Spoth, Ph.D.

University of Oregon
Iowa State University
E. Michael Foster, Ph.D.

John B. Reid, Ph.D.

Pennsylvania State University
Oregon Social Learning Center
Meyer D. Glantz, Ph.D.

Thomas A. Wills, Ph.D.

National Institute on Drug Abuse
Albert Einstein College of Medicine
Mark T. Greenberg, Ph.D.

Pennsylvania State University
NIDA also would like to thank the Community Anti-Drug Coalitions of America for helping organize

a focus group of community leaders in reviewing this publication.
This publication was written by Elizabeth B. Robertson, Ph.D., Susan L. David, M.P.H. (retired), and
Suman A. Rao, Ph.D., National Institute on Drug Abuse.
All materials in this volume are in the public domain and may be used or reproduced without permission
from NIDA or the authors. Citation of the source is appreciated.
The U.S. government does not endorse or favor any specific commercial product or company.

Trade, proprietary, or company names appearing in the publication are used only because they

are considered essential in the context of the studies described here.
NIH Publication No. 04-4212(A)

Printed 1997
Reprinted 1997, 1999, 2001
Second Edition October 2003
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Preventing Drug Use among Children and Adolescents
National Institute on Drug Abuse

Contents
Acknowledgments

ii
Preface

v
Introduction

1
Prevention Principles

2
Chapter 1: Risk Factors and Protective Factors

6
What are risk factors and protective factors?

6
What are the early signs of risk that may predict later drug abuse?

8
What are the highest risk periods for drug abuse among youth?

9
When and how does drug abuse start and progress?

10
Chapter 2: Planning for Drug Abuse Prevention in the Community

12
How can the community develop a plan for research-based prevention?

12
How can the community use the prevention principles in prevention planning?

12
How can the community assess the level of risk for drug abuse?

14
Is the community ready for prevention?

15
How can the community be motivated to implement research-based prevention programs?

16
How can the community assess the effectiveness of current prevention efforts?

17
Chapter 3: Applying Prevention Principles to Drug Abuse Prevention Programs

18
How are risk and protective factors addressed in prevention programs?

18
What are the core elements of effective research-based prevention programs?

21
How can the community implement and sustain effective prevention programs?

24
How can the community evaluate the impact of its program on drug abuse?

24
What are the cost-benefits of community prevention programs?

25
Preventing Drug Use among Children and Adolescents
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Chapter 4: Examples of Research-Based Drug Abuse Prevention Programs

26
Universal Programs

26
Elementary School
• Caring School Community Program
• Classroom-Centered (CC) and Family-School Partnership (FSP) Intervention
• Promoting Alternative Thinking Strategies (PATHS)
• Skills, Opportunity, And Recognition (SOAR)
Middle School
• Guiding Good Choices
• Life Skills Training (LST) Program
• Lions-Quest Skills for Adolescence (SFA)
• Project ALERT
• Project STAR
• The Strengthening Families Program: For Parents and Youth 10–14 (SFP 10–14)
High School
• Life Skills Training: Booster Program
• Lions-Quest Skills for Adolescence
• Project ALERT Plus
• The Strengthening Families Program: For Parents and Youth 10–14
Selective Programs

31
Elementary School
• Focus on Families (FOF)
• The Strengthening Families Program (SFP)
Middle School
• Coping Power
High School
• Adolescents Training and Learning to Avoid Steroids (ATLAS)
Indicated Programs

33
High School
• Project Towards No Drug Abuse (Project TND)
• Reconnecting Youth Program (RY)
Tiered Programs

34
Elementary School
• Early Risers “Skills for Success” Risk Prevention Program
• Fast Track Prevention Trial for Conduct Problems
Middle School
• Adolescent Transitions Program (ATP)
Chapter 5: Selected Resources and References

36
Selected Resources

36
Selected References

38
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Preventing Drug Use among Children and Adolescents
National Institute on Drug Abuse

Preface
Today’s youth face many risks, including drug abuse,
Researchers are also studying older teens who
violence, and HIV/AIDS. Responding to these risks
are already using drugs to find ways to prevent
before they become problems can be difficult. One
further abuse or addiction. Practical issues, such as
of the goals of the National Institute on Drug Abuse
cost-benefit analyses, are being studied. Presenting
(NIDA) is to help the public understand the causes
these findings to the public is one of NIDA’s most
of drug abuse and to prevent its onset. Drug abuse
important responsibilities.
has serious consequences in our homes, schools,
and communities. From NIDA’s perspective, the
We are pleased to offer our newest edition of the
use of all illicit drugs and the inappropriate use of
publication, Preventing Drug Use among Children
licit drugs is considered drug abuse.
and Adolescents: A Research-Based Guide for Parents,
Educators, and Community Leaders, Second Edition.
Prevention science has made great progress in recent
This edition includes updated principles, new questions
years. Many prevention interventions are being tested
and answers, new program information, and expanded
in “real-world” settings so they can be more easily
references and resources. We also invite you to
adapted for community use. Scientists are studying
visit our Web site at www.drugabuse.gov where
a broader range of populations and topics. They
this publication and other materials related to the
have identified, for example, effective interventions
consequences, prevention, and treatment of drug
with younger populations to help prevent risk
abuse are offered. We hope that you will find the
behaviors before drug abuse occurs.
guide useful and helpful to your work.
Nora D. Volkow, M.D.

Director

National Institute on Drug Abuse
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National Institute on Drug Abuse

Introduction
In 1997, the National Institute on Drug Abuse (NIDA)
This second edition, reflecting NIDA’s expanded
published the first edition of Preventing Drug Use
research program and knowledge base, is more than
among Children and Adolescents: A Research-Based
double the size of the first edition. The prevention
Guide to share the latest NIDA-funded prevention
principles have been expanded to provide more
research findings with parents, educators, and
understanding about the latest research, and principles
community leaders. The guide introduced the concept
relevant to each chapter accompany the discussion.
of “research-based prevention” with questions and
Additional questions and answers, a new chapter
answers on risk and protective factors, community
on community planning, and more information
planning and implementation, and 14 prevention
on the core elements in research-based prevention
principles derived from effective drug abuse prevention
programs have been added. Each chapter ends with
research. Examples of research-tested prevention
a “Community Action Box” for primary readers—
programs were also featured. The purpose was to help
parents, educators, and community leaders. As in the
prevention practitioners use the results of prevention
first edition, the descriptions of prevention programs
research to address drug abuse among children and
are presented as examples of research-based
adolescents in communities across the country.
programs currently available.
Since then, NIDA’s prevention research program has
The expanded Selected Resources section offers Web
more than doubled in size and scope to address all
sites, sponsored by Federal and private-sector agencies.
stages of child development, a mix of audiences and
Some feature registries of effective prevention
settings, and the delivery of effective services at the
programs with agency-specific selection criteria
community level. The Institute now focuses on risks
and other resources for community planning. The
for drug abuse and other problem behaviors that
Selected References section includes up-to-date books
occur throughout a child’s development. Prevention
and journal articles that provide more information
interventions designed and tested to address risks can
on prevention research. NIDA hopes that this revised
help children at every step along their developmental
guide is helpful to drug abuse prevention efforts among
path. Working more broadly with families, schools,
children and adolescents in homes, schools, and
and communities, scientists have found effective ways
communities nationwide.
to help people gain the skills and approaches to stop
problem behaviors before they occur. Research funded
by NIDA and other Federal research organizations—
such as the National Institute of Mental Health and
the Centers for Disease Control and Prevention—
shows that early intervention can prevent many
adolescent risk behaviors.
National Institute on Drug Abuse
1

Prevention Principles
These revised prevention principles have emerged from research studies funded by NIDA on the origins of drug
abuse behaviors and the common elements found in research on effective prevention programs. Parents, educators,
and community leaders can use these principles to help guide their thinking, planning, selection, and delivery of
drug abuse prevention programs at the community level. The references following each principle are representative
of current research.
Risk Factors and Protective Factors
• While risk and protective factors can affect
people of all groups, these factors can have
PRINCIPLE 1 Prevention programs should
a different effect depending on a person’s age,
enhance protective factors and reverse or reduce
gender, ethnicity, culture, and environment
risk factors (Hawkins et al. 2002).
(Beauvais et al. 1996; Moon et al. 1999).
• The risk of becoming a drug abuser involves the
PRINCIPLE 2 Prevention programs should address
relationship among the number and type of
all forms of drug abuse, alone or in combination,
risk factors (e.g., deviant attitudes and behaviors)
including the underage use of legal drugs (e.g.,
and protective factors (e.g., parental support)
tobacco or alcohol); the use of illegal drugs (e.g.,
(Wills and McNamara et al. 1996).
marijuana or heroin); and the inappropriate use
• The potential impact of specific risk and
of legally obtained substances (e.g., inhalants),
protective factors changes with age. For
prescription medications, or over-the-counter
example, risk factors within the family have
drugs (Johnston et al. 2002).
greater impact on a younger child, while
PRINCIPLE 3 Prevention programs should
association with drug-abusing peers may be a
address the type of drug abuse problem in the
more significant risk factor for an adolescent
local community, target modifiable risk factors,
(Gerstein and Green 1993; Kumpfer et al. 1998).
and strengthen identified protective factors
• Early intervention with risk factors (e.g.,
(Hawkins et al. 2002).
aggressive behavior and poor self-control)
PRINCIPLE 4 Prevention programs should be
often has a greater impact than later
tailored to address risks specific to population
intervention by changing a child’s life path
or audience characteristics, such as age, gender,
(trajectory) away from problems and toward
and ethnicity, to improve program effectiveness
positive behaviors (Ialongo et al. 2001).
(Oetting et al. 1997).
National Institute on Drug Abuse
2
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Prevention Principles
Prevention Planning
School Programs
Family Programs
PRINCIPLE 6 Prevention programs can be
PRINCIPLE 5 Family-based prevention programs
designed to intervene as early as preschool
should enhance family bonding and relationships
to address risk factors for drug abuse, such
and include parenting skil s; practice in developing,
as aggressive behavior, poor social skills, and
academic difficulties (Webster-Stratton 1998;
These revised prevention principles have emerged from research studies funded by NIDA on the origins of drug
discussing, and enforcing family policies on
Webster-Stratton et al. 2001).
abuse behaviors and the common elements found in research on effective prevention programs. Parents, educators,
substance abuse; and training in drug education
and community leaders can use these principles to help guide their thinking, planning, selection, and delivery of
and information (Ashery et al. 1998).
PRINCIPLE 7 Prevention programs for elementary
drug abuse prevention programs at the community level. The references following each principle are representative
Family bonding is the bedrock of the relationship
school children should target improving academic
of current research.
between parents and children. Bonding can
and social-emotional learning to address risk
be strengthened through skills training on
factors for drug abuse, such as early aggression,
parent supportiveness of children, parent-child
academic failure, and school dropout. Education
communication, and parental involvement
should focus on the following skills (Ialongo
(Kosterman et al. 1997).
et al. 2001; Conduct Problems Prevention Work
Group 2002b):
• Parental monitoring and supervision are
• self-control;
critical for drug abuse prevention. These skills
can be enhanced with training on rule-setting;
• emotional awareness;
techniques for monitoring activities; praise
• communication;
for appropriate behavior; and moderate,
• social problem-solving; and
consistent discipline that enforces defined
family rules (Kosterman et al. 2001).
• academic support, especially in reading.
PRINCIPLE 8
• Drug education and information for parents
Prevention programs for middle or
or caregivers reinforces what children
junior high and high school students should increase
are learning about the harmful effects of
academic and social competence with the fol owing
drugs and opens opportunities for family
skills (Botvin et al.1995; Scheier et al. 1999):
discussions about the abuse of legal and
• study habits and academic support;
illegal substances (Bauman et al. 2001).
• communication;
• Brief, family-focused interventions for the
• peer relationships;
general population can positively change
• self-efficacy and assertiveness;
specific parenting behavior that can reduce
later risks of drug abuse (Spoth et al. 2002b).
• drug resistance skills;
• reinforcement of antidrug attitudes; and
• strengthening of personal commitments
against drug abuse.
National Institute on Drug Abuse
3

Community Programs
Prevention Program Delivery
PRINCIPLE 9 Prevention programs aimed at
PRINCIPLE 12 When communities adapt programs
general populations at key transition points, such
to match their needs, community norms, or
as the transition to middle school, can produce
differing cultural requirements, they should retain
beneficial effects even among high-risk families
core elements of the original research-based
and children. Such interventions do not single
intervention (Spoth et al. 2002b), which include:
out risk populations and, therefore, reduce labeling
and promote bonding to school and community
• Structure (how the program is organized
(Botvin et al. 1995; Dishion et al. 2002).
and constructed);
PRINCIPLE 10 Community prevention programs
• Content (the information, skills, and strategies
that combine two or more effective programs,
of the program); and
such as family-based and school-based
• Delivery (how the program is adapted,
programs, can be more effective than a single
implemented, and evaluated).
program alone (Battistich et al. 1997).
PRINCIPLE 13 Prevention programs should be
PRINCIPLE 11 Community prevention programs
long-term with repeated interventions (i.e.,
reaching populations in multiple settings—for
booster programs) to reinforce the original
example, schools, clubs, faith-based organizations,
prevention goals. Research shows that the
and the media—are most effective when they
benefits from middle school prevention programs
present consistent, community-wide messages
diminish without followup programs in high
in each setting (Chou et al. 1998).
school (Scheier et al. 1999).
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PRINCIPLE 14 Prevention programs should include
teacher training on good classroom management
practices, such as rewarding appropriate student
behavior. Such techniques help to foster students’
positive behavior, achievement, academic motivation,
and school bonding (Ialongo et al. 2001).
PRINCIPLE 15 Prevention programs are most
effective when they employ interactive techniques,
such as peer discussion groups and parent
role-playing, that allow for active involvement in
learning about drug abuse and reinforcing skills
(Botvin et al. 1995).
PRINCIPLE 16 Research-based prevention programs
can be cost-effective. Similar to earlier research,
recent research shows that for each dol ar invested
in prevention, a savings of up to $10 in treatment
for alcohol or other substance abuse can be seen
(Pentz 1998; Hawkins 1999; Aos et al. 2001;
Spoth et al. 2002a).
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5

Chapter 1: Risk Factors and Protective Factors
This chapter describes how risk and protective factors influence drug abuse behaviors, the early signs of risk,
transitions as high-risk periods, and general patterns of drug abuse among children and adolescents. A major
focus is how prevention programs can strengthen protection or intervene to reduce risks.
What are risk factors

actions, this behavior can lead to additional risks
and protective factors?
when the child enters school. Aggressive behavior
in school can lead to rejection by peers, punishment
Studies over the past two decades have tried to
by teachers, and academic failure. Again, if not
determine the origins and pathways of drug abuse
addressed through preventive interventions, these
and addiction—how the problem starts and how it
risks can lead to the most immediate behaviors that
progresses. Many factors have been identified that
put a child at risk for drug abuse, such as skipping
help differentiate those more likely to abuse drugs
school and associating with peers who abuse drugs. In
from those less vulnerable to drug abuse. Factors
focusing on the risk path, research-based prevention
associated with greater potential for drug abuse are
programs can intervene early in a child’s development
called “risk” factors, while those associated with
to strengthen protective factors and reduce risks long
reduced potential for abuse are called “protective”
before problem behaviors develop.
factors. Please note, however, that most individuals
at risk for drug abuse do not start using drugs or
The table below provides a framework for
become addicted. Also, a risk factor for one person
characterizing risk and protective factors in five
may not be for another.
domains, or settings. These domains can then serve
as a focus for prevention. As the first two examples
As discussed in the Introduction, risk and protective
suggest, some risk and protective factors are mutually
factors can affect children in a developmental risk
exclusive—the presence of one means the absence
trajectory, or path. This path captures how risks
of the other. For example, in the Individual domain,
become evident at different stages of a child’s life.
early aggressive behavior, a risk factor, indicates the
For example, early risks, such as out-of-control
absence of impulse control, a key protective factor.
aggressive behavior, may be seen in a very young
Helping a young child learn to control impulsive
child. If not addressed through positive parental
behavior is a focus of some prevention programs.
Risk Factors Domain Protective Factors
Early Aggressive Behavior Individual Impulse Control
Lack of Parental Supervision Family Parental Monitoring
Substance Abuse Peer Academic Competence
Drug Availability School Antidrug Use Policies
Poverty Community Strong Neighborhood Attachment
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Other risk and protective factors are independent of
Chapter 1 Principles
each other, as demonstrated in the table as examples
in the peer, school, and community domains. For
example, in the school domain, drugs may be
Risk Factors and

available, even though the school has “antidrug
Protective Factors
policies.” An intervention may be to strengthen
PRINCIPLE 1 Prevention programs should enhance
enforcement so that school policies create the
protective factors and reverse or reduce risk factors.
intended school environment.
• The risk of becoming a drug abuser involves the
Risk factors for drug abuse represent challenges
relationship among the number and type of risk factors
to an individual’s emotional, social, and academic
(e.g., deviant attitudes and behaviors) and protective
development. These risk factors can produce different
factors (e.g., parental support).
effects, depending on the individual’s personality
• The potential impact of specific risk and protective
traits, phase of development, and environment.
factors changes with age. For example, risk factors
For instance, many serious risks, such as early
within the family have greater impact on a younger
aggressive behavior and poor academic achievement,
child, while association with drug-abusing peers may
be a more significant risk factor for an adolescent.
may indicate that a young child is on a negative
developmental path headed toward problem behavior.
• Early intervention with risk factors (e.g., aggressive
Early intervention, however, can help reduce or reverse
behavior and poor self-control) often has a greater
these risks and change that child’s developmental path.
impact than later intervention by changing a child’s
life path (trajectory) away from problems and toward
For young children already exhibiting
positive behaviors.
serious risk factors, delaying intervention
• While risk and protective factors can affect people of
until adolescence will likely make it more
all groups, these factors can have a different effect
difficult to overcome risks. By adolescence,
depending on a person’s age, gender, ethnicity, culture,
children’s attitudes and behaviors are well
and environment.
established and not easily changed.
PRINCIPLE 2 Prevention programs should address all
Risk factors can influence drug abuse in several
forms of drug abuse, alone or in combination, including
the underage use of legal drugs (e.g., tobacco or alcohol);
ways. They may be additive: The more risks a
the use of il egal drugs (e.g., marijuana or heroin); and the
child is exposed to, the more likely the child will
inappropriate use of legal y obtained substances (e.g., inhalants),
abuse drugs. Some risk factors are particularly
prescription medications, or over-the-counter drugs.
potent, yet may not influence drug abuse unless
PRINCIPLE 3 Prevention programs should address the
certain conditions prevail. Having a family history
type of drug abuse problem in the local community, target
of substance abuse, for example, puts a child at
modifiable risk factors, and strengthen identified
risk for drug abuse. However, in an environment
protective factors.
with no drug-abusing peers and strong antidrug
PRINCIPLE 4
norms, that child is less likely to become a drug
Prevention programs should be tailored
to address risks specific to population or audience
abuser. And the presence of many protective
characteristics, such as age, gender, and ethnicity,
factors can lessen the impact of a few risk factors.
to improve program effectiveness.
For example, strong protection—such as parental
support and involvement—can reduce the influence
of strong risks, such as having substance-abusing
peers. An important goal of prevention, then,
is to change the balance between risk and
protective factors so that protective factors
outweigh risk factors.
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Gender may also determine how an individual
In the Family
responds to risk factors. Research on relationships
Children’s earliest interactions occur within the
within the family shows that adolescent girls respond
family and can be positive or negative. For this
positively to parental support and discipline, while
reason, factors that affect early development in the
adolescent boys sometimes respond negatively.
family are probably the most crucial. Children are
Research on early risk behaviors in the school setting
more likely to experience risk when there is:
shows that aggressive behavior in boys and learning
difficulties in girls are the primary causes of poor peer
• lack of mutual attachment and nurturing

relationships. These poor relationships, in turn, can
by parents or caregivers;
lead to social rejection, a negative school experience,
and problem behaviors including drug abuse.
• ineffective parenting;
• a chaotic home environment;
What are the early signs of risk that
• lack of a significant relationship with

may predict later drug abuse?
a caring adult; and
Some signs of risk can be seen as early as infancy.
• a caregiver who abuses substances, suffers from
Children’s personality traits or temperament can
mental illness, or engages in criminal behavior.
place them at increased risk for later drug abuse.
These experiences, especially the abuse of drugs and
Withdrawn and aggressive boys, for example, often
other substances by parents and other caregivers, can
exhibit problem behaviors in interactions with their
impede bonding to the family and threaten feelings of
families, peers, and others they encounter in social
security that children need for healthy development.
settings. If these behaviors continue, they will likely
On the other hand, families can serve a protective
lead to other risks. These risks can include academic
function when there is:
failure, early peer rejection, and later affiliation with
deviant peers, often the most immediate risk for drug
• a strong bond between children and their families;
abuse in adolescence. Studies have shown that children
with poor academic performance and inappropriate
• parental involvement in a child’s life;
social behavior at ages 7 to 9 are more likely to be
• supportive parenting that meets financial,
involved with substance abuse by age 14 or 15.
emotional, cognitive, and social needs; and
• clear limits and consistent enforcement of discipline.
Finally, critical or sensitive periods in development
may heighten the importance of risk or protective
factors. For example, mutual attachment and bonding
between parents and children usually occurs in infancy
and early childhood. If it fails to occur during those
developmental stages, it is unlikely that a strong positive
attachment will develop later in the child’s life.
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Outside the Family
Family has an important role in providing protection
for children when they are involved in activities
Other risk factors relate to the quality of children’s
outside the family. When children are outside the
relationships in settings outside the family, such as
family setting, the most salient protective factors are:
in their schools, with their peers, teachers, and in
the community. Difficulties in these settings can be
• age-appropriate parental monitoring of social
crucial to a child’s emotional, cognitive, and social
behavior, including establishing curfews, ensuring
development. Some of these risk factors are:
adult supervision of activities outside the home,
knowing the child’s friends, and enforcing
• inappropriate classroom behavior, such

household rules;
as aggression and impulsivity;
• success in academics and involvement

• academic failure;
in extracurricular activities;
• poor social coping skills;
• strong bonds with prosocial institutions, such
• association with peers with problem behaviors,
as school and religious institutions; and
including drug abuse; and
• acceptance of conventional norms against
• misperceptions of the extent and acceptability
drug abuse.
of drug-abusing behaviors in school, peer, and
community environments.
What are the highest risk periods
Association with drug-abusing peers is often the
for drug abuse among youth?
most immediate risk for exposing adolescents to
drug abuse and delinquent behavior. Research has
Research has shown that the key risk periods
shown, however, that addressing such behavior in
for drug abuse occur during major transitions in
interventions can be challenging. For example, a
children’s lives. These transitions include significant
recent study (Dishion et al. 2002) found that placing
changes in physical development (for example,
high-risk youth in a peer group intervention resulted
puberty) or social situations (such as moving
in negative outcomes. Current research is exploring
or parents divorcing) when children experience
the role that adults and positive peers can play in
heightened vulnerability for problem behaviors.
helping to avoid such outcomes in future interventions.
The first big transition for children is when they leave
Other factors—such as drug availability, drug
the security of the family and enter school. Later,
trafficking patterns, and beliefs that drug abuse is
when they advance from elementary school to middle
generally tolerated—are also risks that can influence
or junior high school, they often experience new
young people to start to abuse drugs.
academic and social situations, such as learning to
get along with a wider group of peers and having
greater expectations for academic performance. It
is at this stage—early adolescence—that children
are likely to encounter drug abuse for the first time.
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Then, when they enter high school, young people face
When and how does drug abuse
additional social, psychological, and educational
start and progress?
challenges. At the same time, they may be exposed
to greater availability of drugs, drug abusers, and
Studies such as the National Survey on Drug Use
social engagements involving drugs. These challenges
and Health, formerly called the National Household
can increase the risk that they will abuse alcohol,
Survey on Drug Abuse, reported by the Substance
tobacco, and other drugs.
Abuse and Mental Health Services Administration,
indicate that some children are already abusing
A particularly challenging situation in late adolescence
drugs by age 12 or 13, which likely means that some
is moving away from home for the first time without
may begin even earlier. Early abuse includes such
parental supervision, perhaps to attend college or
drugs as tobacco, alcohol, inhalants, marijuana,
other schooling. Substance abuse, particularly of
and psychotherapeutic drugs. If drug abuse persists
alcohol, remains a major public health problem for
into later adolescence, abusers typically become
college populations.
more involved with marijuana and then advance
When young adults enter the workforce or marry,
to other illegal drugs, while continuing their abuse
they again confront new challenges and stressors
of tobacco and alcohol. Studies have also shown
that may place them at risk for alcohol and other
that early initiation of drug abuse is associated
drug abuse in their adult environments. But these
with greater drug involvement, whether with the
challenges can also be protective when they present
same or different drugs. Note, however, that both
opportunities for young people to grow and pursue
one-time and long-term surveys indicate that most
future goals and interests. Research has shown that
youth do not progress to abusing other drugs. But
these new lifestyles can serve as protective factors
among those who do progress, their drug abuse
as the new roles become more important than being
history can vary by neighborhood drug availability,
involved with drugs.
demographic groups, and other characteristics of the
abuser population. In general, the pattern of abuse is
Risks appear at every transition from early
associated with levels of social disapproval, perceived
childhood through young adulthood; therefore,
risk, and the availability of drugs in the community.
prevention planners need to consider their
target audiences and implement programs
Scientists have proposed several hypotheses as to
that provide support appropriate for each
why individuals first become involved with drugs
developmental stage. They also need to
and then escalate to abuse. One explanation is a
consider how the protective factors involved
biological cause, such as having a family history
in these transitions can be strengthened.
of drug or alcohol abuse, which may genetically
predispose a person to drug abuse. Another
explanation is that starting to abuse a drug may
lead to affiliation with more drug-abusing peers
which, in turn, exposes the individual to other
drugs. Indeed, many factors may be involved.
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Different patterns of drug initiation have been
COMMUNITY ACTION BOX
identified based on gender, race or ethnicity, and
geographic location. For example, research has found
Parents can use information on risk and
that the circumstances in which young people are
protection to help them develop positive
offered drugs can depend on gender. Boys generally
preventive actions (e.g. talking about family
receive more drug offers and at younger ages. Initial
rules) before problems occur.
drug abuse can also be influenced by where drugs
Educators can strengthen learning and bonding to
are offered, such as parks, streets, schools, homes,
school by addressing aggressive behaviors and
or parties. Additionally, drugs may be offered by
poor concentration—risks associated with later
different people including, for example, siblings,
onset of drug abuse and related problems.
friends, or even parents.
Community Leaders can assess community
While most youth do not progress beyond initial
risk and protective factors associated with
use, a small percentage rapidly escalate their
drug problems to best target prevention services.
substance abuse. Researchers have found that these
youth are the most likely to have experienced a
combination of high levels of risk factors with low
levels of protective factors. These adolescents were
characterized by high stress, low parental support,
and low academic competence.
However, there are protective factors that can
suppress the escalation to substance abuse. These
factors include self-control, which tends to inhibit
problem behavior and often increases naturally as
children mature during adolescence. In addition,
protective family structure, individual personality,
and environmental variables can reduce the impact
of serious risks of drug abuse. Preventive interventions
can provide skills and support to high-risk youth
to enhance levels of protective factors and prevent
escalation to drug abuse.
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Chapter 2: Planning for Drug Abuse Prevention
in the Community
This chapter presents a process to help communities as they plan to implement research-based prevention
programs. It provides guidance on applying the prevention principles, assessing needs and community readiness,
motivating the community to take action, and evaluating the impact of the programs implemented. Additional
planning resources are highlighted in Selected Resources and References.
How can the community develop a plan
of the problem and guide the selection of programs
for research-based prevention?
most relevant to the community’s needs. This is an
important process, whether a community is selecting
Prevention research suggests that a well-constructed
a school-based prevention curriculum or planning
community plan incorporates the characteristics
multiple interventions that cut across the
outlined in the following box.
entire community.
Next, an assessment of the community’s readiness

THE COMMUNITY PLAN
for prevention can help determine additional steps
that are needed to educate the community before
• Identifies the specific drugs and other child
and adolescent problems in a community;
beginning the prevention effort. Then, a review
of existing programs is needed to determine gaps
• Builds on existing resources (e.g., current drug abuse
in addressing community needs and identifying
prevention programs);
additional resources.
• Develops short-term goals relevant to implementation
Finally, community planning can benefit from
of research-based prevention programs;
contributions of community organizations that
• Projects long-term objectives so that plans and
provide services to youth. Convening a meeting
resources are available for the future; and
of leaders of youth-serving organizations can aid in
• Incorporates ongoing assessments to evaluate the
coordinating ideas, resources, and expertise to help
effectiveness of prevention strategies.
implement and sustain research-based programs.
Planning for implementation and sustainability requires
resource development for staffing and management,
Planning Process
long-term funding commitments, and linkages with
Planning usually starts with an assessment of drug
existing delivery systems.
abuse and other child and adolescent problems,
which includes measuring the level of substance
How can the community use the
abuse in the community as well as examining the
prevention principles in
level of other community risk factors (e.g., poverty)
prevention planning?
[see section on “How can the community assess
the level of risk for drug abuse?” for more details].
Several prevention principles provide a framework
The results of the assessment can be used to raise
for effective prevention planning and programming
community awareness of the nature and seriousness
by presenting key concepts in implementing research-
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based prevention. Consider, for example, Principle 3:
Chapter 2 Principles
“Prevention programs should address the type of
drug abuse problem in the local community, target
modifiable risk factors, and strengthen identified
Principles for Prevention Planning
protective factors.” This principle describes how the
PRINCIPLE 2 Prevention programs should address al
plan should reflect the reality of the drug problem in
forms of drug abuse, alone or in combination, including
that community and, importantly, what needs to be
the underage use of legal drugs (e.g., tobacco or alcohol);
done to address it.
the use of il egal drugs (e.g., marijuana or heroin); and the
inappropriate use of legal y obtained substances (e.g., inhalants),
Community-wide efforts also can be guided by
prescription medications, or over-the-counter drugs.
Principle 9: “Prevention programs aimed at general
PRINCIPLE 3 Prevention programs should address the
populations at key transition points . . . can produce
type of drug abuse problem in the local community, target
beneficial effects, even among high-risk families and
modifiable risk factors, and strengthen identified
children.” With carefully structured programs, the
protective factors.
community can provide services to all populations,
PRINCIPLE 4 Prevention programs should be tailored
including those at high risk, without labeling or
to address risks specific to population or audience
stigmatizing them.
characteristics, such as age, gender, and ethnicity,
to improve program effectiveness.
In implementing a more specific program, such as
a family program within the educational system,
PRINCIPLE 9 Prevention programs aimed at general
the principles address some of the required content
populations at key transition points, such as the transition
areas. For instance, Principle 5 states, “Family-based
to middle school, can produce beneficial effects even
among high-risk families and children. Such interventions
prevention programs should enhance family bonding
do not single out risk populations and, therefore, reduce
and relationships and include parenting skills; practice
labeling and promote bonding to school and community.
in developing, discussing, and enforcing family policies
on substance abuse; and training in drug education
PRINCIPLE 10 Community prevention programs that
and information.”
combine two or more effective programs, such as family-
based and school-based programs, can be more effective
The principles offer guidance for selecting or adapting
than a single program alone.
effective programs that meet specific community needs.
PRINCIPLE 11 Community prevention programs reaching
It is important to recognize, however, that
populations in multiple settings—for example, schools,
not every program that seems consistent with
clubs, faith-based organizations, and the media—are most
these research-based prevention principles is
effective when they present consistent, community-wide
necessarily effective. To be effective, programs
messages in each setting.
need to incorporate the core elements identified in
research (see Chapter 3). These include appropriate
structure and content, adequate resources for training
and materials, and other implementation requirements.
For more information on resources to help communities
in prevention planning and the research underlying
the prevention principles, see Selected Resources
and References.
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How can the community assess the
As an example, the Communities That Care prevention
level of risk for drug abuse?
operating system, developed by Hawkins and colleagues
at the University of Washington (Hawkins et al. 2002),
To assess the level of risk of youth engaging in drug
is based on epidemiological methods. An assessment
abuse, it is important to:
is conducted to collect data on the distribution of risk
and protective factors at the community level. This
• measure the nature and extent of drug abuse
approach helps local planners identify geographic
patterns and trends;
areas with the highest levels of risk and the lowest
• collect data on the risk and protective factors
levels of protective resources. This analysis tool
throughout the community;
assists planners in selecting the most effective
prevention interventions to address the specific
• understand the community’s culture and how that
risks of neighborhoods.
culture affects and is affected by drug abuse;
Other data sources and measurement instruments
• consult with community leaders working in drug
(such as questionnaires) that can help in community
abuse prevention, treatment, law enforcement,
planning include the following resources.
mental health, and related areas;
• Public access data. Several large national
• assess community awareness of the problem; and
surveys provide data to help local communities
understand how their drug problems relate to
• identify existing prevention efforts already under
the national picture. These include the National
way to address the problem.
Survey on Drug Use and Health, Monitoring the
Researchers have developed many tools to assess
Future Study, and Youth Behavior Risk Study.
the extent of a community’s drug problem. Most of
Information on accessing these data is provided
these tools assess the nature of the problem—what
in Selected Resources and References.
drugs are available and who is abusing them. Some
• Public access questionnaires. The studies listed
of them assess the extent of abuse by estimating
above and many other federally sponsored data sets
how many people are abusing drugs. Others assess
make the data collection instruments available for
factors associated with abuse, such as juvenile
adaptation and use by the public. Communities
delinquency, school absenteeism, and school dropout
can conduct local studies using these instruments
rates. Researchers have also developed instruments
to collect uniform data that can often be compared
that assess individual risk status. It is important
with national findings.
when beginning the assessment process to collect
sufficient information to help local planners target
• Archival data. Data from public access files
the intervention by population and geographic area.
from school systems, health departments, hospital
emergency rooms, law enforcement agencies, and
drug abuse treatment facilities can be analyzed to
identify the nature of the local drug problem and
other youth problems.
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• Ethnographic studies. Ethnographic approaches
Is the community ready for prevention?
use systematic, observational processes to describe
behaviors in natural settings, such as studying the
Identifying a serious level of risk in a community
abuse of drugs by youth gangs, and documenting
does not always translate into community readiness
the individual perspectives of those under observation.
to take action. Based on studies of many small
communities, researchers have identified nine stages
• Other qualitative methods. Other qualitative
of readiness that can guide prevention planning
methods, such as convening focus groups of
(Plested et al. 1999). Applying measures to assess
representatives of drug-abusing subpopulations
readiness, prevention planners can then identify the
or key interviews with community officials, can
critical steps needed to implement programs (see
be used to gain a greater understanding of the
table on page 20). Although much of the research
local drug abuse problem.
on the stages of community readiness has examined
As each of these methods has advantages and
small communities, large communities find that
disadvantages, it is advisable, permitting resources,
these stages provide a structure to describe levels
to use multiple strategies to assess community risk
of awareness of drug issues in their community
to provide the best information possible.
and readiness to embrace a prevention program.
Awareness is assessed at two levels: that of the public
The Community Epidemiology Work Group (CEWG),
(by examining the nature and level of drug coverage
another data source pioneered in the early 1970s by
in the news) and that of officials (by determining
NIDA and communities nationwide, is composed
if they have taken a position on drug abuse

of researchers from 21 U.S. cities who collect or use
in the community).
archival data to characterize the nature of the drug
problem in their locations. CEWG representatives
Community leaders can begin assessing their
meet with NIDA biannually to inform the Institute
community’s readiness by interviewing key
and fellow CEWG members of changing drug trends
informants in their community. Additional
in their cities. The work group has developed a
planning and program sources can be found in
Guide for Community Epidemiology Surveillance
Selected Resources and References. Web sites,
Networks on Drug Abuse to help other communities
contact information, and publications offer further
use this approach to provide up-to-date information
information to guide community efforts.
on local drug abuse problems.
Using information obtained through these many
sources can help community leaders make sound
decisions about programs and policies. Analyzing
these data before implementing new programs can
also help establish a baseline for evaluating results.
To be most informative, periodic assessments need
to be made routinely.
For more information on how communities can
assess the level or risk of drug abuse in their
community, see Selected Resources and References.
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ASSESSING READINESS*
COMMUNITY ACTION
Readiness Stage
Community Response
Ideas
1. No awareness
Relative tolerance of drug abuse
Create motivation. Meet with community
leaders involved with drug abuse prevention;
2. Denial
Not happening here, can’t do
use the media to identify and talk about the
anything about it
problem; encourage the community to see
3. Vague awareness
Awareness, but no motivation
how it relates to community issues; begin
preplanning.
4. Preplanning
Leaders aware, some motivation
5. Preparation
Active energetic leadership
Work together. Develop plans for prevention
and decisionmaking
programming through coalitions and other
community groups.
6. Initiation
Data used to support
Identify and implement research-based programs.
prevention actions
7. Stabilization
Community generally supports
Evaluate and improve ongoing programs.
existing program
8. Confirmation/
Decisionmakers support improving Institutionalize and expand programs to reach
Expansion
or expanding programs
more populations.
9. Professionalization
Knowledgeable of community drug Put multicomponent programs in place for
problem; expect effective solutions
all audiences.
* Plested et al. 1999.
How can the community be motivated
But care is needed in organizing a community-level
to implement research-based
coalition to ensure that its programming incorporates
prevention programs?
research-tested strategies and programs—at the
individual, school, and community levels. Having a
The methods needed to motivate a community to
supportive infrastructure that includes representatives
act depend on the particular community’s stage of
across the community can reinforce prevention
readiness. At lower stages of readiness, individual
messages, provide resources, and sustain prevention
and small group meetings may be needed to attract
programming. Introducing a school-based curriculum,
support from those with great influence in the
however, requires less community involvement, but is
community. At higher levels of readiness, it may be
still a focused preventive effort.
possible to establish a community board or coalition
of key leaders from public- and private-sector
Research has shown that prevention programs
organizations. This can provide the impetus for action.
can use the media to raise public awareness
of the seriousness of a community’s drug
Community coalitions can and do hold community-
problem and prevent drug abuse among
wide meetings, develop public education campaigns,
specific populations. Using local data and speakers
present data that support the need for research-based
from the community demonstrates that the drug
prevention programming, and attract sponsors for
problem is real and that action is needed. Providing
comprehensive drug abuse prevention strategies.
some of the examples of research-based programs
described in Chapter 4 can help mobilize the
community for change.
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How can the community assess
In assessing the impact of individual programs, it is
the effectiveness of current
important for communities to document how well
prevention efforts?
the program is delivered and the level of intervention
participants receive. For example, in assessing a
Assessing prevention efforts can be challenging for
school-based prevention program, key questions
a community, given limited resources and limited
to be asked include:
access to expertise in program evaluation. Many
communities begin the process with a structured
a Have the teachers mastered the content and
review of current prevention programs to determine:
interactive teaching strategies needed for the
selected curriculum?
a What programs are currently in place

in the community?
a How much exposure have the students had
to each content area?
a Were strict scientific standards used to test
the programs during their development?
a Is there an assessment component?
a Do the programs match community needs?
The community plan should guide actions for prevention
over time. Once communities are mobilized, program
a Are the programs being carried out as designed?
implementation and sustainability require clear,
measurable goals, long-term resources, sustained
a What percentage of at-risk youth is being
leadership, and community support to maintain
reached by the program?
momentum for preventive change. Continuing
Another evaluation approach is to track existing
evaluations keep the community informed and
data over time on drug abuse among students in
allow for periodic reassessment of needs and goals.
school, rates of truancy, school suspensions, drug-
abuse arrests, and drug-related emergency room
admissions. The use of the information obtained in
COMMUNITY ACTION BOX
the initial community drug abuse assessment can
Parents can work with others in their community
serve as a baseline for measuring change in long-
to increase awareness about the local drug
term trends. Because the nature and extent of drug
abuse problem and the need for research-based
abuse problems can change with time, it is wise to
prevention programs.
periodically assess community risk and protective
factors to help ensure that the programs in place
Educators can work with others in their school
appropriately address current community needs.
and school system to review current programs,
and identify research-based prevention
Communities may wish to consult with State and
interventions appropriate for students.
county prevention authorities for assistance in planning
and implementation efforts. Also, federally supported
Community Leaders can organize a community
publications and other resources are available,
group to develop a community prevention plan,
as noted in Selected Resources and References.
coordinate resources and activities, and support
research-based prevention in all sectors

of the community.
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Chapter 3: Applying Prevention Principles to
Drug Abuse Prevention Programs
This chapter describes how the prevention principles have been applied to create effective family, school, and
community programs. It offers information on working with risk and protective factors, adapting programs while
maintaining fidelity to core elements, implementing and evaluating programs, and understanding the cost-benefits
of research-based prevention. The goal is to help communities implement research-based prevention programs.
How are risk and protective factors
Tiered programs, such as the Adolescent Transitions
addressed in prevention programs?
Program, incorporate all three levels of intervention.
Others, such as Early Risers “Skills for Success”
Risk and protective factors are the primary targets
Prevention Program, may have only two levels
of effective prevention programs used in the family,
of intervention.
school, and community settings. Prevention programs
are usually designed to reach specific populations
Details of the programs used as examples in the
in their primary settings, such as reaching children
following sections are provided in Chapter 4.
at school or through recreational or after-school
In the Family
programs. However, in recent years it has become
more common to find programs for any given target
Prevention programs can strengthen protective factors
group in a variety of settings, such as holding a
among young children by teaching parents better
family-based program in a school or a church. The
family communication skills, developmentally
goal of these programs is to build new and strengthen
appropriate discipline styles, firm and consistent rule
existing protective factors and reverse or reduce
enforcement, and other family management skills.
modifiable risk factors in youth.
Parents also can be taught how to increase their
emotional, social, cognitive, and material support,
Prevention programs can be described by the audience
which includes, for example, meeting their children’s
or intervention level for which they are designed:
financial, transportation, health care, and homework
needs. Research confirms the benefit of parents taking
• Universal programs are designed for the general
a more active role in their children’s lives, by talking
population, such as all students in a school.
with them about drugs, monitoring their activities,
• Selective programs target groups at risk, or subsets
getting to know their friends, understanding their
of the general population such as children of drug
problems and concerns, providing consistent rules
abusers or poor school achievers.
and discipline, and being involved in their learning
and education. The importance of the parent-child
• Indicated programs are designed for people who
relationship continues through adolescence and beyond.
are already experimenting with drugs.
An example of a universal family-based program is
the Strengthening Families Program For Parents and
Youth, 10–14, which provides rural parents guidance
on family management skills, communication,
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academic support, and parent-child relationships.
Chapter 3 Principles
Recognizing that it can be difficult to attract
parents to this program, the researchers encourage
participation through flexibility in scheduling and
Principles for Programs
location. Offering conveniences such as babysitting,
PRINCIPLE 5 Family-based prevention programs should
transportation, and meals make participation more
enhance family bonding and relationships and include
practical for many rural parents, while enhancing
parenting skills; practice in developing, discussing, and
the program’s success in reaching its goals.
enforcing family policies on substance abuse; and training
in drug education and information.
Another type of family program operates within a
PRINCIPLE 6
school setting. The Adolescent Transitions Program,
Prevention programs can be designed to
intervene as early as preschool to address risk factors
for example, is a tiered intervention family program.
for drug abuse, such as aggressive behavior, poor social
All families can get involved with the universal
skills, and academic difficulties.
intervention, which makes available a Family Resource
Room where information on parenting is provided.
PRINCIPLE 7 Prevention programs for elementary school
children should target improving academic and social-
The Family Check-Up, the selective level of this
emotional learning to address risk factors for drug abuse,
program, is an assessment process to identify and
such as early aggression, academic failure, and
help families at greater risk by providing them with
school dropout.
information and interventions specific to their needs.
PRINCIPLE 8
Families already engaged in problem behaviors and
Prevention programs for middle or junior
high and high school students should increase academic
identified as needing an indicated intervention are
and social competence.
provided more intense assistance and information
tailored to their problem. Such assistance might
PRINCIPLE 9 Prevention programs aimed at general
include, for example, individual or family therapy,
populations at key transition points, such as the transition
to middle school, can produce beneficial effects even
intensive parent coaching, therapeutic foster care, or
among high-risk families and children. Such interventions
other family-specific interventions. The uniqueness
do not single out risk populations and, therefore, reduce
of the tiered approach is that the whole school
labeling and promote bonding to school and community.
participates in the program and all individuals or
PRINCIPLE 10
families receive the appropriate level of help without
Community prevention programs that
combine two or more effective programs, such as family-
being labeled in the process.
based and school-based programs, can be more effective
In School
than a single program alone.
PRINCIPLE 11
Prevention programs in schools focus on children’s
Community prevention programs reaching
populations in multiple settings—for example, schools,
social and academic skills, including enhancing
clubs, faith-based organizations, and the media—are most
peer relationships, self-control, coping skills, social
effective when they present consistent, community-wide
behaviors, and drug offer refusal skills. School-based
messages in each setting.
prevention programs should be integrated within
the school’s own goal of enhanced academic
performance. Evidence is emerging that a major risk
for school failure is a child’s inability to read by the
third and fourth grades (Barrera et al. 2002), and
school failure is strongly associated with drug abuse.
Integrated programs strengthen students’ bonding
to school and reduce their likelihood of dropping
out. Most prevention curricula include a normative
education component designed to correct the
misperception that many students are abusing drugs.
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Chapter 3 Principles
Most research-based prevention interventions in
schools include curricula that teach many of the
behavioral and social skills described above. The
Principles for Program Delivery
Life Skills Training Program exemplifies universal
PRINCIPLE 12 When communities adapt programs to
classroom programs that are provided to middle-
match their needs, community norms, or differing cultural
schoolers. The program teaches drug resistance,
requirements, they should retain core elements of the
self-management, and general social skills in a
original research-based intervention.
3-year curriculum, with the third year a booster
PRINCIPLE 13 Prevention programs should be long-term
session offered when students enter high school.
with repeated interventions (i.e., booster programs) to
The Caring School Community Program is another
reinforce the original prevention goals. Research shows
that the benefits from middle school prevention programs
type of school-based intervention. This universal
diminish without followup programs in high school.
elementary school program focuses on establishing
a “sense of community” among the classroom, school,
PRINCIPLE 14 Prevention programs should include
and family settings. The community support that
teacher training in good classroom management practices,
such as rewarding appropriate student behavior. Such
results helps children succeed in school and cope
techniques help to foster student’s positive behavior,
with stress and other problems when they occur.
achievement, academic motivation, and school bonding.
An indicated intervention that reaches high school
PRINCIPLE 15 Prevention programs are most effective
students, Project Towards No Drug Abuse focuses on
when they employ interactive techniques, such as peer
students who have failed to succeed in school and are
discussion groups and parent role-playing, that allow
engaged in drug abuse and other problem behaviors.
for active involvement in learning about drug abuse and
reinforcing skills.
The program seeks to rebuild students’ interest in
school and their future, correct their misperceptions
PRINCIPLE 16 Research-based prevention programs
about drug abuse, and strengthen protective factors,
can be cost-effective. Similar to earlier research, recent
including positive decisionmaking and commitment.
research shows that for each dollar invested in prevention,
a savings of up to $10 in treatment for alcohol or other
Recent research suggests caution when
substance abuse can be seen.
grouping high-risk teens in peer group
interventions for drug abuse prevention.
Such groups have been shown to produce
negative effects, as participants appear to
reinforce substance abuse behaviors over time
(Dishion et al. 2002). Research is examining
how to prevent such effects, with a particular
focus on the role of adults and positive peers.
In the Community
Prevention programs work at the community level
with civic, religious, law enforcement, and other
government organizations to enhance antidrug
norms and prosocial behaviors. Strategies to change
key aspects of the environment are often employed
at the community level. These can involve instituting
new policies, such as the drug-free school concept,
or strengthening community practices, such as asking
for proof of age to buy cigarettes.
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Many programs coordinate prevention efforts
What are the core elements of effective
across settings to communicate consistent messages
research-based prevention programs?
through school, work, religious institutions, and the
media. Research has shown that programs that reach
In recent years, many research-based prevention
youth through multiple sources can strongly impact
programs have proven effective. These programs
community norms (Chou et al. 1998). Community-
were tested with rigorous designs in diverse
based programs also typically include development
communities in a wide variety of settings, and with
of policies or enforcement of regulations, mass media
a variety of populations. The most rigorous design
efforts, and community-wide awareness programs.
tests the program’s effects on a group that receives
Examples include establishing youth curfew, having
the intervention (i.e., “experimental group”) and
advertising restrictions, reducing the density of alcohol
compares results to a second group that did not
outlets in the community, raising cigarette prices,
receive the intervention (i.e., “control group”).
and creating drug-free school zones. Some carefully
As communities review prevention programs to
structured and targeted media interventions have
determine which best fit their needs, the following
proven to be very effective in reducing drug abuse.
core elements of effective research-based programs
For example, a mass media campaign targeting
should be considered.
sensation-seeking youth reduced marijuana abuse
by 27 percent among high sensation-seeking youth
• Structure—how each program is organized
(Palmgreen et al. 2001).
and constructed;
Project STAR is an example of a multicomponent
• Content—how the information, skills, and
drug abuse prevention program for the community.
strategies are presented; and
This project tested whether a coordinated effort
that encompassed schools, parents, community
• Delivery—how the program is selected or adapted
organizations, health policies, and the media could
and implemented, as well as how it is evaluated
make a difference in preventing drug abuse among
in a specific community.
youth. Project STAR reached all children and
When adapting programs to match community
families in the community. The middle school
characteristics, it is important to retain these core
curriculum was the core of the program and was
elements to ensure that the most effective aspects of
reinforced by homework and other activities of the
the program remain intact. Core elements help build
parent component. Health policies and mass media
effective research-based prevention programs.
components were incorporated as well. Long-term
followup studies have shown significant impacts in
Each core element contains descriptive features, which
reducing substance abuse, with benefits lasting well
are presented in the following sections. Tables are
into participants’ adult years.
included in each section to provide examples of
how these features fit together in programs.
National Institute on Drug Abuse
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Structure
The setting describes where the program takes place.
Prevention programs are usually designed to reach
Structure addresses program type, audience, and
target populations in their primary setting, such as
setting. Several program types have been shown
reaching children at school. It is becoming more
to be effective in preventing drug abuse. School-
common, however, for effective programs to be
based programs, the first to be fully developed
conducted in settings other than their primary
and tested, have become the primary approach
setting—for example, holding a family-based
for reaching all children. Family-based programs
program in a school or a school-based program
have proven effective in reaching both children
in a youth organization such as Boys/Girls Clubs.
and their parents in a variety of settings. Media
Multicomponent programs reach populations

and computer technology programs are beginning
in a variety of settings.
to demonstrate effectiveness in reaching people at
the community level as well as the individual level.
Content
Research also shows that combining two or
Content is composed of information, skills
more effective programs, such as family and
development, methods, and services. Information
school programs, can be even more effective
can include facts about drugs and their effects, as
than a single program alone. These are called
well as drug laws and policies. Drug information
multicomponent programs.
alone, however, has not been found to be effective in
deterring drug abuse. Combining information with
The following examples illustrate program structure:
skills, methods, and services produces more effective
Structure of Prevention Programs
results. Programs include skills development training
to build and improve behaviors in important areas,
Program Type Audience
Setting
such as communication within the family, social
Community
(Universal)
All Youth

Billboards
and emotional development, academic and social
competence in children, and peer resistance
School
Middle School
(Selective)
After-School
strategies in adolescents.
Students
Family
High-RiskYouth
Clinic
Methods are oriented toward structural change,
(Indicated)
and Their Families
such as establishing and enforcing school rules on
substance abuse, or enforcing existing laws, such
Within these categories, programs have been designed
as those on tobacco sales to minors. Services could
to specifically target the needs of a particular audience,
include school counseling and assistance, peer
such as an indicated prevention program for high-
counseling, family therapy, and health care. These
risk boys. Examples of other subcategories would
content areas are designed to reduce modifiable risk
include urban or rural populations, racial and ethnic
factors and strengthen protective factors.
minorities, and different age groups. Researchers are
testing how to modify effective programs to best
The table below describes the type of content
address such audience differences.
included in programs.
Content of Prevention Programs
Program Types
Information
Skills Development
Methods
Services
Community
Drug Trends
Social Skills
Tolerence Policies
Drug-Free Zones
School
Drug Effects
Resistance Skills
Norms Change
School Counseling and
Assistance
Family
Drug Abuse
Parenting Skills
Home Drug-Testing;
Family Therapy
Symptoms
Curfew
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Delivery
Adaptation involves shaping a program to fit the
needs of a specific population in various settings.
Delivery includes program selection or adaptation
Scientists have been exploring how best to culturally
and implementation. The following table describes
adapt effective programs to a specific environment
various delivery approaches.
(such as a rural environment) and population (only
boys, for example). In the process of adaptation, the
Delivery of Prevention Programs
program’s core elements are maintained to ensure the
Program
Program Selection Implementation
effectiveness of the intervention, while addressing the
Type
or Adaptation
Features
community’s needs. Several research-based adapted
programs are now available, such as the Life Skills
Spanish-Speaking
Consistent
Community
Multimedia
Training Program for inner-city minority youth.
Population
Messages
For programs that have not yet been adapted and
School
Gender
Booster Sessions
studied in a research protocol, it is best to implement
Family
Rural
Recruitment/
Retention
the program as designed to ensure the most effective
outcomes. Implementation refers to how the program
During the selection process, communities match
is delivered, including the number of sessions,
effective research-based programs to their community
methods used, and program followup. Research
needs. In Chapter 2, it was suggested that communities
has found that how a program is implemented can
conduct a structured review of existing programs to
determine its effectiveness in preventing drug abuse.
determine what gaps remain, given risk and protective
factors in the community and the community’s drug
Use of interactive methods and appropriate
problems and needs. This information can then be
booster sessions helps to reinforce earlier
incorporated into the community plan, which guides
program content and skills to maintain
the selection of new research-based programs.
program benefits.
For initial guidance to aid the selection process,
communities can refer to the description of programs
in several categories found in Chapter 4. Additional
planning and program resources can be found in
Selected Resources and References, which offers Web
sites, contact information, and publications to guide
community efforts.
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How can the community implement and
How can the community evaluate the
sustain effective prevention programs?
impact of its program on drug abuse?
After considering risk and protective factors
Conducting evaluations of community prevention
within the community and selecting and adapting
programs can be challenging. Many community
prevention programs to address those risks, the
leaders have consulted with university faculty members
community must begin to implement those programs.
and other local and State evaluation experts to assist
In many communities, coalitions formed during the
in designing and implementing evaluation procedures.
community planning process remain involved in
Ensuring appropriate evaluation design is important
overseeing program implementation. They continue
because errors can result in findings that do not show
to review progress toward goals and objectives set
a clear relationship between the program and the
out in the community plan. Responsibility for actual
outcomes. Were the results truly attributable to the
implementation, however, generally resides within the
program’s effects and not some other source, such
local public or private community-based organization
as other community events or the maturation

in the educational, social service, or other local system
of the target groups?
implementing the programs.
An evaluation should identify what was accomplished
To ensure effective implementation, research-based
in the program, how it was carried out, and its effects.
school and family programs often require extensive
To ensure a thorough evaluation, the program
human and financial resources and a serious
implementer and staff should assess ongoing
commitment to training and technical assistance.
adherence to program elements. Keeping records
In addition to resources, special attention is needed
of content delivered, session attendance, content
to attract and keep program participants interested
feedback quizzes, and independent observations
and involved in the programs. This is especially
of implementation fidelity can help monitor the
important when involving families in rural and poverty
effectiveness of program implementation and
settings. Research has shown that extra effort in
provide key information on why a program

providing incentives, maximal schedule flexibility,
is or is not achieving its intended effects.
minimal time demands, free meals, transportation,
baby-sitting, personal contact, and endorsement from
important community leaders all help to attract and
retain program participants. In short, how a program
is delivered to specific audiences is critical to its success.
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Evaluation pitfalls can be avoided by consulting with
What are the cost-benefits of
experts who can guide the evaluation design by:
community prevention programs?
• using tested data-collection instruments;
Research has demonstrated that preventing substance
• obtaining good baseline, or preintervention,
abuse and other problem behaviors can have a
information;
net benefit after accounting for costs. In a recent
study, Spoth and associates (2002a) performed
• using control or comparison groups who did not
cost-effectiveness and benefit-cost analyses on data
receive the intervention, but whose characteristics
from two long-term interventions already shown
are similar to those who did receive it;
to be effective in preventing substance abuse: Iowa
Strengthening Families Program (ISFP; now called
• monitoring the quality of program implementation;
The Strengthening Families Program: For Parents
• ensuring that postintervention followup includes
and Youth 10–14), and Preparing for the Drug-Free
a large percentage of the target population; and
Years (PDFY; now called Guiding Good Choices).
Both interventions were found to have net benefits
• using appropriate statistical methods to analyze
by preventing adult cases of alcohol abuse and thus
the data.
saving future costs for alcohol abuse treatment.
Benefit-to-cost ratios were $9.60 for each dollar
In addition to assessing program impact, evaluation
invested in prevention for the ISFP group, and $5.85
is an ongoing process that can provide guidance on
per dollar invested in prevention for the PDFY group.
maintaining the program’s responsiveness to changing
For each family in the ISFP condition, there was a
community needs.
benefit of $5,923; and the PDFY condition resulted
The evaluation process needs to answer questions
in a benefit of $2,697 per family. In addition, an
about the program and its outcomes, including:
analysis of the Skills, Opportunity, And Recognition
(SOAR) program had a benefit-to-cost ratio of $4.25
a What was accomplished in the program?
for every dollar spent (Hawkins et al. 1999; Aos et
a
al. 2001). An earlier study (Pentz 1998) found that
How was the program carried out?
for every dollar spent on drug abuse prevention,
a Who participated in it?
communities could save from $4 to $5 in costs
for drug abuse treatment and counseling.
a How much of the program was received

by participants?
COMMUNITY ACTION BOX
a Is there a connection between the amount

of program received and outcomes?
Parents can work with others in the community
to use the prevention principles in selecting drug
a Was the program implemented as intended?
abuse programs.
a Did the program achieve what was expected
Educators can incorporate research-based
in the short term?
content and delivery into their regular
classroom curricula.
a Did the program produce the desired
long-term effects?
Community Leaders can work with evaluation
experts to evaluate program progress and
develop improvements in outcomes.
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Chapter 4: Examples of Research-Based

Drug Abuse Prevention Programs
To help those working in drug abuse prevention,
Universal Programs
NIDA, in cooperation with prevention scientists,
presents the following examples of research-based
Elementary School
programs that use a variety of strategies proven
Caring School Community Program (Formerly, Child
effective in preventing drug abuse. Each program
Development Project) (Battistich et al. 1997; U.S.
was developed as part of a research protocol in which
Department of Education 2001). This is a universal
an intervention group and a comparison group were
family-plus-school program to reduce risk and bolster
matched on important characteristics, such as age,
protective factors among elementary school children.
grade in school, parents’ level of education, family
The program focuses on strengthening students’
income, community size, and risk and protective
“sense of community,” or connection, to school.
factors. The interventions were tested in a family,
Research has shown that this sense of community
school, or community setting, all with positive results.
has been pivotal to reducing drug use, violence,
Prevention research continues to identify effective
and mental health problems, while promoting
programs and strategies, thus this list is not meant
academic motivation and achievement. The program
to be exhaustive.
consists of a set of mutually reinforcing classroom,
school, and family involvement approaches. These
Many of these research-based programs include
promote positive peer, teacher-student, and home-
approaches to identifying early risk factors and
school relationships and the development of social,
addressing them long before a child encounters
emotional, and character-related skills. The program
substance abuse. Whether the intervention focuses on
provides detailed instructional and implementation
improving teachers’ skills in classroom management
materials and accompanying staff development.
and academic support or on parents’ communication
skills, early positive support can reduce risks and
Contact for Materials and Research:
increase protection. Also, recent research is focused
Eric Schaps, Ph.D.

on adapting interventions to address specific risks by
Caring School Community Program
gender, ethnic or racial identification, and geographic
Developmental Studies Center

settings to improve the effectiveness of programs for
2000 Embarcadero, Suite 305
Oakland, CA 94606-5300
specific audiences.
Phone: 510-533-0213
The programs are presented within their audience
Fax: 510-464-3670
category (universal, selective, indicated, or tiered)
E-mail: Eric_Schaps@devstu.org
Web site: www.devstu.org
and for whom they are designed (elementary, middle,
or high school students). Since these programs are
only examples, community planners may wish to
explore additional programs and planning resources,
which are highlighted in Selected Resources and
References. With NIDA’s continued support of
research on effective prevention strategies at all levels
of prevention, new research-based programs will
continue to be made available in the future.
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Classroom-Centered (CC) and Family-School
behaviors, increased self-control, and an improved
Partnership (FSP) Intervention (Ialongo et al. 2001).
ability to tolerate frustration and use conflict-
The CC and FSP interventions are multicomponent,
resolution strategies.
universal first-grade interventions to reduce later onset
of violence and aggressive behavior and to improve
Contact for Materials:
academic performance. The CC intervention combines
Channing Bete Company
two effective classroom programs, the “Good Behavior
One Community Place
Game” and “Mastery Learning,” and includes
South Deerfield, MA 01373-0200
classroom management and organizational strategies,
Phone: 877-896-8532
as well as reading and mathematics curricula. The
Fax: 800-499-6464
E-mail: PrevSci@channing-bete.com
CC intervention also focuses on enhancing teachers’
Web site: www.channing-bete.com
behavior management and instructional skills. The
Contact for Research:
FSP intervention targets the same risk factors of
aggression and learning problems, but directly
Mark T. Greenberg, Ph.D.
Prevention Research Center
involves parents. It seeks to improve parent-teacher
Pennsylvania State University
communication, parental teaching, and children’s
110 Henderson Building-South
behavior management strategies in the home.
University Park, PA 16802-6504
Findings show that sixth-graders exposed to the
Phone: 814-863-0112
CC intervention in first grade had significantly
Fax: 814-865-2530
E-mail: mxg47@psu.edu
reduced their aggressive behavior, as compared
Web site: www.prevention.psu.edu/PATHS
with control students.
Contact for Training:
Contact for Materials and Research:
PATHS Training, LLC

Carol A. Kusché, Ph.D.

Nicholas Ialongo, Ph.D.

927 10th Avenue E.
Department of Mental Health

Seattle, WA 98102
Johns Hopkins Bloomberg

School of Public Health

Phone and Fax: 206-323-6688
Johns Hopkins University
E-mail: ckusche@attglobal.ne
624 N. Broadway
Baltimore, MD 21205
Skills, Opportunity, And Recognition (SOAR)
Phone: 410-550-3441
(Formerly, Seattle Social Development Program)
Fax: 410-550-3461
(Lonczak et al. 2002; U.S. Department of Education
E-mail: nialongo@jhsph.edu
2001; Hawkins et al. 1999). This universal school-
based intervention for grades one through six seeks
Promoting Alternative Thinking Strategies
to reduce childhood risks for delinquency and
(PATHS) (Greenberg and Kusché 1998). PATHS is
drug abuse by enhancing protective factors. The
a comprehensive program for promoting emotional
multicomponent intervention combines training
health and social competencies and reducing aggression
for teachers, parents, and children during the
and behavior problems in elementary school children,
elementary grades to promote children’s bonding
while enhancing the educational process in the
to school, positive school behavior, and academic
classroom. This K–5 curriculum is designed for use
achievement. These strategies are designed to enhance
by educators and counselors in a multiyear, universal
opportunities, skills, and rewards for children’s
prevention model. Although primarily for use in
prosocial involvement in school and their families.
school and classrooms, information and activities
are also included for use with parents. PATHS has
been shown to improve protective factors and
reduce behavioral risk factors that impact youth
problem behaviors. Studies report reduced aggressive
26
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27

Long-term followup results show positive outcomes
Contact for Research:
for participants, including reduced antisocial behavior,
J. David Hawkins, Ph.D.

misbehavior, alienation and teen pregnancy, and
Social Development Research Group

improved academic skills, commitment to school,
University of Washington

9725 Third Avenue NE, Suite 401
and positive relationships with people.
Seattle, WA 98115
Phone: 206-543-7655

Contact for Materials:
Fax: 206-543-4507
Channing Bete Company

E-mail: jdh@u.washington.edu
One Community Place

Web site: www.depts.washington.edu/sdrg
South Deerfield, MA 01373-0200
Contact for Materials:
Phone: 877-896-8532
Fax: 800-499-6464
Channing Bete Company

E-mail: PrevSci@channing-bete.com
One Community Place

Web site: www.channing-bete.com
South Deerfield, MA 01373-0200
Phone: 877-896-8532
Contact for Research:
Fax: 800-499-6464
J. David Hawkins, Ph.D.

E-mail: PrevSci@channing-bete.com
Social Development Research Group

Web site: www.channing-bete.com
University of Washington

9725 Third Avenue NE, Suite 401
Life Skills Training (LST) Program (Botvin et al.
Seattle, WA 98115

1995, 1997, 2003; U.S. Department of Education
Phone: 206-543-7655
2001). LST is designed to address a wide range of risk
Fax: 206-543-4507
E-mail: jdh@u.washington.edu
and protective factors by teaching general personal
Web site: www.depts.washington.edu/sdrg
and social skills, along with drug resistance skills
and normative education. This universal program
Middle School
consists of a 3-year prevention curriculum for students
in middle or junior high school. LST contains 15
Guiding Good Choices (GGC) (Formerly, Preparing
sessions during the first year, 10 booster sessions
for the Drug-Free Years) (Hawkins et al. 1999;
during the second, and 5 sessions during the third
Kosterman et al. 1997; U.S. Department of Education
year. The program can be taught either in grades 6, 7,
2001; Spoth et al. 2002b). This curriculum was first
and 8 (for middle school) or grades 7, 8, and 9 (for
researched as part of the Seattle Social Development
junior high schools). LST covers three major content
Project at the University of Washington to educate
areas: (1) drug resistance skills and information,
parents on how to reduce risk factors and strengthen
(2) self-management skills, and (3) general social
bonding in their families. In five 2-hour sessions,
skills. The program has been extensively tested over
parents are shown how to (1) create age-appropriate
the past 20 years and found to reduce the prevalence
opportunities for family involvement and interaction;
of tobacco, alcohol, and illicit drug use relative to
(2) set clear expectations, monitor children, and apply
controls by 50 to 87 percent. When combined with
discipline; (3) teach their children peer coping strategies;
booster sessions, LST was shown to reduce the
(4) adopt family conflict management approaches;
prevalence of substance abuse long term by as much
and (5) express positive feelings to enhance family
as 66 percent, with benefits still in place beyond
bonding. Dr. Richard Spoth of Iowa State University
the high school years. Although LST was originally
independently tested this intervention for rural
tested predominantly with White youth, several studies
parents and found the program to be effective in
have shown that the LST program is also effective
inhibiting alcohol and marijuana use. Special efforts
were made to ensure recruitment and retention
of study participants.
28
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with inner-city minority youth. Moreover, an
Contact for Materials:
age-appropriate version of the LST program for upper
Greg Long

elementary school students was recently developed
Lions-Quest
and shown to reduce tobacco and alcohol use (Botvin
1984-B Coffman Road

Newark, OH 43055

et al. 2003). It contains 24 classes (8 classes per year)
to be taught during either grades 3 to 5 or 4 to 6.
Phone: 740-522-6405 or 800-446-2700
Fax: 740-522-6580
E-mail: info@lions-quest.org
Contact for Materials and Training:
Web site: www.lions-quest.org
National Health Promotion Associates, Inc.
Contact for Research:
Life Skills Training

711 Westchester Avenue
Marvin Eisen, Ph.D.

White Plains, NY 10604

Population Studies Center

The Urban Institute

Phone: 914-421-2525
2100 M Street, NW

Fax: 914-683-6998

Washington, DC 20037
E-mail: LSTinfo@nhpanet.com
Web site: www.lifeskillstraining.com
Phone: 202-261-5858
Fax: 202-452-1840
Contact for Research:
E-mail: meisen@ui.urban.org
Gilbert Botvin, Ph.D.

Institute for Prevention Research
Project ALERT (U.S. Department of Education 2001).
Weill Medical College of Cornell University
This drug prevention curriculum is a 2-year, universal
411 East 69th Street, Room 203
New York, NY 10021
program for middle school students that reduces the
onset and regular use of substances among youth.
Phone: 212-746-1270
Fax: 212-746-8390
The 14-lesson program is designed to prevent drug
E-mail: gjbotvin@.med.cornell.edu
use initiation and the transition to regular use. It
focuses on substances that adolescents typically use
Lions-Quest Skills for Adolescence (SFA) (Eisen et al.
first and most widely—alcohol, tobacco, marijuana,
2002; U.S. Department of Education 2001). SFA is a
and inhalants. Project ALERT uses participatory
commercially available, universal, life skills education
activities and videos to help students establish nondrug
program in use in schools nationwide. A rigorous
norms, develop reasons not to use, and resist prodrug
school-based trial of SFA funded by a NIDA research
pressures. The program has prevented marijuana use
grant compared the effectiveness of SFA delivered
initiation, decreased current and heavy smoking, curbed
in sixth grade with “standard” drug prevention
alcohol misuse, reduced prodrug attitudes and beliefs,
programs in preventing or delaying the onset of
and helped smokers quit. The program has proven
students’ tobacco, alcohol, and illegal substance use
successful with high- and low-risk youth from
through middle school. The 40-session version of SFA
a variety of communities.
tested includes social influence and social cognitive
approaches to teaching cognitive-behavioral skills
Contact for Materials:
for building self-esteem and personal responsibility,
G. Bridget Ryan

communicating effectively, making better decisions,
Project ALERT
resisting social influences and asserting rights, and
725 S. Figueroa Street, Suite 970
Los Angeles, CA 90017
increasing drug use knowledge and consequences
(Quest International, 3rd edition 1992.) Some of
Phone: 800-253-7810
Fax: 213-623-0585
the results after 1 year indicate that exposure to the
E-mail: info@projectalert.best.org
program can help deter initiation of regular cigarette
Web site: www.projectalert.best.org
smoking and marijuana use; these results held across
all racial/ethnic groups studied. Additional findings
after 2 years indicate lower initiation and regular
marijuana use across all groups, as well as lower
binge drinking rates among Hispanic students.
28
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Contact for Research:
The Strengthening Families Program: For Parents
Phyllis L. Ellickson, Ph.D.
and Youth 10–14 (SFP 10–4) (Formerly, the Iowa
Director, Center for Research on

Strengthening Families Program) (Spoth, Redmond,
Maternal, Child, and Adolescent Health
and Shin 2000, 2001). This program offers seven
The RAND Corporation
1700 Main Street
sessions, each attended by youth and their parents.
P.O. Box 2138
Program implementation and evaluation have been
Santa Monica, CA 90407-2138
conducted through partnerships that include state
Phone: 310-393-0411
university researchers, Cooperative Extension System
Fax: 310-451-7062
staff, local schools, and community implementers.
E-mail: Phyllis_ellickson@rand.org
Web site: www.rand.org
Longitudinal study of comparisons with control
group families showed positive effects on parents’
Project STAR (Chou et al. 1998; U.S. Department of
child management practices (for example, setting
Education 2001). Project STAR is a comprehensive
standards, monitoring children, and applying
drug abuse prevention community program with
consistent discipline) and on parent-child affective
components for schools, parents, community
quality. In addition, a recent evaluation found
organizations, and health policymakers. An additional
delayed initiation of substance use at the 6-year
component targets mass media to encourage publicizing
followup. Other findings showed improved youth
positive efforts for drug prevention. The middle
resistance to peer pressure to use alcohol, reduced
school component is a social influence curriculum
affiliation with antisocial peers, and reduced levels of
that is incorporated into classroom instruction by
problem behaviors. Importantly, conservative benefit-
trained teachers over a 2-year timetable. In the
cost calculations indicate returns of $9.60 per dollar
parent program, parents work with children on
invested in SFP.
homework, learn family communication skills, and
Contact for Materials and Research:
get involved in community action. Strategies range
from individual-level change, such as teaching youth
Virginia Molgaard, Ph.D.

Prevention Program Development

drug resistance skills, to school and community-change,
The Strengthening Families Program:

including limiting youth access to alcohol or drugs.
For Parents and Youth 10–14

Long-term followup studies showed significant
Institute for Social and Behavioral Research

reductions in drug use among participants, when
Iowa State University

2625 North Loop Drive, Suite 500

compared with adolescents in the community who
Ames, IA 50010-8296
had not received prevention intervention.
Phone: 515-294-8762
Fax: 515-294-3613
Contact for Materials and Research:
E-mail: vmolgaar@iastate.edu
Karen Bernstein, M.P.H.

Web site: www.extension.iastate.edu/sfp/
University of Southern California
Contact for Research and Evaluation Information:
Institute for Prevention Research
1000 S. Fremont Avenue, Unit #8

Richard Spoth, Ph.D.

Alhambra, CA 91803
c/o Pandora Lamar

Institute for Social and Behavioral Research
Phone: 626-457-6687
Iowa State University

Fax: 626-457-6695
2625 North Loop Drive, Suite 500
E-mail: Karenber@usc.edu
Ames, IA 50010-8296
Phone: 515-294-5383
Fax: 515-294-3613
E-mail: rlspoth@iastate.edu; cc: plamar@iastate.edu
Web site: www.projectfamily.isbr.iastate.edu
30
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in the experimental condition reported having stolen
High School
something in the previous 6 months. After 2 years
Life Skills Training: Booster Program. The 3-year
of family skills training, positive effects were still
LST universal classroom program contains 15 booster
evident in parents’ drug refusal skills, and positive
sessions during the first year, 10 during the second,
effects had emerged in parent problemsolving skills
and 5 during the third year. See the Life Skills
in general situations. No statistically significant
Training description above for background and
differences in drug use were found between those in
contact information.
experimental versus control conditions, although the
direction of difference still favored experimental par-
Lions-Quest Skills for Adolescence. (Eisen 2002; U.S.
ticipants. Importantly, the strength of program effects
Department of Education 2001). See description
on children was substantially stronger at the 2-year
above for background and contact information.
followup. Note that the direction of differences on
all primary child outcome measures were stronger
Project ALERT Plus. An enhanced version of Project
at the second-year assessment than at the end of the
ALERT has been added as a high school component
first year. These findings suggest that interventions to
and is being tested in 45 rural communities. See the
prevent relapse among parents and substance abuse
Project ALERT description above for background
among their children may produce immediate, as well
and contact information.
as delayed, or “sleeper” effects on targeted risk and
The Strengthening Families Program: For Parents
protective factors and substance use. The promise of
and Youth 10–14. (Formerly, the Iowa Strengthening
the FOF program is evident in the early reduction
Families Program). See description above for
in family-related risk factors—particularly for very
background and contact information.
high-risk families—with an overall trend toward
positive program effects on child outcomes.
Selective Programs
Contact for Materials and Research:
Richard F. Catalano, Ph.D.

Elementary School
Social Development Research Group

9725 Third Avenue, NE, Suite 401

Focus on Families (FOF) (Catalano et al. 1999,
University of Washington
Seattle, WA 98115
2002). A selective program for parents receiving
methadone treatment and their children, FOF seeks
Phone: 206-543-6382
Fax: 206-543-4507
to reduce parents’ use of illegal drugs by teaching
E-mail: catalano@u.washington.edu
them skills for relapse prevention and coping. Parents
Web site: depts.washington.edu/sdrg
are also taught how to better manage their families
to reduce their children’s risk for future drug abuse.
The parent training consists of a 5-hour family
retreat and 32 parent training sessions of 1.5 hours
each. Children attend 12 of the sessions to practice
developmentally appropriate skills with their parents.
Results from an experimental evaluation of FOF
found positive program effects on parents at the 1-year
followup, especially in parenting skills, rule-setting,
domestic conflict, drug refusal skills, and drug use.
At the 1-year assessment, significantly fewer children
30
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The Strengthening Families Program (SFP) (Kumpfer
Middle School
et al. 1996, 2002). SFP, a universal and selective
Coping Power (Lochman and Wells 2002). Coping
multicomponent, family-focused prevention program,
Power is a multicomponent child and parent preventive
provides support for families with 6- to 11-year-olds.
intervention directed at preadolescent children at
The program began as an effort to help drug-abusing
high risk for aggressiveness and later drug abuse
parents improve their parenting skills and reduce
and delinquency. The child component is derived
their children’s risk for subsequent problems.
from an anger coping program, primarily tested
It has shown success in elementary schools and
with highly aggressive boys and shown to reduce
communities. Strengthening Families has three
substance use. The Coping Power Child Component
components: a behavioral parent training program,
is a 16-month program for fifth- and sixth-graders.
children’s skills training program, and family skills
Group sessions usually occur before or after school
training program. In each of the 14 weekly sessions,
or during nonacademic periods. Training focuses
parents and children are trained separately in the first
on teaching children how to identify and cope with
hour. During the second hour, parents and children
anxiety and anger; controlling impulsiveness; and
come together in the family skills training portion.
developing social, academic, and problemsolving
The session begins with families sharing dinner.
skills at school and home. Parents are also provided
Barriers to attendance are reduced by providing
training throughout the program. Results indicate
child care, transportation, and small incentives. This
that the intervention produced relatively lower rates
approach has been evaluated in a variety of settings
of substance use at postintervention than seen among
and with several racial and ethnic groups. Spanish-
the controls. Also, children of families receiving
language manuals are available. Primary outcomes
the Coping Power child and parent components
include reduced family conflict, youth conduct
significantly reduced aggressive behavior, as rated
disorders, aggressiveness, and substance abuse, as
by parents and teachers.
well as improved youth social skills, parenting skills,
and family communication and organization.
Contact for Materials and Research:
Contact for Materials and Research:
John E. Lochman, Ph.D.

Department of Psychology

Karol Kumpfer, Ph.D.

University of Alabama
University of Utah

P.O. Box 870348
Department of Health Promotion
Tuscaloosa, AL 35487
300 S. 1850 E. Room 215

Phone: 205-348-7678
Salt Lake City, UT 84112-0920
Fax: 205-348-8648
Phone: 801-581-7718
E-mail: jlochman@gp.as.ua.edu
Fax: 801-581-5872
E-mail: karol.kumpfer@health.utah.edu
Web site: www.strengtheningfamiliesprogram.org
Contact for Training:
Henry O. Whiteside, Ph.D.
Lutragroup
5215 Pioneer Fork Road
Salt Lake City, UT 84108-1678
Phone: 801-583-4601
Fax: 801-583-7979
E-mail: hwhiteside@lutragroup.com
32
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33

High School
Indicated Programs
Adolescents Training and Learning to Avoid Steroids
High School
(ATLAS) (Goldberg et al. 2000). ATLAS is a
multicomponent selective program for male high
Project Towards No Drug Abuse (Project TND)
school athletes, designed to reduce risk factors for
(Sussman et al. 2002). This indicated prevention
use of anabolic steroids and other drugs, while
intervention targets high school age youth who
providing healthy sports nutrition and strength-training
attend alternative or traditional high schools. The
alternatives to illicit use of athletic-enhancing
goal is to prevent the transition from drug use to
substances. Coaches and peer teammates facilitate
drug abuse, considering the developmental issues
curriculum delivery with scripted manuals in small
faced by older teens, particularly those at risk for
cooperative learning groups, taking advantage of an
drug abuse. At the core of Project TND is a set of
influential coaching staff and the team atmosphere
12 in-class sessions that provide motivation and
where peers share common goals. Seven 45-minute
cognitive misperception correction, social and self-
classroom sessions and seven physical training periods
control skills, and decisionmaking material targeting
involve role-playing, student-created campaigns,
the use of cigarettes, alcohol, marijuana, and hard
and educational games. Instructional aids include
drugs and violence-related behavior, such as carrying
pocket-sized food and exercise guides and easy-to-
a weapon. The classroom program has been found
follow student workbooks. Parents are involved
to be effective at 1-year followup across three true
through parent-student homework and are given
experimental field trials. The 12-session version is
the booklet, Family Guide to Sports Nutrition.
effective across outcome variables, and many effects
Attitudes and alcohol and illicit drug use, as well as
are maintained at 2-year followup.
nutrition behaviors and exercise self-efficacy, remained
significantly healthier among ATLAS program
Contact for Materials and Research:
participants at a 1-year followup.
Steve Sussman, Ph.D., FAAHB

Institute for Health Promotion
and Disease Prevention Research

Contact for Materials:
Departments of Preventive Medicine
Division of Health Promotion

and Psychology
and Sports Medicine

University of Southern California
Oregon Health & Science University
1000 S. Fremont Avenue, Unit 8
Building A-4, Room 4124
Phone: 503-494-7900
Alhambra, CA 91803
Web site: www.ohsu.edu/som-hpsm/atlas.html
Phone: 626-457-6635
Fax: 626-457-4012
Contact for Research:
E-mail: ssussma@hsc.usc.edu
Linn Goldberg, M.D., FACSM

Division of Health Promotion

Reconnecting Youth Program (RY) (Eggert et al.
and Sports Medicine

1995, 2001; Thompson et al. 1997). RY is a school-
Oregon Health & Science University

3181 SW Sam Jackson Park Road

based indicated prevention program for high school
Portland, OR 97201-3098
students with poor school achievement and potential
Phone: 503-494-8051
for dropping out. Participants may also show signs
Fax: 503-494-1310
of multiple problem behaviors, such as substance
E-mail: goldberl@ohsu.edu
abuse, depression, aggression, or suicidal behaviors.
Web site: www.atlasprogram.com
Students are screened for eligibility and then invited
to participate in the program. The program goals are
to increase school performance, reduce drug use, and
32
Preventing Drug Use among Children and Adolescents
National Institute on Drug Abuse
33

learn skills to manage mood and emotions. RY blends
Tiered Programs
small group work (10–12 students per class) to foster
positive peer bonding, with social skills training in
Elementary School
a daily, semester-long class. RY skills, taught by an
Early Risers “Skills for Success” Risk Prevention
RY specially trained teacher or group leader, include
Program (August et al. 2001; August et al. 2002;
self-esteem enhancement, decisionmaking, personal
August et al., in press). Early Risers is a selective,
control, and interpersonal communication. Early
multicomponent, preventive intervention for children
experiments have shown that participation in RY
at heightened risk for early onset of serious conduct
improved school performance (20-percent increase
problems, including licit and illicit drug use. The
in GPA), decreased school dropout, reduced hard
program’s focus is on elementary school children
drug use (by 60 percent), and decreased drug use
with early aggressive behavior. It is designed to deflect
control problems, such as adverse consequences and
children from the “early starter” developmental
progression to heavier drug use. Recent studies of a
pathway toward normal development by effecting
refined RY program model (with skills training on
positive change in academic competence, behavioral
depression and anger management and increased
self-regulation, social competence, and parent
monitoring of drug use) have found greater decreases
investment in the child. Early Risers has two
in hard drug use, depression, perceived stress, and
broad components: CORE, a set of child-focused
anger control problems.
intervention components delivered continuously
in school and over the summer for 2 or 3 years,
Contact for Materials:
implemented in tandem with FLEX, a family
Reconnecting Youth: A Peer Group Approach
support and empowerment component tailored to
to Building Life Skills (Revised Edition)
National Educational Service
meet family-specific needs and delivery through
304 West Kirkwood Avenue, Suite 2
home visits. Recent findings reveal that program
Bloomington, IN 47404
participants showed greater gains in social skills, peer
Phone: 800-733-6786 or 812-336-7790
reputation, prosocial friendship selection, academic
Fax: 812-336-7790
achievement, and parent discipline than did controls.
E-mail: nes@nesonline.com
Web site: www.nesonline.com
Contact for Materials and Research:
Gerald J. August, Ph.D.

Contact for Research and Program Evaluation:
Division of Child and Adolescent Psychiatry
Jerald R. Herting, Ph.D.
University of Minnesota Medical School

Reconnecting Youth Prevention
P256/2B West, 2450 Riverside Avenue
Research Program
Minneapolis, MN 55454-1495
Psychosocial and Community Health
Phone: 612-273-9711
University of Washington School of Nursing
Fax: 612-273-9779
9709 Third Avenue NE, Suite 510
E-mail: augus001@tc.umn.edu

Seattle, WA 98115
Phone: 206-543-3810 or 206-616-6478
Fast Track Prevention Trial for Conduct Problems
Fax: 206-221-3674
E-mail: herting@u.washington.edu
(Conduct Problems Prevention Research Group 2002c).
Web site: www.son.washington.edu/department/pch/ry
Fast Track is a comprehensive preventive intervention
for young children at high risk for long-term antisocial
Contact for Training:
behavior. Based on a developmental model, the
Leona L. Eggert or Liela J. Nicholas,
intervention includes a universal classroom program
Program Developers
(adapted from the PATHS curriculum) for high-risk
Reconnecting Youth Prevention Programs
children selected in kindergarten; it also includes
Phone: 425-861-1177
training for parents. Children receive social skills
Fax: 425-861-8071
training, academic tutoring, and home visits to improve
E-mail: RYprog@verizon.net
34
Preventing Drug Use among Children and Adolescents
National Institute on Drug Abuse
35

academic and social competencies and reduce
problem behavior and substance use. The indicated
problems. In first grade, the classroom intervention
level, the Parent Focus curriculum, provides direct
builds skills in (1) emotional understanding and
professional support to parents to make the changes
communication, (2) friendship, (3) self-control, and
indicated by the Family Check-Up. Services may
(4) social problemsolving. The selective intervention
include behavioral family therapy, parenting groups,
reaches parents and children at higher risk for
or case management services.
conduct problems. Parenting strategies provide
skills to support school adjustment, improve the
Contact for Materials and Research:
child’s behavior, build parents’ self-control, promote
Thomas J. Dishion, Ph.D.

appropriate expectations for the child’s behavior, and
University of Oregon

improve parent-child interaction. By the end of third
Child and Family Center
195 West 12th Avenue
grade, 37 percent of the intervention group were free of
Eugene, OR 97401
serious conduct problems, compared with 27 percent
Phone: 541-346-4805
of the control group.
Fax: 541-346-4858
Contact for Materials and Research:
Conduct Problems Prevention
Research Group
Karen L. Bierman, Ph.D.
Pennsylvania State University

Prevention Research Center

110 Henderson-Building South

University Park, PA 16802-6504
Phone: 814-865-3879
Fax: 814-865-3246
E-mail: prevention@psu.edu
Middle School
Adolescent Transitions Program (ATP) (Dishion et al.
2002). ATP is a school-based program that uses a
tiered approach to provide prevention services to
students in middle and junior high school and their
parents. The universal intervention level, directed
to parents of all students in a school, establishes a
Family Resource Room to engage parents, establish
norms for parenting practices, and disseminate
information about risks for problem behavior and
substance use. The selective intervention level, the
Family Check-Up, offers family assessment and
professional support to identify families at risk for
34
Preventing Drug Use among Children and Adolescents
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35

Chapter 5: Selected Resources and References
Below are resources relevant to drug abuse prevention. Information on NIDA’s Web site is fol owed by Web sites for
other Federal agencies and private organizations. These resources and the selected references that fol ow are excel ent
sources of information in helping communities plan and implement research-based drug prevention programs.
Selected Resources
Other Federal Resources
Center for Substance Abuse Prevention (CSAP)
National Institute on Drug Abuse (NIDA)
Substance Abuse and Mental Health Services
National Institutes of Health (NIH)

Administration (SAMHSA), DHHS
U.S. Department of Health and

5600 Fishers Lane
Human Services (DHHS)
Rockwall 2, 9th Floor, Suite 900
Rockville, MD 20857
NIDA’s Web site (www.drugabuse.gov) provides
Phone: 301-443-9110
factual information on all aspects of drug abuse,
www.prevention.samhsa.gov
particularly the effects of drugs on the brain and
Centers for Disease Control and Prevention (CDC), DHHS
body, the prevention of drug abuse among children
1600 Clifton Road
and adolescents, the latest research on treatment
Atlanta, GA 30333
for addiction, and statistics on the extent of drug
Phone: 404-639-3534
Phone: 800-311-3435 (toll-free)
abuse in the United States. The Web site allows
www.cdc.gov
visitors to print or order publications, public service
announcements and posters, science education
Safe and Drug-Free Schools Program
curricula, research reports and fact sheets on specific
U.S. Department of Education (DoE)
400 Maryland Avenue, SW
drugs or classes of drugs, and the NIDA NOTES
Washington, DC 20202
newsletter. The site also links to related Web sites
Phone: 800-872-5327 (toll-free)
in the public and private sector.
www.ed.gov
Drug Enforcement Administration (DEA)
U.S. Department of Justice (DOJ)
2401 Jefferson Davis Highway
Alexandria, VA 22301
Phone: 202-307-1000
www.dea.gov
Knowledge Exchange Network, SAMHSA, DHHS
P.O. Box 42490
Washington, DC 20015
Phone: 800-789-2647 (toll-free)
www.mentalhealth.org
36
Preventing Drug Use among Children and Adolescents
National Institute on Drug Abuse
37

National Clearinghouse for Alcohol and
Other Selected Resources
Drug Information (NCADI), SAMHSA, DHHS
Phone: 800-729-6686 (toll-free)
American Academy of Child and Adolescent Psychiatry
www.ncadi.samhsa.gov
(AACAP)
3615 Wisconsin Avenue, NW
National Institute on Alcohol Abuse and Alcoholism

Washington, DC 20016
(NIAAA), NIH, DHHS
Phone: 202-966-7300
6000 Executive Boulevard, Willco Building
www.aacap.org
Bethesda, MD 20892
Phone: 301-443-3860
American Academy of Family Physicians (AAFP): KidsHealth
www.niaaa.nih.gov
11400 Tomahawk Creek Parkway
Leawood, KS 66211
www.familydoctor.org
National Institute of Mental Health (NIMH), NIH, DHHS
6001 Executive Boulevard, Room 8184, MSC 9663
American Academy of Pediatrics (AAP)
Bethesda, MD 20892
141 Northwest Point Boulevard
Phone: 301-443-4513
Elk Grove, IL 60007-1098
www.nimh.nih.gov
Phone: 847-434-4000
www.aap.org
National Institutes of Health (NIH), DHHS
9000 Rockville Pike
American Psychological Association (APA)
Bethesda, MD 20892
750 First Street, NE
Phone: 301-496-4000
Washington, DC 20002
www.nih.gov
Phone: 800-374-2121 (toll-free)
Phone: 202-336-5510
National Library of Medicine (NLM), NIH, DHHS
www.apa.org
8600 Rockville Pike
Bethesda, MD 20894
American Society of Addiction Medicine (ASAM)
Phone: 301-594-5983
4601 North Park Avenue, Arcade Suite 101
Phone: 888-346-3656 (toll-free)
Chevy Chase, MD 20815
www.nlm.nih.gov
Phone: 301-656-3920
www.asam.org
Office of Juvenile Justice and Delinquency Prevention

(OJJDP), DOJ
Blueprints for Violence Prevention, Center for the Study

810 Seventh Street
and Prevention of Violence
Washington, DC 20531
Institute on Behavioral Science
Phone: 202-307-5911
University of Colorado at Boulder
www.ojjdp.ncjrs.org/pubs/substance.html
900 28th Street, Suite 107
439 UCB
Office of National Drug Control Policy (ONDCP)
Boulder, CO 80309
P.O. Box 6000
Phone: 303-492-1032
Rockville, MD 20849
www.colorado.edu/cspv/blueprints/
Phone: 800-666-3332 (toll-free)
www.whitehousedrugpolicy.gov
Center on Addiction and Substance Abuse (CASA)
at Columbia University
Substance Abuse and Mental Health Services Administration
633 Third Avenue, 19th Floor
(SAMHSA), DHHS
New York, NY 10017
5600 Fishers Lane
Phone: 212-841-5200
Rockville, MD 20857
www.casacolumbia.org
Phone: 301-443-8956
www.samhsa.gov
36
Preventing Drug Use among Children and Adolescents
National Institute on Drug Abuse
37

Community Anti-Drug Coalitions of America (CADCA)
National Prevention Network (NPN)
901 North Pitt Street, Suite 300
808 17th Street, NW, Suite 410
Alexandria, VA 22314
Washington, DC 20006
Phone: 800-542-2322 (toll-free)
Phone: 202-293-0090
www.cadca.org
www.nasadad.org/Departments/Prevention/prevhme1.htm
Drug Strategies, Inc.
Partnership for a Drug-Free America
1150 Connecticut Avenue, NW, Suite 800
405 Lexington Avenue, Suite 1601
Washington, DC 20036
New York, NY 10174
Phone: 202-289-9070
Phone: 212-922-1560
www.drugstrategies.org
www.drugfreeamerica.org
Join Together
Society for Prevention Research (SPR)
One Appleton Street, 4th Floor
1300 I Street, NW, Suite 250 West
Boston, MA 02116
Washington, DC 20005
Phone: 617-437-1500
Phone: 202-216-9670
www.jointogether.org
www.preventionresearch.org
Latino Behavioral Health Institute
P.O. Box 1008
Selected References
Thousand Oaks, CA 91360
Phone: 213-738-2882
The following references have been selected as
www.lbhi.org
either summaries of the literature of the past several
National Asian Pacific American Families Against
years or as the latest findings on specific aspects of
Substance Abuse (NAPAFASA)
prevention research, which have been cited in this
340 East Second Street, Suite 409
Los Angeles, CA 90012
publication. For a more comprehensive list of research
Phone: 213-625-5795
citations, please consult the NIDA Web site at
www.napafasa.org
www.drugabuse.gov.
National Criminal Justice Reference Service (NCJRS)
Aos, S.; Phipps, P.; Barnoski, R.; and Lieb, R. The Comparative
P.O. Box 6000
Costs and Benefits of Programs to Reduce Crime. Vol. 4 (1-05-1201).
Rockville, MD 20849
Olympia, WA: Washington State Institute for Public Policy,
Phone: 800-851-3420 (toll-free)
May 2001.
Phone: 301-519-5500
www.ncjrs.org
Ashery, R.S.; Robertson, E.B.; and Kumpfer K.L.; eds. Drug
Abuse Prevention Through Family Interventions. NIDA Research
National Families in Action (NFIA)
Monograph No. 177. Washington, DC: U.S. Government Printing
2957 Clairmont Road, NE, Suite 150
Office, 1998.
Atlanta, GA 30329
Phone: 404-248-9676
August, G.J.; Realmuto, G.M.; Hektner, J.M.; and Bloomquist, M.L.
www.nationalfamilies.org
An integrated components preventive intervention for aggressive
elementary school children: The Early Risers Program. Journal of
National Hispanic Science Network (NHSN)
Consulting and Clinical Psychology 69(4):614–626, 2001.
Center for Family Studies
Department of Psychiatry & Behavioral Sciences
August, G.J.; Hektner, J.M.; Egan, E.A.; Realmuto, G.M.; and
University of Miami School of Medicine
Bloomquist, M.L. The Early Risers longitudinal trial: Examination
1425 NW 10th Avenue, 3rd Floor
of 3-year outcomes in aggressive children with intent-to-treat
Miami, FL 33136-1024
and as-intended analyses. Psychology of Addictive Behaviors
Phone: 305-243-2340
16(43):827–839, 2002.
www.hispanicscience.org
August, G.J.; Lee, S.S.; Bloomquist, M.L.; Realmuto, G.M.; and
Hektner, J.M. Dissemination of an evidence-based prevention
innovation for aggressive children living in a culturally diverse,
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Conduct Problems Prevention Research Group. Evaluation of the
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