Community-Based Substance Use Prevention

by

Abigail A. Fagan, C. Cory Lowe

• LAST REVIEWED: 25 August 2021
• LAST MODIFIED: 25 August 2021
• DOI: 10.1093/obo/9780195396607-0310

Introduction

Community-based substance use prevention involves changing the community context to reduce the prevalence of substance use among community members. The specific actions taken to prevent substance use will vary depending on the initiative but should include activities that target community-level factors that influence substance use, as well as the implementation of specific, evidence-based policies and programs that reach as many individuals as possible in the community. Many community-based prevention efforts are led by coalitions of community members. Ideally, these coalitions will include representation from diverse groups and organizations and comprise all stakeholders concerned about substance use. The use of broad-based coalitions helps ensure that prevention efforts are community-specific, responsive to community needs, and culturally relevant. Participation by community stakeholders and organizations also increases the likelihood that prevention programs are implemented in multiple contexts, reach large numbers of individuals in order to achieve community-level reductions in substance use, and can be sustained over time. Coalitions can also work to change local policies, regulations, and/or ordinances to reduce all community members’ access to substances and opportunities to use them. Community-based prevention can be very challenging, especially in under-resourced communities. In any community, it can be difficult to recruit community members to volunteer to participate in such initiatives and to sustain their interest over time. In addition, maintaining active coalitions, enacting policy changes, and implementing prevention programs requires significant human and financial resources. Communities are also likely to need technical support and ongoing consultation from researchers to help them plan, implement, and evaluate the success of their efforts. Despite these difficulties, some community-based prevention efforts have been demonstrated as effective in reducing substance use/abuse. Although these interventions vary in their complexity and mechanisms for achieving change, common features of successful community-based approaches include the following: (1) clear definition of the specific problem(s) to be prevented; (2) involvement of community members, often through broad-based coalitions; (3) assessment of community-specific needs and resources; (4) implementation of prevention programs, practices, and policies to address these needs; and (5) monitoring of these activities over time to ensure their effectiveness and sustainability. By following these steps and using interventions that have prior evidence of effectiveness from well-conducted research studies, communities should be able to achieve significant reduction in community rates of substance use.

General Overviews

According to Wandersman and Florin 2003, community-level interventions are conceptualized as “multicomponent interventions that generally combine individual and environmental change strategies across multiple settings to prevent dysfunction and promote well-being among population groups in a defined local community.” Community-based substance use prevention strategies take this approach when seeking to prevent substance use/abuse by community members, and many rely on efforts by community coalitions to do so. The works discussed in this section cover a range of topics related to community-based substance use prevention. Both Stevenson and Mitchell 2003 and Wandersman and Florin 2003 provide general conceptualizations of community-based prevention and collaboration. Wagenaar and Perry 1994 and Hawkins, et al. 2002 describe specific and different types of community-based interventions used to prevent substance use/abuse and the theories that inform them. Stith, et al. 2006 reviews the process of coalition development and characteristics of effective coalitions. Merzel and D’Afflitti 2003 focuses on the challenges associated with community-based prevention. Flay 2000 recommends supplementing school-based prevention programs with broader community or environmental interventions to produce community-wide reductions in substance use and related behaviors. However, in a review of community-based prevention efforts, Fagan and Hawkins 2012 concludes that the use of environmental strategies alone does not significantly impact youth substance use and recommends that coalitions implement evidence-based programs throughout the community, especially school-based curricula. The literature cited in this section also identifies several challenges associated with community-based prevention. For example, Merzel and D’Afflitti 2003 discusses the fact that these strategies are often difficult to evaluate, coalitions can be difficult to develop and sustain, and, in the past, interventions have failed to base interventions on theory or provide sufficient dosing in the community. Alternatively, as described by Stith, et al. 2006, there are several factors that contribute to the effectiveness of coalitions, such as the diversity of members, coalition leadership, community readiness and access to training and resources, and implementing effective interventions with fidelity.

• Fagan, A. A. and J. D. Hawkins. 2012. Community-based substance use prevention. In The Oxford handbook on crime prevention. Edited by B. C. Welsh and D. P. Farrington, 247–268. New York: Oxford Univ. Press.

  DOI: 10.1093/oxfordhb/9780195398823.013.0013

  This chapter provides a brief overview of community-based prevention, conceptualized as efforts that attempt to prevent substance use by changing “the environment in which youths reside using approaches that are owned and operated by the local community” (p. 249). It reviews the outcomes of these studies and summarizes the characteristics of effective efforts, such as their structure, use of evidence-based interventions, and inclusion of school-based interventions.

• Flay, B. R. 2000. Approaches to substance use prevention utilizing school curriculum plus social environment change. Addictive Behaviors 25.6: 861–885.

  DOI: 10.1016/s0306-4603(00)00130-1

  School-based prevention curricula has played a major role in prevention science. This article reviews whether, to what extent, and under what conditions the effects of school-based prevention programs are enhanced by other environmental strategies, including broader community-based efforts to change policies related to alcohol and drug use. Its results suggested that parsing the independent effects of different components is difficult and requires sophisticated methodological approaches.

• Hawkins, J. D., R. F. Catalano, and M. W. Arthur. 2002. Promoting science-based prevention in communities. Addictive Behaviors 27.6: 951–976.

  DOI: 10.1016/S0306-4603(02)00298-8

  This article argues that a public heath model of prevention that targets risk and protective factors for problem behaviors using appropriate evidence-based interventions is the most promising approach to prevention. Next, it reviews the Social Development Model, a developmental theory of positive and negative behaviors, and how the Communities That Care (CTC) system promotes effective community prevention efforts through its phased approach. Finally, it reviews the evidence in support of CTC.

• Merzel, C., and J. D’Afflitti. 2003. Reconsidering community-based health promotion: Promise, performance, and potential. American Journal of Public Health 93.4: 557–574.

  DOI: 10.2105/ajph.93.4.557

  This critical review of thirty-two community-based health prevention programs identifies the characteristics of successful interventions and the challenges they pose. These interventions often have modest effects that are often difficult to detect because of reduced statistical power, and because it is difficult to isolate effects in the presence of secular trends. There may be problems with implementation, insufficient “dosing” or penetration of interventions across the community, lack of a guiding theory, and limited community participation.

• Stevenson, J., and R. Mitchell. 2003. Community-level collaboration for substance abuse prevention. Journal of Primary Prevention 23:371–404.

  DOI: 10.1023/A:1021397825740

  This article provides important conceptual, theoretical, and practical guidance on community collaboration for substance use prevention. It begins by reviewing conceptualizations of collaboration and different classifications of collaborative efforts. Next, it provides a critical review of studies that examine how different collaborative models (i.e., community-capacity building, service integration, and policy change) may influence substance use and other problem behaviors and highlights how these models effect change.

• Stith, S., I. Pruitt, J. Dees, et al. 2006. Implementing community-based prevention programming: A review of the literature. Journal of Primary Prevention 27.6: 599–617.

  DOI: 10.1007/s10935-006-0062-8

  This systematic review identifies common characteristics of effective community-based prevention. The most important factors are (1) community readiness and capacity; (2) effective, inclusive coalitions comprising diverse stakeholders and led by organized and knowledgeable leaders; (3) fit between interventions and the community; (4) implementation fidelity; and (5) adequate resources, training, and assistance.

• Wagenaar, A. C., and C. L. Perry. 1994. Community strategies for the reduction of youth drinking: Theory and application. Journal of Research on Adolescence 4.2: 319–345.

  DOI: 10.1207/s15327795jra0402_8

  This article provides a rationale for population- and/or community-wide alcohol prevention strategies based on a novel and complex social ecological model of alcohol use. The model integrates many influential theories of deviance and organizes the relationships among many risk and protective factors. Finally, it discusses how two community-based prevention efforts (Communities Mobilizing for Change on Alcohol and Project Northland) reflect this theory and target risk and protective factors across various domains (e.g., peers, family, school).

• Wandersman, A., and P. Florin. 2003. Community intervention and effective prevention. American Psychologist 58.6: 441–448.

  DOI: 10.1037/0003-066X.58.6-7.441

  This article defines community-level interventions and explains their underlying rationale. Next it reviews more and less effective community-level prevention efforts and argues that variation in effectiveness is likely due to challenges associated with (1) evaluations, (2) developing and sustaining coalitions, and (3) implementing appropriate interventions. Finally, it introduces the Getting to Outcomes model and how it can be used to develop, implement, and evaluate effective community-level interventions.