Several federal agencies have compiled information about evidence-based substance use disorder prevention programs in rural communities. Rural program planners should review the evaluation criteria and program content to determine if these programs can address the needs of their communities. The majority of prevention programs described in this section target children and adolescents and are, therefore, school-based. The examples in this toolkit are not exhaustive and additional programs can be found in various registries and databases including:
- Substance Abuse and Mental Health Administration's Evidence-Based Practices (EBP) Resource Center
- National Institute of Justice's CrimeSolutions.gov database
- Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute's County Health Rankings & Roadmaps program database
- Community Preventive Services Task Force's Community Guide
- The Surgeon General's Report on Alcohol, Drugs, and Health
Examples of Prevention Programs
- Fast Track: Fast Track is a comprehensive, long term prevention program that begins with children entering kindergarten and follows them through tenth grade. Intervention components change as children age and include components such as a teacher-led classroom curriculum, parent training groups, home visits, and child tutoring. One study showed that the Fast Track intervention reduced the likelihood of alcohol use and binge drinking as well as the probability of individuals developing serious substance use disorders. This intervention has been rated effective by the National Institute of Justice and is listed in The Surgeon General's Report on Alcohol, Drugs, and Health as an evidence-based prevention program.
- LifeSkills Training (LST) Program: LST is a universal, classroom based prevention program implemented among middle school students. The program consists of a three-year curriculum that teaches drug resistance skills along with general social skills. An LST booster program can be offered after students enter high school. Curriculum materials are available for a fee and are available in Spanish. LST has been shown to reduce the prevalence of both alcohol and illicit drug use and has a cost to benefit ratio of $17.35 in benefits for every dollar spent. LST is recommended by the National Institute on Drug Abuse and listed in The Surgeon General's Report on Alcohol, Drugs, and Health as an evidence-based prevention program.
- The Strengthening Families Program: For Parents and Youth 10–14 (SFP 10–14): This universal, family-centered program includes seven two-hour sessions and four optional booster sessions where youth and parents attend the first hour separately and the second hour together. Parent sessions focus on education about the risk factors for developing substance use disorders, as well as managing family conflict and encouraging positive child involvement in family activities. Children receive education on resisting peer pressure and drug resistance skills. SFP 10-14 has demonstrated benefit to cost ratio of $6.45 in benefit for every dollar spent. Curriculum materials are available for a fee, and are available in Spanish. SFP 10-14 is recommended by the National Institute on Drug Abuse, the Substance Abuse and Mental Health Services Administration (SAMHSA), and is listed in The Surgeon General's Report on Alcohol, Drugs, and Health as an evidence-based prevention program.
- Strong African American Families (SAAF): SAAF is a seven-week program targeting rural African American families with children from 10 to 14 years old. It is a parental training program that works to strengthen attachments between parents and children, ultimately reducing alcohol and drug use. SAAF has been rated as an effective program for reducing child alcohol use and other youth risk behaviors by the National Institute of Justice.
- Guiding Good Choices: This universal, parent-focused intervention (formerly, Preparing for the Drug-Free Years) consists of five two-hour sessions that teach parents about setting clear expectations, monitoring children, teaching children how to cope with peer pressure, adopting positive conflict management strategies, and enhancing family bonding. Curriculum materials are available for a fee, and are available in Spanish. This intervention has benefit to cost ratio of $2.77 in benefit for every dollar spent. Good Choices is recommended by the National Institute on Drug Abuse, SAMHSA, the National Institute of Justice, and is listed in The Surgeon General's Report on Alcohol, Drugs, and Health as an evidence-based prevention program.
- The Nurse-Family Partnership Program: This selective prevention program targets children under the age of five. Trained nurses provide intensive, in-home visits to at-risk, first-time mothers during their pregnancy. The Nurse-Family Partnership Program has demonstrated benefit to cost ratio of $1.15 in benefits for every dollar spent, and is listed in The Surgeon General's Report on Alcohol, Drugs, and Health as an evidence-based prevention program.
- All Stars: All Stars is a school and community-based intervention that targets middle school students. Key components include promoting positive norms, planning a future free of risky behaviors, and positive interactions with parents and trusted adults. This intervention consists of 13 45-minute sessions delivered weekly by teachers, prevention specialists, or other community-based staff. All Stars has benefit to cost ratio of $25.81 in benefit for every dollar spent, and is considered a promising program by SAMHSA for reducing substance use disorders .
- The Narconon Truth About Drugs Video Program: This universal prevention program targets both middle and high school students with a multimedia curriculum consisting of eight sessions. The videos provide accurate information on various drugs and first hand stories of dependence and recovery from young adults. Implementation materials are required and include an educator's manual, four DVDs, a teacher's DVD, flyers, and pre- and post-student surveys. SAMHSA has rated this program as promising for reducing alcohol, cannabis, inhalant, hallucinogen, amphetamine/stimulant, cocaine, sedative/hypnotic/anxiolytic, opioid, and other substance disorders.
Considerations for Implementation
Many of these prevention programs have significant implementation costs. Programs including LifeSkills, the Strengthening Families Program, and Guiding Good Choices require the purchase of curriculum while some programs require training either in person or via web-based training. Travel, curriculum costs, and other training related expenses may be a barrier for rural providers.
There is no “best mix” of universal, selective, and indicated programs for a given population. Additionally, despite that there are a number of evidence-based programs for preventing substance use disorders, not all programs have been tested in rural populations. Additionally, there are limited number of programs suitable for use in workplaces or targeting older adults.
Resources to Learn More
Prescription Drug Misuse: Selected Strategies and Associated Risk Factors
This brief document provides a table that describes seven different strategies for preventing misuse of prescription drugs. It then describes the strategy and identifies associated risk factors that may indicate a strategy is applicable.
Organization(s): Substance Abuse and Mental Health Services Administration; Center for the Application of Prevention Technologies
Substance Misuse in Rural Settings
Describes the unique burden of substance misuse disorders in rural communities and the challenges to addressing substance misuse prevention.
Organization(s): Substance Abuse and Mental Health Services Administration
of Substance Abuse Prevention for Early Childhood: A Research-Based Guide
Describes the importance of addressing substance use prevention in early childhood as well as lists effective program interventions.
Organization(s): National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services
A guide for using a planning process to plan, implement, and evaluate prevention programs in communities.
Organization(s): Substance Abuse and Mental Health Services Administration