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Division of Mental Health and Addiction Services
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National Suicide Prevention Lifeline   Nacional de Prevencion del Suicidio
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Substance Abuse and Mental Health Services Administration (SAMHSA)
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Universal Prevention

The mission of universal prevention is to deter the onset of drug abuse by providing all individuals in a population with the information and skills necessary to prevent the problem.  All members of the population share the same general risk for drug abuse, although the risk may vary greatly among individuals.  Universal prevention programs are delivered to large groups without any prior screening for drug abuse risk status of the individual program recipients.  The entire population is assumed at-risk for substance abuse.

Examples:   Substance abuse education in schools, media and public awareness. (i.e., Red Ribbon Week, Alcohol Awareness Month)

Selective Prevention Strategies

Selective prevention targets specific subgroups of the population that are believed to be at greater risk than others.  Age, gender, family history, place of residence (i.e., high drug use, or low-income neighborhoods) and victimization, or physical and/or sexual abuse may define the targeted subgroups.  Selective prevention targets the entire subgroup regardless of the degree of risk of any individual within the group.  One individual in the subgroup may not be at personal risk for substance abuse, whereas another individual in the same subgroup may be abusing substances.  The selective prevention program is presented to the entire subgroup because the subgroup as a whole is at higher risk for substance abuse than the general population.  An individual's personal risk is not specifically assessed or identified and is based solely on a presumption given in his or her membership in the at-risk subgroup.

Examples:   Skills training for groups affected by environmental influences like high crime rate, unemployment and community disorganization.

Indicated Prevention Strategies

Indicated prevention approaches are used for individuals who may or may not exhibit early signs of substance abuse but exhibit risk factors.  Examples of risk factors include school failure, interpersonal social problems, delinquency, and other anti-social behaviors and psychological problems such as depression and suicidal behavior that increase their chances of developing a substance abuse problem. Indicated prevention programs typically address risk factors associated with the individual, such as conduct disorders and alienation from parents, schools, and positive peer groups.  The aim of indicated prevention programs is not just the reduction in first time substance abuse but also reduction in the length of time the signs continue, delay of onset of substance abuse, and/or reduction in the severity of substance abuse.  Individuals can be referred to indicated prevention programs by parents, teachers, school counselors, school nurses, youth workers, friends or the courts.

Examples:   Youth already engaged in substance abuse and/or negative behaviors, such as truancy, early anti-social behavior, Children of Substance Abusers.  

  • Indicated prevention strategies identify individuals who are experiencing early signs of substance abuse and other related problem behaviors associated with substance abuse and target them with special programs.
  • The individuals identified at this stage, though showing signs of early substance abuse, have not reached the point where a clinical diagnosis of substance abuse can be made.
  • Indicated prevention strategies are used for individuals who may or may not be abusing substances, but exhibit risk factors such as:

    • school failure
    • interpersonal social problems
    • delinquency and other antisocial behaviors
    • psychological problems such as depression
    • suicidal behavior that increases their chances of developing a drug abuse problem 
  • Indicated prevention strategies require a precise assessment of an individual's personal risk and level of related problem behaviors, rather than relying on the person's membership in an at-risk group as in the selected approach. 
  • Programs are frequently extensive and highly intensive; they typically operate for longer periods of time, at a greater frequency of contact and require greater effort on the part of participants than do selective or universal programs.
  • Programs require highly skilled staff who have clinical training, counseling and other skills.  In the field of substance abuse, an indicated prevention intervention would be a substance abuse program for high school students who are experiencing a number of problem behaviors, including truancy, failing academic grades, juvenile depression, suicidal ideation, and early signs of substance abuse.

Drug Abuse Prevention: What Works, National Institute of Drug Abuse, NIH Publication No. 97-45110

"Reducing Risks for Mental Health Disorders: Frontiers for Preventive Intervention Research." National Institute of Medicine

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