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Preventing Alcohol Abuse
and Dependence
NIAAA Social Work Education
Module 3
(revised 3/04)
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Outline
Prevention Frameworks
Prevention Factors
Prevention Strategies
Prevention Examples
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Prevention Frameworks
What is prevention?
Actions that minimize or eliminate
conditions known to contribute to a specific
condition, problem, illness, or disorder
Establishing conditions that enhance
opportunities to achieve healthy outcomes
Occurs prior to the problem appearing or
becoming serious/severe
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Frameworks (continued)
Universal-Selective-Indicated Framework
Universal preventive
intervention is:
applied to everyone in a
population, regardless
of risk level
benefits outweigh
risks/costs for everyone
©2002 Microsoft Corporation.
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Frameworks (continued)
Universal-Selective-Indicated Framework
Selective prevention is:
focused on groups whose
risk of developing the
problem is above average
higher “risk” level does
not mean the problem
WILL develop
©2002 Microsoft Corporation.
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Frameworks (continued)
Indicated prevention efforts
apply to individuals who:
exhibit specific risk factors
or
have conditions that
identify them as being at
risk for development of the
problem ©2002 Microsoft Corporation.
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Frameworks (continued)
Public Health prevention
framework:
primary,
secondary
tertiary
©2002 Microsoft Corporation.
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Prevention Factors
Within each type of prevention, the aim
is to reduce the occurrence of new cases
This is accomplished by:
decreasing risk and vulnerability factors
and/or
strengthening protective and resilience
factors
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Vulnerability and Resilience
Full continuum (low to high)
Factors intrinsic to the individual
Biology (genetics, constitution,
hormonal, disability, etc.)
Experiences and learning
(personal history)
Behaviors and traits (e.g.,
personality, temperament, etc.) ©2002 Microsoft Corporation.
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Risk and Protection
Full continuum (low to high)
Extrinsic to individual (environmental
contexts):
– Family and other social institutions
– Reinforcers/consequences
(current)
– Access to alcohol
– Programs, policies
– Resources, access
©2002 Microsoft Corporation.
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Interaction of Factors
VULNERABILITY
Low High
Low I Low II Moderate
Probability Probability
RISK
High III Moderate IV High
Probability Probability
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Review of Research on Factors
Individual and Interpersonal Factors
Sensation seeking Family conflict/low
Poor impulse control family bonding
Family Academic failure/low
behavior/attitudes school commitment
promote alcohol Rebelliousness
Inconsistent Early onset of alcohol
parenting/discipline use
Source: Hawkins et. al, 1992
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Research Review (continued)
Contextual & Other Environmental Factors
Availability of substances
Economic deprivation
Poor housing
Neighborhood disorganization
Laws/norms favoring alcohol consumption
Source: Hawkins et. al, 1992
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Prevention Strategies
Shift groups from a higher probability of
alcohol use disorders toward a lower
probability. Utilize a combination of efforts to:
1. Increase protective factors
2. Decrease risk factors
3. Increase resilience factors
4. Decrease vulnerability factors
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Prevention Strategies (continued)
Six domains for organizing alcohol
prevention efforts (SAMHSA, 2001):
Individual School
Family Community
Peer Society / Environments
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Prevention Strategies (continued)
Individual Domain
– Build social and personal skills
– Design culturally sensitive interventions
– Provide alternatives for youth in high risk contexts
– Recognize relationships between substance use
and other health/mental health problems
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Prevention Strategies (continued)
Family Domain
– Target entire family system
– Develop bonds between and within families
– Ensure cultural sensitivity
– Respond to “isms”
– Develop parenting skills; train parents
– Offer practice opportunities
– Promote family communication
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Prevention Strategies (continued)
Peer Domain
– Structure alternative supervised activities
– Add social and personal skills building
opportunities
– Offer alternative intensive programs
– Communicate peer norms against alcohol
– Involve youth in program development
– Involve youth in interventions
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Prevention Strategies (continued)
School Domain
– Correct prevalence misconceptions
– Provide skills practice opportunities
– Use booster sessions to retain skills
– Involve parents
– Communicate commitment to prevention
– Control school environment and other
areas
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Prevention Strategies (continued)
Community Domain
– Develop integrated, comprehensive interventions
– Community service
– Perform benefit/cost analyses (employers)
– Coalition building and maintenance
– Assign goals, tasks, and responsibilities
– Organize alcohol-free events
– Support a range of prevention activities
– Organize at the neighborhood level
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Prevention Strategies (continued)
Society/Environmental Domain
– Media efforts
– Beverage server training and liability
– Increase cost through excise taxes
– Limit retail alcohol outlets
– Enforce minimum age laws and other policies
– Feedback to merchants
– Enact/enforce impaired operations deterrence
laws
Moving from Strategies to
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Programs
Target underlying contributing
factors
Consult literature
Assess strengths, barriers,
resources
Develop and implement
program
Evaluate intervention
(Source: CSAP, 1995) ©2002 Microsoft Corporation.
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Examples of Prevention Programs
Life Skills Training
Seventh Generation Program
Project Northland
Communities Mobilizing for Change
Community Trials Project
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Program Examples
Life Skills Training
– Universal strategy
– Youth-targeted
– Cognitive behavioral psycho-educational
approach
– 15 sessions to teach general personal and social
skills; how to resist social influences
– Focus on problem solving, decision-making,
self-awareness, effective communication,
assertiveness, and stress reduction
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Program Examples (continued)
Seventh Generation Program
– Selective (urban American Indian youth, grades 4-7)
– 13 week after-school program plus 5 week booster
– Grounded within American Indian culture
– Corrects inaccurate stereotypes of Indian drinking
– Enhances personal and cultural values of non-use
– Enhances self-esteem and Indian identity
– Focuses on decision making and refusal skills
– Encourages meaningful commitment to not use
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Program Examples (continued)
Project Northland
– Selective (6th-8th grade, parents, community)
– Resistance skills training with homework that
involved the parents
– Peer-directed alcohol-free activities
– Student-developed anti-alcohol plays performed
for parents
– Newsletters to parents
– Community organization efforts to develop
policies regarding under-age drinking
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Program Examples (continued)
Communities Mobilizing for Change
– Universal (change community and policies to
reduce youth access to alcohol)
– Responsible beverage server training
– Shortened hours for alcohol sales
– Citizen monitoring of alcohol outlets
– Use of police decoys who appeared to be
underage
– Educational programs for youth and adults
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Program Examples (continued)
Community Trials Project
– Universal (reducing alcohol-related injury)
– Knowledge, values, and mobilization
– Responsible beverage service practices
– Reduction of underage drinking
– Increasing the “costs” of drinking and
driving
– Reducing access to alcohol (controlling
outlet density and location)
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Conclusions
Social work prevention activities:
1. Provide information
2. Promote awareness and self-efficacy
3. Provide skills building
4. Provide healthy alternatives
5. Change norms
6. Foster community collaboration
(Source: Bush, 2000)