This view will ensure that the health care system not only treats the symptoms of disease but also concentrates on the underlying drivers that have fueled the unrelenting rise in incidence of SUD and overdose. In turn, this broader focus on prevention and treatment can also contribute significantly to promoting overall health and well-being. Addressing these underlying determinants of health has the potential to enhance not only addiction outcomes but also broader societal health outcomes, fostering healthier, more resilient communities. Secondary prevention interventions using a socioecological framework focus on biopsychosocial and environmental strategies that target early identification of OUD and support for those with OUD. As illustrated in Figure 3, several risk factors impede and/or challenge the success of screening and treatment referral, including stigma, discrimination, and insufficient provider competency and/or knowledge, all of which can influence an individual’s engagement in their health and human services. Data support the assertion that close family relationships can ameliorate the impact that trauma, stress, and adversity have on an individual’s physical health over their life span (Chen, Brody, and Miller, 2017; Brody et al., 2016).

For instance, when dealing with individuals who have comorbid alcohol use disorders and mood or anxiety disorders, both conditions are addressed concurrently. The above examples highlight the complex interplay among the three levels of prevention and the socioecological levels of influence, wherein multidirectional interactions among levels means that factors at one level are often facilitated or restricted by factors at another. For example, individual-level factors—such as individual behaviors, psychological state, and physiological mechanisms—are both supported and limited by interpersonal factors like social support, sense of community cohesion, and access to person-centered care.

Ways to prevent opioid use disorder

Understanding this interplay, social epidemiology recognizes that people make places and places make people (Macintyre and Ellaway, 2003). While not the focus of this current work, the authors recognize that this complex person-environment interaction can occur across the life course and is intergenerational (Latimore et al., in press). The focus on reducing opioid prescriptions may have the veneer of a less punitive and more medical approach to preventing SUD but is still a supply-side narrative (El-Sabawi, 2019). Moreover, a purely biomedical focus for preventing SUD offers limited insight into the structural and systemic factors driving racial and ethnic disparities in overdose deaths. Long-term analyses suggest a consistent record of positive accomplishment for substance use outcomes in communities with a DFC grantee from 2002 to 2012.

Primary, Secondary, and Tertiary Prevention of Substance Use Disorders through Socioecological Strategies

While there is general agreement that recovery involves achieving a state of improved well-being, varying perspectives exist on the nature of addiction, the goals of treatment, the necessity of treatment, and the possibility of complete remission. At one end of the spectrum, proponents argue that long-term abstinence is the primary criterion for recovery. Conversely, alternative schools of thought adopt a more inclusive approach to recovery, recognizing that complete abstinence may not be immediately feasible or desirable for everyone.

FIGURE 3. Secondary Prevention: Examples of Risks and Protective Factors for Those with Opioid Use Disorder.

Rich Roll aptly described this analogy in his podcast interview with Dr. Anna Lembke, which can be found on YouTube 15. In the analogy, the wooden horse represents the psychiatric comorbidity, while the city of Troy symbolizes the challenges posed by SUDs. The patients, akin to the Greeks, believe that once the ‘horse’ of psychiatric treatment is inside, it will reveal its true potential to address their substance use concerns. The latest information and resources on mental disorders shared on X, Facebook, YouTube, LinkedIn, and Instagram. Over 40 research groups conduct basic neuroscience research and clinical investigations of mental illnesses, brain function, and behavior at the NIH campus in Bethesda, Maryland. Find out how NIMH engages a range of stakeholder organizations as part of its efforts to ensure the greatest public health impact of the research we support.

Public Health

  • In the context of OUD, a primary prevention approach under the traditional biomedical model aims to avoid the onset of OUD by, for example, educating clinicians and patients on alternative modalities and non-opioid medications for effective pain management to reduce exposure to prescribed opioids.
  • This task is prone to various forms of bias, especially in the absence of collateral information or observation.
  • The literature has yielded mixed findings regarding the effectiveness of particular pharmacological treatments, especially Selective Serotonin Reuptake Inhibitors (SSRIs).
  • The focus on reducing opioid prescriptions may have the veneer of a less punitive and more medical approach to preventing SUD but is still a supply-side narrative (El-Sabawi, 2019).
  • Strategies to prevent substance use — especially in adolescents — and help people get treatment can reduce drug and alcohol misuse, related health problems, and deaths.

Service providers and policy makers should consider how they can create a health-promoting environment regardless of whether an individual has ever used drugs, is diagnosed with SUD, or engages in high-risk substance use. Indeed, the health care industry depends on the biomedical model, with a focus on diagnosis, precise and prescriptive treatment, and decision-chart resolutions (Fricton et al., 2015). However, expanding the broader health care system’s understanding of prevention beyond the body’s mechanistic functions is critical to stemming the nation’s ongoing rise in overdoses and future substance use epidemics. Universal prevention approaches include the use of environmental prevention strategies, which are tailored to local community characteristics and address the root causes of risky behaviors by creating environments that make it easier to act in healthy ways. The successful execution of these strategies often involves lawmakers, local officials, and community leaders, as well as the acceptance and active involvement of members from various sectors of the community (such as business, faith, schools, and health). For example, the use of this type of strategy may offer fewer places for young people to purchase alcohol, so consuming alcohol becomes less convenient; therefore, less is consumed.

Race, often treated in biomedical perspectives as biologically defined (Ioannidis, Powe, and Yancy, 2021), is recognized as a socially constructed factor that is not biologically determined but does create differences in biological outcomes (Krieger, Dorling, and McCartney, 2012; Roberts, 2012). In the ensuing years, US drug policy has consistently prioritized addressing the perceived moral outrage against drug use through tough-on-crime policies and a seemingly unrestricted cascade of federal dollars invested in drug interdiction (Shepard and Blackley, 2004). However, rather than serving as an effective public health strategy, this punitive approach has only served to perpetuate stigmatizing attitudes by erroneously associating drug use with social deviance and criminality (Dineen and Pendo, 2021).

Psychiatrists face the challenging task of distinguishing valid diagnoses from invalid ones in this controversial area, further complicated by the lack of clear-cut criteria and objective measures. Substance Use Resources in Washington State for Professionals/Providers A curated selection of resources and information for professionals and providers in the substance use disorder field. Visit the SAMHSA Center for the Application of Prevention Technologies’ Evaluating Environmental Change Strategies webpage for more prevention information and resources. The Foundational helping skills training manual is a resource from the joint WHO/UNICEF initiative on Ensuring Quality in Psychosocial and Mental Health… Unless otherwise specified, the information on our website and in our publications is in the public domain and may be reused or copied without permission.

Integrated care models, which combine SUD and mental health treatment, have demonstrated efficacy in improving outcomes for this complex population 18. These models acknowledge that individuals with dual diagnoses often face overlapping challenges that cannot be effectively addressed in isolation 19. Studies have shown that individuals receiving integrated care experience enhanced treatment engagement, reduced substance use, improved mental health, and an overall better quality of life 20,21.

This approach not only recognizes the complex interplay between these disorders but also emphasizes the importance of tailored interventions that promote the overall well-being of individuals with dual diagnoses. Many people with substance use disorders also experience other mental disorders like depression, anxiety, or bipolar disorder. Effective treatments for substance use disorders are available, but very few people get the treatment they need.

Instead of investing in prevention and early intervention programs and providing access to appropriate services, we tolerate unconscionable rates of suicide5, school drop-out6, homelessness7, and involvement in the juvenile justice system8. While we can and do work to provide mental health services and supports and to promote recovery for individuals in need, the overwhelming number of those struggling is a reminder of prevention of substance use and mental disorders how often we wait too long to take action. The primary, secondary, and tertiary prevention classification is somewhat ill fitting for the nonlinear nature of addiction and other chronic health conditions, particularly if the treatment approach does not consider the social and environment factors impacting disease and health.

Also 15.7 million adults (aged 18 or older) and 2.8 million youth (aged 12 to 17) had a major depressive episode during the past year. In 2014, an estimated 22.5 million Americans aged 12 and older self-reported needing treatment for alcohol or illicit drug use, and 11.8 million adults self-reported needing mental health treatment or counseling in the past year. These disorders are among the top conditions that cause disability and carry a high burden of disease in the United States, resulting in significant costs to families, employers, and publicly funded health systems. By 2020, mental and substance use disorders will surpass all physical diseases as a major cause of disability worldwide. Addressing the impact of substance use alone is estimated to cost Americans more than $600 billion each year.

  • Interventions to strengthen parenting and parents’ knowledge and skills are a particularly effective intervention for improving youth behavior.18 Collocation of behavioral health within primary care also offers important opportunities for more wide-spread use of prevention.
  • Share your concerns about the benefits and risks of prescription opioids and other pain treatment strategies.
  • The outlined interventions and strategies can serve as a starting point and inspiration for stakeholders interested in addressing OUD and other related SUDs.
  • To treat those with opioid use disorder, it is crucial to expand access to evidence-based treatments, including medications for opioid use disorder (MOUD).
  • Hence, rather than imposing a blanket restriction on the use of SSRIs for individuals with dual disorders, a judicious and case-by-case evaluation is recommended.
  • For example, individual-level factors—such as individual behaviors, psychological state, and physiological mechanisms—are both supported and limited by interpersonal factors like social support, sense of community cohesion, and access to person-centered care.

The authors then discuss how a socioecological framework—which considers the complex interplay among individual, interpersonal, societal, and structural factors—can offer a more comprehensive and effective means of understanding SUD prevention. Mental and substance use disorders can have a powerful effect on the health of individuals, their families, and their communities. In 2014, an estimated 9.8 million adults aged 18 and older in the United States had a serious mental illness, and 1.7 million of which were aged 18 to 25.

Health Care Providers

The prevalence of past 30-day use of alcohol, tobacco, and marijuana declined significantly among both middle school and high school students. The prevalence of past 30-day alcohol use dropped the most in absolute percentage point terms, declining by 2.8 percentage points among middle school students and declining by 3.8 percentage points among high school students. The prevalence of past 30-day tobacco use declined by 1.9 percentage points among middle school students, and by 3.2 percentage points among high school students from DFC grantees’ first report to their most recent report. Though significant, the declines in the prevalence of past 30-day marijuana use were less pronounced, declining by 1.3 percentage points among middle school students and by 0.7 percentage points among high school students.