GOAL 2: Develop new and improved strategies to prevent drug use and its consequences
Considerable evidence has accumulated over the past four decades that substance use problems often can be prevented through interventions targeting one or more risk or protective factors. Interventions targeting child and adolescent risk factors for substance use disorders (SUDs) may reduce other behavioral health problems, such as aggression, and improve educational and later-life outcomes. Some interventions have been found to show continued effects long after intervention exposure and many deliver a significant return on investment in terms of reduced societal costs.12,70,71
Genetics have been shown to account for roughly half of the risk for SUDs.50 Environmental influences include social as well as biological factors arising from prenatal and childhood environments that influence both gene expression and development, such as stress, nutrition, parental drug use, or illnesses (including pain) that affect an individual’s likelihood of using drugs.61,72–74 Sociocultural environments (e.g., policy, peers, family, and communities) also play pivotal roles in the initiation of drug use, escalation of use, and SUD trajectories.61,75
An increased understanding of neurodevelopmental adaptations to the environment that influence risk of substance use is leading researchers to think of prevention as affecting not only behavior but also brain development and function, including neuroendocrine stress responses and neuroplasticity. For example, maltreated children in foster care receiving a prevention intervention for preschoolers not only showed improved behavioral functioning (leading to increased likelihood of successful transition into permanent homes) but also showed better stress regulation (measured by cortisol levels) approaching that of a control group of children in the general population.76,77 Thus, we are entering an era when neurodevelopment can be directly targeted through prevention science.
Most substance use begins during adolescence, a time in which aspects of brain development, such as the slow maturation of the prefrontal cortex, interact synergistically with social pressures arising from new social roles, peer environments, insufficient or disrupted sleep, and stressful life transitions to heighten risk.78 In addition, patterns of behaviors and interactions in family, school, and peer contexts become more established as the child moves into adolescence; consequently, while prevention interventions aimed at older children and teenagers can be effective, they have a greater challenge in positively influencing the decisions of youth who may already be on a risky life track.
Vulnerability for substance use and related problems has been shown to peak during critical life transitions, including biological transitions such as puberty and social/environmental transitions such as attending a new school, parental divorce or military deployment, or graduation.72,79–82 Despite strong evidence supporting the effectiveness of prevention strategies targeted for both individuals and communities, relatively few effective interventions have been widely adopted or faithfully implemented, and thus their potential to positively impact public health has been limited.83 Implementation research is therefore an important part of this overall prevention goal, as is capitalizing on the opportunities generated by health care reform. Unprecedented and rapid change in health care policy and technology has the potential to expand not only the reach of treatment but also to improve the delivery of evidence-based prevention interventions.
To design and deliver targeted prevention approaches to the individuals and communities who stand most to benefit from them, NIDA will support prevention research that builds on our growing experience in evaluating prevention interventions and that leverages the accumulating basic science on the developmental, biological, genetic, and neurobiological mechanisms underlying drug use and addiction. To facilitate the development of new prevention strategies, NIDA will support research to: