Principles of Substance Abuse Prevention for Early Childhood

Substance abuse and addiction are preventable disorders that interfere with normal healthy functioning, contributing to physical and behavioral health problems, injuries, lost income and productivity, and family dysfunction. While substance use generally begins during the adolescent years, there are known biological, psychological, social, and environmental factors that contribute to the risk that begin accumulating as early as the prenatal period. This creates opportunities to intervene very early in an individual’s life and thereby prevent substance use disorders—and, along with them, a range of other related behavioral problems—long before they would normally manifest themselves.

The second edition of NIDA’s Preventing Drug Abuse Among Children and Adolescents (2003) noted that “early intervention can prevent many adolescent risks.” This special supplement to that volume reflects a growing body of research that has continued to accumulate showing that providing a stable home environment, adequate nutrition, physical and cognitive stimulation, warm supportive parenting, and good classroom management in the early years of a child’s life (prenatal through age 8) can lead the child to develop strong self-regulation (i.e., emotional and behavioral control) and other qualities that protect against a multitude of risks and increase the likelihood of positive developmental outcomes. Positive effects of these interventions include delayed initiation and decreased use of drugs when the child reaches adolescence.

By adolescence, children’s attitudes, behaviors, family interactions, and relationships—factors that may influence propensity to try or become addicted to drugs—are well established and not as easily changed. For young children already exhibiting serious risk factors for later drug use, delaying intervention until later childhood or adolescence may make it more difficult to overcome accumulated risk factors and achieve positive outcomes.

Our increased understanding of brain development and neuroplasticity across the first two decades of life also supports implementing early intervention. The prenatal, child, and adolescent brain is undergoing rapid and significant change, including the formation of new synapses and, after about age 5, the progressive pruning of unused synaptic connections and reinforcement of major circuits. Synaptic plasticity makes early childhood extremely sensitive to experiences and environmental influences (including family interactions and social contexts) that may act either as risk factors for later drug use and related problems or that may be protective against those risks. Thus the earlier an intervention occurs, the greater the potential to take advantage of biological, emotional, and behavioral sensitive periods to alter the course of development in a positive, healthy direction.

Research supports the value of interventions that reduce risk factors, promote protective factors, and increase access to resources (e.g., school- and community-based family support services) in the lives of young children and those closest to them. Substantial data from many long-term studies now indicate that intervening with children and families who are showing early risk factors for substance abuse is effective, and the benefits of such interventions continue into adolescence and young adulthood and even into adulthood.

Research has also found that a large number of early risk factors for substance abuse are simultaneously risk factors for other mental, emotional, and behavior problems. For example, early-onset externalizing behavior problems, such as aggressive and disruptive behaviors in the preschool years, have been found to relate to increased risk for outcomes such as conduct disorders, substance use, delinquency, and risky sexual behaviors in adolescence. Given that this is the case, it is not surprising that interventions designed to prevent substance abuse have shown many positive benefits that extend to other outcomes—including improved personal, social, and familial functioning; higher academic and career achievement; and less involvement with the juvenile justice system and mental health services.

Early childhood prevention interventions can be costly to implement, but the research balancing the benefits of these programs against their costs shows they are good—occasionally very good—investments. Among interventions for which such data are available, savings range from $2.88 for every dollar invested (the Nurse-Family Partnership, described in "Research-Based Early Intervention Substance Abuse Prevention Programs") to as much as $25.92 (the Good Behavior Game, used in the Classroom-Centered Intervention) (Aos et al., 2004). Thus, a well-conceived and well-implemented intervention for very young children can not only dramatically improve the quality of life for the children and families involved but also benefit the community and society as a whole.

This guide, intended for parents, practitioners, and policymakers, begins with a list of 7 principles addressing the specific ways in which early interventions can have positive effects on development; these principles reflect findings on the influence of intervening early with vulnerable populations on the course of child development and on common elements of successful early childhood programs. This is followed, in “Why is Early Childhood Important to Substance Abuse Prevention?” and “Risk and Protective Factors,” with an overview of child development from the prenatal period through age 8 (the span covered by this resource) and the various factors that either place a child at risk for later substance use or offer protection against that risk.

Intervening in Early Childhood” describes common elements of early childhood interventions that target individual, family, school, and community precursors of drug use, abuse, and addiction. “Research-Based Early Intervention Substance Abuse Prevention Programs” includes information on specific early childhood intervention programs for which the National Institute on Drug Abuse (NIDA) has provided research support, and a section on “Selected Resources” provides links to many Federal agencies, professional and academic organizations, and non-governmental agencies that engage in early-childhood-prevention–related initiatives. Two appendices for policymakers, researchers, and practitioners go into greater detail on how early childhood interventions are designed and how to select the right intervention for a community’s specific needs. The “Selected References” in each section includes up-to-date sources that provide more in-depth coverage of all of the concepts, principles, and programs discussed.

Early childhood risks can lead to immediate and long-term problems that increase a child’s chances of substance abuse and other problems in adolescence and later in life. It is now known that intervening early is a worthwhile strategy for setting children on a healthier path that may avoid these difficulties. NIDA hopes that this guide is helpful to substance abuse prevention efforts for children at home, in schools, and in communities nationwide.

Selected Reference