Principles of Substance Abuse Prevention for Early Childhood

Seven principles of prevention for early childhood (which is defined here as the prenatal period and infancy through the transition to elementary school around age 8) have emerged from research studies funded (in full or in part) by NIDA. The detailed rationale for these principles appears in “Why is Early Childhood Important to Substance Abuse Prevention?,” “Risk and Protective Factors,” and “Intervening in Early Childhood.”

  • Principle 1 (Overarching Principle): Intervening early in childhood can alter the life course trajectory in a positive direction (Kellam et al., 2008; Kitzman et al., 2010). Substance abuse and other problem behaviors that manifest during adolescence have their roots in the developmental changes that occur earlier—as far back as the prenatal period. While prevention can be effective at any age, it can have particularly strong effects when applied early in a person’s life, when development is most easily shaped and the child’s life is most easily set on a positive course.

The following specific principles collectively provide support for Principle 1.

  • Principle 2: Intervening early in childhood can both increase protective factors and reduce risk factors (August et al., 2003; Catalano et al., 2003). Risk factors are qualities of children and their environments that place children at greater risk of later behavioral problems such as substance abuse; protective factors are qualities that promote successful coping and adaptation and thereby reduce those risks. All children have a mix of both. Interventions aim to shift the balance toward protective factors.
  • Principle 3: Intervening early in childhood can have positive long-term effects (Degarmo et al., 2009; Shaw et al., 2006). Early childhood interventions focus on settings and behaviors that may not appear relevant for adjustment later in childhood or in adolescence, but they help set the stage for positive self-regulation and other protective factors that ultimately reduce the risk of drug use.
  • Principle 4: Intervening in early childhood can have effects on a wide array of behaviors (Beets et al., 2009; Hawkins et al., 2008; Snyder et al., 2010), even behaviors not specifically targeted by the intervention (Hawkins et al., 1999; Kellam et al., 2014; Lonczak et al., 2002). Because behaviors (both positive and negative) are linked to each other, risk factors for substance use may simultaneously put a child at risk for other problems such as mental illness or difficulties at school. This is why intervening to prevent one undesirable outcome may have a broad effect, improving the child’s life trajectory in multiple ways.
  • Principle 5: Early childhood interventions can positively affect children’s biological functioning (Bruce et al., 2009; Fisher et al., 2007). The benefits of intervention are not limited to behavioral or psychological outcomes—research has shown they can also affect physical health. For example, one intervention for young children in the foster care system looked at cortisol level, a biological measure of the stress response. Over time, the stress response of children receiving the intervention showed better regulation and became similar to that of children in the general population.
  • Principle 6: Early childhood prevention interventions should target the proximal environments of the child (Tolan et al., 2004; Webster-Stratton et al., 2008). The family environment is the most important context across all periods of early child development, and thus parents are a major target of many early childhood interventions (Dishion et al., 2008; Fisher et al., 2011). But as a child grows older, he or she typically spends more and more time out of the home, perhaps attending day care, then attending preschool followed by elementary school (Beets et al., 2009; Conduct Problems Prevention Research Group, 1999; Hawkins et al., 1999; Ialongo et al., 1999; Snyder et al., 2010). Interventions for different age groups and targeting different types of problems should focus on the most relevant context(s)—the home, school, day care, or a combination.
  • Principle 7: Positively affecting a child’s behavior through early intervention can elicit positive behaviors in adult caregivers and in other children, improving the overall social environment (Fisher & Stoolmiller, 2008; Shaw et al., 2009). Behavioral changes in children and the adults who interact with them can be mutually self-reinforcing. Improving the child’s family or school environment can, over time, cause the child’s social behavior to become more positive and healthy (or pro-social); this, in turn, can elicit more positive interactions with others and improve the social environment as a result.
Selected References
  • August GJ, Lee SS, Bloomquist L, Realmuto GM, Hektner JM. Dissemination of an evidence-based prevention innovation for aggressive children living in culturally diverse, urban neighborhoods: the Early Risers effectiveness study. Prev Sci. 2003;4(4):271-286.
  • Beets MW, Flay BR, Vuchinich S, et al. Use of a social and character development program to prevent substance use, violent behaviors, and sexual activity among elementary-school students in Hawaii. Am J Public Health 2009;99(8):1438-1445.
  • Bruce J, McDermott J, Fisher P, Fox N. Using behavioral and electrophysiological measures to assess the effects of a preventive intervention: a preliminary study with preschool-aged foster children. Prev Sci. 2009;10(2):129140.
  • Catalano RF, Mazza JJ, Harachi TW, Abbott RD, Haggerty KP, Fleming CB. Raising healthy children through enhancing social development in elementary school: results after 1.5 years. J Sch Psychol. 2003;41(2):143-164.
  • Conduct Problems Prevention Research Group. Initial impact of the Fast Track prevention trial for conduct problems: II. Classroom effects. J Consult Clin Psychol. 1999;67(5):648-657.
  • DeGarmo DS, Eddy JM, Reid JB, Fetrow RA. Evaluating mediators of the impact of the Linking the Interests of Families and Teachers (LIFT) multimodal preventive intervention on substance use initiation and growth across adolescence. Prev Sci. 2009;10(3):208-220.
  • Dishion TJ, Connell AM, Weaver CM, Shaw DS, Gardner F, Wilson MN. The Family Check-Up with high-risk indigent families: preventing problem behavior by increasing parents’ positive behavior support in early childhood. Child Dev. 2008;79(5):1395-1414.
  • Fisher PA, Stoolmiller M, Gunnar MR, Burraston BO. Effects of a therapeutic intervention for foster preschoolers on diurnal cortisol activity. Psychoneuroendocrinology. 2007;32(8–10):892-905.
  • Fisher PA, Stoolmiller M, Mannering AM, Takahasi A, Chamberlain P. Foster placement disruptions associated with problem behavior: mitigating a threshold effect. J Consult Clin Psychol. 2011;79(4):481-487.
  • Fisher PA, Stoolmiller M. Intervention effects on foster parent stress: associations with child cortisol levels. Dev Psychopathol. 2008;20(3):1003-1021.
  • Hawkins JD, Catalano RF, Kosterman R, Abbott RD, Hill KG. Preventing adolescent health-risk behaviors by strengthening protection during childhood. Arch Pediatr Adolesc Med. 1999;153(3):226-234.
  • Hawkins JD, Kosterman R, Catalano R, Hill KG, Abbott RD. Effects of social development intervention in childhood 15 years later. Arch Pediatr Adolesc Med. 2008;162(12):1133-1141.
  • Ialongo NS, Werthamer L, Kellam SG, Brown CH, Wang S, Lin Y. Proximal impact of two first-grade preventive interventions on the early risk behaviors for later substance abuse, depression, and antisocial behavior. Am J Community Psychol. 1999;27(5):599-641.
  • Kellam SG, Brown CH, Poduska JM, et al. Effects of a universal classroom behavior management program in first and second grades on young adult behavioral, psychiatric, and social outcomes. Drug Alcohol Depend. 2008;95(Suppl 1):S5-S28.
  • Kellam SG, Wang W, Mackenzie ACL. The impact of the Good Behavior Game, a universal classroom-based preventive intervention in first and second grades, on high-risk sexual behaviors and drug abuse and dependence disorders into young adulthood. Prev Sci. 2014;15(Suppl. 1):S6-S18.
  • Kitzman H, Olds D, Cole R, et al. Enduring effects of prenatal and infancy home visiting by nurses on children: follow-up of a randomized trial among children at age 12 years. Arch Pediatr Adolesc Med. 2010;164(5):412-418.
  • Lonczak HS, Abbott RD, Hawkins JD, Kosterman R, Catalano RF. Effects of the Seattle Social Development Project on sexual behavior, pregnancy, birth, and sexually transmitted disease outcomes by age 21 years. Arch Pediatr Adolesc Med. 2002;156(5):438-447.
  • Shaw D, Connell A, Dishion T, Wilson M, Gardner F. Improvements in maternal depression as a mediator of intervention effects on early childhood problem behavior. Dev Psychopathol. 2009;21(2):417-439.
  • Shaw DS, Dishion TJ, Supplee L, Gardner F, Arnds K. Randomized trial of a family-centered approach to the prevention of early conduct problems: 2-year effects of the family check-up in early childhood. J Consult Clin Psychol. 2006;74(1):1-9.
  • Snyder FJ, Vuchinich S, Acock A, et al. Impact of the Positive Action program on school-level indicators of academic achievement, absenteeism, and disciplinary outcomes: a matched-pair, cluster randomized, controlled trial. J Res Educ Eff. 2010;3(1):26-55.
  • Tolan P, Gorman-Smith D, Henry D. Supporting families in a high-risk setting: proximal effects of the SAFEChildren preventive intervention. J Consult Clin Psychol. 2004;72(5):855-869.
  • Webster-Stratton C, Reid MJ, Stoolmiller M. Preventing conduct problems and improving school readiness: evaluation of the Incredible Years Teacher and Child Training Programs in high-risk schools. J Child Psychol Psychiatry. 2008;49(5):471-488.