The chapter then describes how communities can build the capacity to implement effective programs and policies community wide to prevent substance use and related harms, and concludes with research recommendations.īeginning in the twentieth century, the major illnesses leading to death shifted from infectious diseases, such as tuberculosis and infections in newborns, to noncommunicable diseases, such as heart disease, diabetes, and cancer. Detailed reviews of these programs and policies are in Appendix B - Evidence-Based Prevention Programs and Policies. The chapter continues with a review of the rigorous research on the effectiveness and population impact of prevention policies, most of which are associated with alcohol misuse, as there is limited scientific literature on policy interventions for other drugs. 18 This discussion is followed by a review of rigorous research on substance use initiation and misuse prevention programs that have demonstrated evidence of effectiveness. The chapter also includes a system of categorizing prevention strategies defined by the Institute of Medicine (IOM). The chapter discusses the predictors of substance use initiation early in life and substance misuse throughout the lifespan, called risk factors, as well as factors that can mitigate those risks, called protective factors. This chapter uses the term evidence-based interventions (EBIs) to refer to programs and policies supported by research. See Chapter 4 - Early Intervention, Treatment, and Management of Substance Use Disorders. The good news is that there is strong scientific evidence supporting the effectiveness of prevention programs and policies. 6, 15- 17 This chapter will demonstrate that prevention can markedly reduce the burden of disease and related costs. Evidence-based prevention interventions, carried out before the need for treatment, are critical because they can delay early use and stop the progression from use to problematic use or to a substance use disorder (including its severest form, addiction), all of which are associated with costly individual, social, and public health consequences. Given the impact of substance misuse on public health and the increased risk for long-term medical consequences, including substance use disorders, it is critical to prevent substance misuse from starting and to identify those who have already begun to misuse substances and intervene early. Substance misuse is also associated with a wide range of health and social problems, including heart disease, stroke, high blood pressure, various cancers (e.g., breast cancer), mental disorders, neonatal abstinence syndrome (NAS), driving under the influence (DUI) and other transportation-related injuries, 8, 9 sexual assault and rape, 10, 11 unintended pregnancy, sexually transmitted infections, 12 intentional and unintentional injuries, 13 and property crimes. In addition, alcohol is involved in about 20 percent of the overdose deaths related to prescription opioid pain relievers. 7 Over half of these alcohol-related deaths and three-quarters of the alcohol-related economic costs were due to binge drinking. 4 The yearly economic impact of alcohol misuse and alcohol use disorders is estimated at $249 billion ($2.05 per drink) in 2010 6 and the impact of illicit drug use and drug use disorders is estimated at $193 billion-figures that include both direct and indirect costs related to crime, health, and lost productivity. In 2014, over 43,000 people died from a drug overdose, more than in any previous year on record 2 and alcohol misuse accounts for about 88,000 deaths in the United States each year (including 1 in 10 total deaths among working-age adults). As discussed in earlier chapters, the misuse of alcohol and drugs and substance use disorders has a huge impact on public health in the United States.
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