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What is prevention?
Why is the prevention of alcohol, tobacco,
and other drugs (ATOD) problems important?
What is the importance of prevention in health
care reform?
What do we now spend on ATOD problem prevention
efforts?
How can prevention efforts reduce costs and
boost the economy?
How do we know that prevention works?
Why should we continue to invest resources
in prevention?
How does prevention work?
Who should practice prevention?
What is the Center for Substance Abuse Prevention
(CSAP) seeking to promote?
How is CSAP's position on drinking alcoholic
beverages different from temperance and prohibition models?
What are the major needs for substance abuse
prevention?
Who benefits from prevention?
How do I get additional information?
Prevention is the sum of our efforts to ensure healthy, safe,
and productive lives for all Americans. As applied to alcohol,
tobacco, and other drugs (ATOD), prevention means keeping
the many problems related to the use and abuse of these substances
from occurring.
Successful ATOD problem prevention means that underage youth,
pregnant women, and others at high risk do not use
alcohol, tobacco, or other drugs. They do not cause
harm to themselves and to those around them.
Prevention reduces the risk of danger and fosters a safe
environment. Successful prevention leads to reduction in traffic
fatalities, violence, HIV/AIDS and other sexually transmitted
diseases (STDs), rape, teen pregnancy, child abuse, cancer
and heart disease, injuries and trauma, and other problems
associated with substance abuse. Thanks to prevention, our
children stay in school. Our workers stay on the job. Prevention
works! Let's make prevention work for everyone.
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ATOD problems cost years of quality life. And, they cost
money. For example, alcohol and other drug problems cost
each man, woman, and child in America $800 a year, or nearly
$200 billion. If alcohol were never used carelessly in
our society, about 100,000 fewer people would die annually
from unnecessary illness and injury. Each year, smoking
takes the lives of about 400,000 and passive smoking about
50,000.
In addition, prevention efforts strengthen our communities,
schools, families, and individuals. Drug dealers are less
likely to infiltrate strong communities. Schools with strong
policies against smoking and drinking are healthier. Family
members who serve as healthy role models help inoculate their
offspring. Mentors offer support for healthy individual development.
These facts also help explain why ATOD problem prevention
is important:
Nearly 7 out of 10 manslaughter offenses occur after a person
has been drinking or using other drugs.
Smoking and the use of other tobacco products cause cancer
and heart disease. Alcohol also is a factor in these diseases.
The use and abuse of these substances frequently contribute
to teen pregnancy, HIV/ AIDS/ STD transmission, child abuse,
and other social problems.
According to one analysis, persons who abuse alcohol and
other drugs use two and one half times the medical benefits
as non-users; and children of substance abusers also use
more health care services.
Violence and disease represent large costs to taxpayers struggling
with a record-setting deficit and ever increasing health care
costs. Prevention means less money must be spent on preventable
diseases. Incarceration is one part of the cost of violence
and crime associated with ATOD problems. Violence diverts
law enforcement personnel, clogs the courts, causes economic
loss and mental anguish for victims, and dulls the potential
of our Nation and our people.
Without prevention, young people make unhealthy and unsafe
choices, jeopardizing our future abilities to compete in the
global marketplace. We are unable to foster vital communities
and ensure our Nation's vitality. Alcohol, tobacco, and other
drug problems reduce human capital- people who can be working,
paying taxes, making neighborhoods safe, and enhancing our
ability as a country to compete in a new global economy.
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Prevention is a major key to reduced health care costs. We
can reduce costs associated with:
Spinal cord and head injuries resulting from alcohol- and
drug-impaired driving.
Health, education, and rehabilitation costs associated with
children born with Fetal Alcohol Syndrome or who are addicted,
at birth, to illegal drugs.
Chemotherapy and radiation for treatment of cancer occurring
in passive smokers.
ATOD-related emergency room visits.
Imaging for broken bones and internal injuries associated
with alcohol and other drug use.
Burn treatment and rehabilitation for persons injured by
cigarette-caused fires.
According to one analysis, we could reduce the Nation's
expenditures on health care by 90.4 billion if alcohol and
other drug problems were prevented.
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Currently, the Federal Government spends only $50 per
person each year on prevention, treatment, and interdiction
related to fighting drug problems (including $3.7 billion
to State and local governments.
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In two ways. As stated above, prevention can help reduce
health care costs. Second, if we can keep our children in
school and learning the skills they need, and if we can keep
our workers productive in the workforce, we will boost revenues
in a highly competitive environment.
We will produce the goods and services need to expand our
resources to reduce the deficit.
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Percentages of the population engaging in high-risk behaviors
are decreasing. For instance, in 1979, nearly 20 percent of
all adolescents ages 12 to 17 were drinking regularly. By
1991, that number dropped to under 10 percent. The incidence
of liver cirrhosis also has dropped significantly. Alcohol-related
traffic fatalities decreased by 10 percent, representing large
numbers of young lives saved.
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There are two very important reasons. First, we have to set
up more intensive and repetitive interventions among those
who have not been easily persuaded by previous efforts. For
example, there are still over 4 million youngsters who drink
illegally. There are young people and adults who are at
very high-risk, for example, school failures, runaways, those
who have been abused, children of substance abusers, and those
living in high-risk environments. We have not yet achieved
great success with these high-risk audiences despite demonstrations
of promising approaches.
Second, if prevention efforts are not continued at an intensive
level, the gains fall off. Young people entering school today,
for instance, believe that smoking is harmful, but the rates
of smoking begin to increase without "resistance"
skill training and practice and policies that restrict availability,
and other prevention efforts. Because prevention efforts have
decreased, significant gains have not been made in reducing
the use of tobacco products by youths.
More clearly, we can see that if we do not continue prevention
efforts, diseases return. The recent resurgence of TB and
measles underlines what happens when prevention efforts are
not sustained.
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Several strategies are used effectively, especially, in combination:
Information Dissemination: This strategy provides
awareness and knowledge of the nature and extent of ATOD
use, abuse, and addiction and their effects on individuals,
families, and communities, as well as information to increase
perceptions of risk associated with ATOD use. It
also provides knowledge and awareness of prevention policies,
programs, and services. It helps set and reinforce norms
(for example, underage drinking and drug dealers will not
be tolerated in this neighborhood).
Prevention Education: This strategy aims to affect
critical life and social skills, including decision making,
refusal skills, critical analysis (for example, of media
messages), and systematic and judgmental abilities. Children
learn to comprehend and integrate no-use messages.
Alternatives: This strategy calls for the participation
of targeted population in activities that exclude ATOD use
by youth. Constructive and healthy activities offset the
attraction to, or otherwise meet the needs usually filled
by, ATOD use.
Problem Identification and Referral: This strategy
calls for identification, education, and counseling for
those youth who have indulged in age-appropriate use of
tobacco products or alcohol, or who have indulged in the
first use of illicit drugs. Activities under this strategy
would include screening for tendencies toward substance
abuse and referral for preventive treatment for curbing
such tendencies.
Community-Based Process: This strategy aims to enhance
the ability of the community to provide prevention and treatment
services to ATOD disorders more effectively. Activities
include organizing, planning, enhancing efficiency and effectiveness
of services implementation, interagency collaboration, coalition
building, and networking. Building healthy communities encourages
healthy lifestyle choices.
Environmental Approach: This strategy sets up or
changes written and unwritten community standards, codes,
and attitudes-influencing incidence and prevalence of ATOD
problems in the general population. Included are laws to
restrict availability and access, price increases, and community-wide
actions.
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Everyone. Policy makers can deliberate after assessing
the impact of policy decisions on alcohol, tobacco, and other
drug problems, for example: zoning regulations for liquor
stores, excise taxes on alcohol and tobacco, and the access
to alcohol by youth at sports stadiums.
Educators can weave prevention themes and messages
into their skill-building exercises-regardless of content-
in science, math, reading, and social studies.
The faith community can help set low-risk community
norms.
Youth-serving organization leaders can offer alternatives
or mentoring programs.
Parents and older siblings can serve as role models
and reinforce healthy lifestyle choices and have a good dialogue
about drugs, AIDS, and other sensitive topics.
Grandparents can help children practice refusal skills.
Media representatives can develop stories celebrating
youth who have chosen not to drink, smoke, or use drugs; stations
can air public service announcements and programs.
Governments can transfer knowledge about what works,
with whom, and under what conditions.
Law enforcement personnel can enforce laws related
to driving under the influence and underage sales of tobacco
and alcohol.
Health care providers can conduct 5 minute screenings
at lifecycle points in their patients' lives, for example,
when children enter school, when they get sports or camp physicals,
when they enter college, when they get married, when they
consider pregnancy, when they enter the job market, when they
experience a crisis, or when they retire.
Pharmacists can provide information about the harms
associated with alcohol abuse, tobacco, and illicit drug use,
as well as mixing medications with alcohol and tobacco.
Businesses can sponsor alternative programs for youth,
skill-building seminars, and mentoring programs.
Volunteers can become a "friend" to a child of a
substance abuser.
Child welfare workers can look for signs of alcohol
or drug abuse in the home and make referrals.
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A society of people who make low-risk or no risk decisions
about alcohol, tobacco, and other drugs. Such decisions greatly
reduce the incidence and prevalence of injury, disease, and
death associated with the use and abuse of these substances.
And, these decisions produce a society that encourages early
identification and treatment of those who already have ATOD
problems.
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For those 21 and over, CSAP discourages high-risk drinking
and drinking that places the drinker or others at risk from
harm- such as drinking by drivers, pregnant women, or
people who are alcohol dependent or alcoholic. CSAP follows
the U.S. Dietary Guidelines of the U.S. Departments of Health
and Human Services and Agriculture that recommend men limit
themselves to two drinks per day and women to one drink per
day. CSAP also supports those who voluntarily abstain from
alcohol and other drugs for health, safety, religious, or
cultural reasons.
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Better studies to assess exactly what prevention services
and policies work best for whom and under what conditions.
For example, what works best for high sensation-seeking youth?
What works best in communities beset with high levels of unemployment,
poverty, and crime? What works best with men who have few
personal support systems?
Additional resources for implementation of prevention policies
and practices at the community level, especially where hopelessness,
despair, and poverty prevail.
Expanded resources for addressing the myths and misconceptions
about ATOD use (for example, that alcohol intoxication is
funny or is seen as a rite of passage for the young) and to
increase the realistic perception of harm.
More culturally appropriate prevention messages and mechanisms
to reach audiences with less exposure to traditional information
channels.
Ways to change norm- especially within high-risk environments,
for examples, college and university campuses, military installations,
and high crime areas.
A reduction in the disproportionate share of messages aimed
at promoting alcohol and tobacco products among low-income
populations.
A decrease of availability and access to alcohol and tobacco
products by youth.
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Everyone benefits from prevention. We already practice
many types of prevention- when we brush our teeth, fasten
our seatbelts, and look both ways before crossing an intersection.
We keep medicines, poisons, weapons, and sharp instruments
out of children's reach. We read the warning labels of over-the-counter
and prescription drugs. We encourage good nutrition and physical
fitness. We limit out intake of fat and salt. We protect the
safety of our food and water, our housing, and our automobiles.
We make prevention happen in many ways and benefit from the
results. Our children are not poisoned. We have fewer injuries.
We do not experience overdoses. We avoid obesity and related
illness.
We can do the same in terms of preventing alcohol, tobacco,
and other drug problems and reap many benefits. Let's make
prevention a priority. Let's keep our children in school,
our workers employed, and our country on the leading edge
in the global competition.
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Call or write the National Clearinghouse for Alcohol and
Drug Information at 1-800-729-6686; P.O. Box 2345 Rockville,
MD 20852. Free materials will be sent to you within 4 to 6
weeks.
Source: Office of Alcoholism and Substance Abuse Services
(OASAS), http://www.oasas.state.ny.us/
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