7.3 Prevention of Substance Abuse and Mental Illness by SAMHSA

Overview

Promoting mental health and preventing mental and/or substance use disorders are fundamental to SAMHSA’s (Substance Abuse and Mental Health Services Administration) mission to reduce the impact of behavioral health conditions in America’s communities.

Mental and substance use disorders can have a powerful effect on the health of individuals, their families, and their communities. In 2014, an estimated 9.8 million adults aged 18 and older in the United States had a serious mental illness, and 1.7 million of which were aged 18 to 25. Also 15.7 million adults (aged 18 or older) and 2.8 million youth (aged 12 to 17) had a major depressive episode during the past year. In 2014, an estimated 22.5 million Americans aged 12 and older self-reported needing treatment for alcohol or illicit drug use, and 11.8 million adults self-reported needing mental health treatment or counseling in the past year. These disorders are among the top conditions that cause disability and carry a high burden of disease in the United States, resulting in significant costs to families, employers, and publicly funded health systems. By 2020, mental and substance use disorders will surpass all physical diseases as a major cause of disability worldwide.  In addition, drug and alcohol use can lead to other chronic diseases such as diabetes and heart disease. Addressing the impact of substance use alone is estimated to cost Americans more than $600 billion each year.

Preventing mental and/or substance use disorders and related problems in children, adolescents, and young adults is critical to Americans’ behavioral and physical health. Behaviors and symptoms that signal the development of a behavioral disorder often manifest two to four years before a disorder is present. In addition, people with a mental health issue are more likely to use alcohol or drugs than those not affected by a mental illness. Results from the 2014 NSDUH report (PDF | 3.4 MB)showed that of those adults with any mental illness, 18.2% had a substance use disorder, while those adults with no mental illness only had a 6.3% rate of substance use disorder in the past year. If communities and families can intervene early, behavioral health disorders might be prevented, or symptoms can be mitigated.

Data have shown that early intervention following the first episode of a serious mental illness can make an impact. Coordinated, specialized services offered during or shortly after the first episode of psychosis are effective for improving clinical and functional outcomes.

In addition, the Institute of Medicine and National Research Council’s Preventing Mental, Emotional, and Behavioral Disorders Among Young People report – 2009(link is external) notes that cost-benefit ratios for early treatment and prevention programs for addictions and mental illness programs range from 1:2 to 1:10. This means a $1 investment yields $2 to $10 savings in health costs, criminal and juvenile justice costs, educational costs, and lost productivity.

Continuum of Care

A comprehensive approach to behavioral health also means seeing prevention as part of an overall continuum of care. The Behavioral Health Continuum of Care Model recognizes multiple opportunities for addressing behavioral health problems and disorders. Based on the Mental Health Intervention Spectrum, first introduced in a 1994 Institute of Medicine report, the model includes the following components:

• Promotion—These strategies are designed to create environments and conditions that support behavioral health and the ability of individuals to withstand challenges. Promotion strategies also reinforce the entire continuum of behavioral health services.
• Prevention—Delivered prior to the onset of a disorder, these interventions are intended to prevent or reduce the risk of developing a behavioral health problem, such as underage alcohol use, prescription drug misuse and abuse, and illicit drug use.
• Treatment—These services are for people diagnosed with substance use or other behavioral health disorder.
• Recovery—These services support individuals’ abilities to live productive lives in the community and can often help with abstinence.

Risk and Protective Factors

People have biological and psychological characteristics that can make them vulnerable or resilient to potential behavioral health problems. Individual-level protective factors might include a positive self-image, self-control, or social competence.

In addition, people do not live in isolation, they are part of families, communities, and society. A variety of risk and protective factors exist within each of these environmental contexts. Learn more from the SAMHSA Center for the Application of Prevention Technologies’ Key Features of Risk and Protective Factors webpage and from the Risk and Protective Factors and Initiation of Substance Use: Results from the 2014 National Survey on Drug Use and Health (PDF | 1.5 MB). Review the chapter on Risk Factors and Protective Factors in the National Institute on Drug Abuse’s report, Preventing Drug Use among Children and Adolescents.

Evidence-Based Practices

Experts attest that an optimal mix of prevention interventions is required to address substance use issues in communities because they are among the most difficult social problems to prevent or reduce. SAMHSA’s program grantees should consider comprehensive solutions that fit the particular needs of their communities and population, within a cultural context and take into consideration unique local circumstances, including community readiness. Some interventions may be evidence-based, while others may document their effectiveness based on other sources of information and empirical data.

Early intervention also is critical to treating mental illness before it can cause tragic results like serious impairment, unemployment, homelessness, poverty, and suicide. The Community Mental Health Services Block Grant (MHBG) directs states to set aside 5% of their MHBG allocation, which is administered by SAMHSA, to support evidence-based programs that address the needs of individuals with early serious mental illness, including psychotic disorders. The Guidance for Revision of the FY2014-2015 MHBG Behavioral Health Assessment and Plan (PDF | 92 KB) provides additional information.

Review SAMHSA’s criteria for defining a prevention program or early intervention as evidence-based. Also, search SAMHSA’s Evidence-Based Practices Resource Center to find evidence-based programs related to prevention and early intervention for all behavioral health issues.

Prevention Strategies

Many prevention approaches, such as selective prevention strategies, focus on helping individuals develop the knowledge, attitudes, and skills they need to make good choices or change harmful behaviors. Many of these strategies can be classroom-based. Learn more from the SAMHSA Center for the Application of Prevention Technologies’ comprehensive review of classroom-based programs.

Universal prevention approaches include the use of environmental prevention strategies, which are tailored to local community characteristics and address the root causes of risky behaviors by creating environments that make it easier to act in healthy ways. The successful execution of these strategies often involves lawmakers, local officials, and community leaders, as well as the acceptance and active involvement of members from various sectors of the community (such as business, faith, schools, and health). For example, the use of this type of strategy may offer fewer places for young people to purchase alcohol, so consuming alcohol becomes less convenient; therefore, less is consumed.

Environmental change strategies have specific advantages over strategies that focus exclusively on the individual. Because they target a much broader audience, they have the potential to produce widespread changes in behavior at the population level. Further, when implemented effectively, they can create shifts in both individual attitudes and community norms that can have long-term, substantial effects. Strategies that target the environment include:

• Communication and education
• Enforcement

Visit the SAMHSA Center for the Application of Prevention Technologies’ Evaluating Environmental Change Strategies webpage for more prevention information and resources.

SAMHSA is a leader in the promotion of prevention and early intervention, most notably through its Strategic Prevention Framework (SPF) and participation in the President’s Now Is The Time initiative.

Learn about SAMHSA’s many preventions and early intervention programs, initiatives, and partnerships:

• SAMHSA’s Efforts Related to Prevention and Early Intervention
• SAMHSA’s Prevention Efforts for Specific Populations
• Grants Related to the Prevention of Substance Abuse and Mental Illness
• Publications and Resources on the Prevention of Substance Abuse and Mental Illness

Cultural Awareness and Competency

Improving cultural and linguistic competence is an important strategy for addressing persistent behavioral health disparities experienced by diverse communities, including the lesbian, gay, bisexual, and transgender population and racial and ethnic minority groups. These diverse populations tend to have less access to prevention services and poorer behavioral health outcomes.

Cultural and linguistic competence includes, but is not limited to, the ability of an individual or organization to interact effectively with people of different cultures. To produce positive change, prevention practitioners must understand the cultural and linguistic context of the community, and they must have the willingness and skills to work within this context.

For diverse populations to benefit from prevention and early intervention programs, SAMHSA ensures that culture and language be considered at every step when developing and then implementing these programs. For more information and resources, visit the Strategic Prevention Framework’s Cultural Competence webpage. In addition, the SAMHSA Center for the Application of Prevention Technologies lists the elements of a culturally competent prevention system. With regard to the development of a culturally diverse workforce, the Now Is The Time: Minority Fellowship Program – Youth expands on the existing Minority Fellowship program to support master’s level-trained behavioral health providers in the fields of psychology, social work, professional counseling, marriage and family therapy, and nursing. In addition, SAMHSA supports the Now Is The Time: Minority Fellowship Program – Addiction Counselors, which supports students pursuing master’s level degrees in addiction/substance abuse counseling as well as the Minority Fellowship Program whose purpose is to reduce health disparities and improve healthcare outcomes of racially and ethnically diverse populations by increasing the number of culturally competent behavioral health professionals available to underserved populations in the public and private nonprofit sectors.

Community Coalitions

Community coalitions are increasingly used as a vehicle to foster improvements in community health. A coalition is traditionally defined as “a group of individuals representing diverse organizations, factions or constituencies who agree to work together to achieve a common goal.” Community coalitions differ from other types of coalitions in that they include professional and grassroots members committed to working together to influence long-term health and welfare practices in their community. Additionally, given their ability to leverage existing resources in the community and convene diverse organizations, community coalitions connote a type of collaboration that is considered to be sustainable over time.

The federal government has increasingly used community coalitions as a programmatic approach to address emerging community health issues. Community coalitions are composed of diverse organizations that form an alliance in order to pursue a common goal. The activities of community coalitions include outreach, education, prevention, service delivery, capacity building, empowerment, community action, and systems change. The presumption is that successful community coalitions are able to identify new resources to continue their activities and sustain their impact in the community over time. Given the large investment in community coalitions, researchers are beginning to systematically explore the factors that affect the sustainability of community coalitions once their initial funding ends.

The Office of National Drug Control Policy (ONDCP) and the SAMHSA Center for Substance Abuse Prevention (CSAP) support Drug-Free Communities (DFC) Support Program grants, which were created by the Drug-Free Communities Act of 1997 (Public Law 105-20). The DFC Support Program has two goals:

• Establish and strengthen collaboration among communities, public and private non-profit agencies, as well as federal, state, local, and tribal governments to support the efforts of community coalitions working to prevent and reduce substance use among youth.
• Reduce substance use among youth and, over time, reduce substance abuse among adults by addressing the factors in a community that increase the risk of substance abuse and promoting the factors that minimize the risk of substance abuse.

Long-term analyses suggest a consistent record of positive accomplishment for substance use outcomes in communities with a DFC grantee from 2002 to 2012. The prevalence of past 30-day use of alcohol, tobacco, and marijuana declined significantly among both middle school and high school students. The prevalence of past 30-day alcohol use dropped the most in absolute percentage point terms, declining by 2.8 percentage points among middle school students and declining by 3.8 percentage points among high school students. The prevalence of past 30-day tobacco use declined by 1.9 percentage points among middle school students, and by 3.2 percentage points among high school students from DFC grantees’ first report to their most recent report. Though significant, the declines in the prevalence of past 30-day marijuana use were less pronounced, declining by 1.3 percentage points among middle school students and by 0.7 percentage points among high school students. Learn more from the Drug Free Communities Support Program 2012 National Evaluation Report.

SAMHSA has demonstrated that behavioral health is essential to health, prevention works, treatment is effective, and people recover from mental and/or substance use disorders.