Early Interventions Can Break Generational Cycle of Drug Use

The combination of the COVID-19 pandemic and escalating drug use among adolescents between the ages of 12 and 19 has posted a unique challenge for schools and communities.

During the recent Rx and Illicit Drug Summit in Atlanta, Jane Sanville, MPH, a senior policy analyst for the Office of National Drug Control Policy (ONDCP), was joined by Karl G. Hill, PhD, professor, program director, Prevention Science Program, University of Colorado Boulder, Robert Vincent, MSEd, associate administrator for alcohol prevention and treatment policy, Substance Abuse and Mental Health Services Administration (SAMHSA), and Erin Wick, MBA, SUDP, senior director, behavioral health and integrated student supports, Capital Region Educational Service District 113 in Washington, to discuss a model for providing screening, interventions, treatment referrals, and recovery resources for the adolescent population.

Sanville recently spoke with Addiction Professional by email to discuss the importance of prevention initiatives, resources for prevention, and steps that schools and communities can take to address the drug use epidemic.

Editor’s note: This interview has been edited for length and clarity.

Do you think prevention can play a role in tackling the opioid epidemic?

Sanville: Prevention is an essential element in reducing the impact of drug use, including opioid use. An article published in the American Journal of Public Health noted that focusing on youth to prevent later substance use is an underused response to the US opioid epidemic. Similar to approaches used in addressing other health conditions like cancer or heart disease, a range of efforts can make a difference, including supporting healthy environments, screening services, prevention interventions, identifying individuals at risk or with early/treatable disease, treatment options, recovery support, and rescue approaches.

Why is preventing drug use early in an individual’s life important?

Sanville: Adolescence is a critical risk period as 2 simultaneous conditions converge—drug use escalates at the same time the brain is especially vulnerable to damage from drug use. During adolescence there is a significant reorganization of brain regions necessary for intellectual function, memory, emotional regulation, and decision-making. Research shows that early age of onset is an important predictor for the development of a substance use disorder later in life and that prevention interventions can have positive long-term effects in reducing substance use.

How can prevention have a multigenerational impact?

Sanville: A study presented at the Rx Summit by Dr Hill, “Outcomes of Childhood Preventive Intervention Across 2 Generations: A Nonrandomized Controlled Trial,” is thought to be the first study to report significant intervention differences in the offspring of participants in a universal childhood preventive intervention. The initial trial was conducted in public elementary schools operating in high-crime areas in Seattle, Washington. There was follow-up of the firstborn offspring of 182 parents who had been in the full intervention vs control conditions in childhood. Significant differences in the offspring of intervention parents were observed across 4 domains, including drug use, improved early child developmental functioning, lower teacher-rated behavioral problems, and higher teacher-rated academic skills and performance.

What would you suggest as a good first step for schools who want address substance use and mental health services?

Sanville: Schools are uniquely positioned to provide programs and services that promote student health and optimal wellness while removing barriers to active learning. A good first step is to assess your school’s unique challenges, strengths, drug use patterns, the background and needs of the students, etc. Drawing on this information, a school can start with a modest initiative, focusing on an issue of particular concern and expand from there. SAMHSA has a guide to help schools get started: Student Assistance: A Guide for Administrators.

Given the interest in school-based behavioral health services, is their sufficient access to substance use and mental health services for youth prevention, intervention, treatment, and recovery. If not, what do you see as the most important areas to focus on?

Sanville: There has been remarkable progress in development and testing of a variety of developmentally appropriate interventions and treatments during the last 2 decades. Continued advancements in the understanding of adolescent substance use disorder and mental illness, as well as improvements in the quality and effectiveness of evidence-based treatment leave little doubt as to the efficacy of treating substance use and mental health disorders, for those who get to treatment.

However, after nearly 2 decades, the availability of intervention and treatment services for substance use and mental health disorders for adolescents remains poor with the current rates for adolescents receiving treatment for substance use disorder at less than 5% of young people (12-17) receiving needed substance use treatment, and only 49% of young people receive needed mental health services. Barriers to care are especially challenging within underserved communities. These issues become more pronounced when you account for relapse, and readmission as a common factor in the treatment of adolescents, and particularly prevalent when substance use disorder is accompanied by 1 or more mental health disorders.

The most important areas to focus on are:

• Substance use and mental health issues should be addressed comprehensively. Prevention often serves as the “front door” to access school and community support services. Prevention programming should use diverse strategies across multiple sectors with both public- and private-sector resources.
• Preventative services, such as early identification, screening, and intervention, are key areas to focus on. Especially, before the age of 15, given that substance use disorders are early childhood and adolescent onset disorders. Research indicates that if we intervene early, we can cut decades off the substance use career of the individual, reducing the impacts to the individual, their family, and society.
• Insufficient access to substance use and mental health prevention and treatment services with inadequate or no early intervention or recovery support services for adolescents. Despite the availability of valid and reliable methods for screening and assessment, the identification and referral for adolescents who are experiencing either substance use or mental health related issue, in most cases it goes uninterrupted until an acute episode or significant event occurs that often exacerbates the situation.

Are there models and or guidelines for substance and mental health services in schools that you think are essential to preventing or intervening early in substance misuse?

Sanville: Provide integrated substance and mental health services through School-Based Behavioral Health Centers. Given that most adolescents are involved in some type of educational program, schools may be the ideal setting in which to identify substance use or mental health problems affecting the adolescent’s academic success. Student Assistance Programs, programs like Project AWARE, and School-Based Mental Health Centers are examples and are implementable for schools with large implementations already in place in many states.

Given that each state’s approach is often different, are there policies, programs, and practices that either impede or support efforts by federal, state, or local agencies to effectively serve youth?

Sanville: Given that each state’s approach is locally driven, there may be a need to unify and further integrate the system at the state and federal level, and rethink how discretionary programs and funding affects the delivery of services. States may wish to consider leveraging healthcare reform efforts to establish funding streams specifically for school-based substance and mental health services as part of their block grants. There are several states that are already doing this either through Student Assistance Programs, School-Based Health Centers, or School-Based Mental Health Centers.

For more information on evidence-based prevention initiatives, Jane Sanville recommends the following resources:

• Blueprints for Healthy Youth Development at the University of Colorado Boulder
• Washington State Institute for Public Policy
• Evidence-Based Practices Resource Center from SAMHSA
• Prevention Technology Transfer Center (PTTC) Network
• Evidence-based Prevention and Intervention Support (EPIS) at the Edna Bennett Pierce Prevention Research Center, Penn State College of Health and Human Development
• The Community Toolbox, a public service of the University of Kansas that is developed and managed by the KU Center for Community Health and Development

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