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Surgeon General’s Report Summary – Chapter 3

Surgeon General’s Report Summary – Chapter 3
Surgeon General’s Report Summary – Chapter 3

Introduction To Evidence-Based Prevention Intervention

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. 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 – Pg. 3-1

The term intervention is used throughout this Report, but the meaning is different from what is commonly known. When people think of the word intervention, they normally think about friends or loved ones confronting a friend or family member about their drinking or using. This type of intervention is called the “Johnson Intervention”, which was a model developed in the 1960’s. This type of intervention has not been proven as an effective way to help people find recovery, and may turn a person off from finding necessary treatment.

The term Evidence-Based Intervention (EBI) is a program delivered by a professional, policy, or service, and is aimed at preventing or treating substance misuse, or a substance use disorder. These programs or policies have been backed by research.

The Importance Of Prevention

The leading causes of death for those aged 15 to 24 are substance use, violence, risky driving, mental health problems, and risky sexual activity. Pg. 3-3

Substance misuse can begin at any age, but many people begin using and misusing drugs or alcohol during adolescence. While the percentage of people who develop a substance use disorder, and the rate at which they develop a disorder varies, early substance misuse can increase the chances of developing a disorder at a later age.

While many people in the U.S. do not have a substance use disorder, substance misuse still brings about negative consequences. Those negative consequences include:

  • Loss of employment
  • Deteriorating relationships
  • Increases in sickness and death (i.e. – poisoning, motor vehicle crashes, violence, or accidents)
  • Poor school performance
  • Diminished mental health
  • Pg. 3-4

Along with treating individuals with substance use disorders, it is also vital to implement EBI’s to prevent, or reduce, early substance use. However, while EBI’s are vital to prevention, they are either underutilized, or show little to no rate of effectiveness.

The prevention science reviewed in this chapter demonstrates that effective prevention programs and policies exist, and if implemented well, they can markedly reduce substance misuse and related threats to the health of the population.

Pg. 3-4

Risk And Protective Factors

As discussed in earlier chapters, the age at which a person begins using alcohol or other substances can influence whether that person develops a substance use disorder at a later age, or not. Environmental or physiological changes can be powerful at any age, but specifically in adolescence. Natural changes like puberty, or community changes like changing schools, graduation, having parent’s divorce, or the deployment of a parent are all potential risk factors for substance use or abuse. By implementing policies and programs on several levels, programs on the family, academic, and one on one levels can enhance policy interventions geared toward the greater population. Through this enhancement, a reduction in risk factors, and an increase in protective factors, has been shown.

As well as preventing substance misuse through these policies and programs, results have also shown potential for predicting other difficulties experienced by youth like psychiatric conditions, school dropout, delinquency, and violence. Pg. 3-5

Although low-income and disadvantaged groups are commonly exposed to greater risk factors, studies have shown higher income households show higher amounts of binge drinking.

The efficacy rates of these policies and programs differ across gender, cultural, and lower/ higher income groups because of different risk and protective factors. Therefore, it is important to note possible subpopulation variances when implementing these policies and programs.

Tables 3.1 and 3.2 on pages 3-5, 3-6, and 3-7 provide greater details of potential risk and protective factors for adolescent and young adult substance use.

Three Types of Prevention Intervention

The three types of prevention interventions as described by the Institute of Medicine (IOM) are:

Universal interventions:

  • Attempt to reduce risk factors and increase protective factors for everyone in a certain community
  • Example of community-based programs: setting a minimum legal drinking age, reducing availability of substances
  • Example of school-based programs: promote social and emotional competencies to reduce stress, express emotion appropriately, resist negative social influences
  • The impact of universal interventions is greater than interventions focused solely on individuals
  • Pg. 3-8

Selective interventions

  • Are delivered to particular communities, families, or children who are at increased risk of substance misuse problems
  • Target Audiences: families living in poverty, children of depressed or substance using parents
  • Children who have difficulties with social skills
  • Deliver specialized prevention services to individuals with the goal of reducing identified risk factors, increasing protective factors, or both
  • Selective programs are specifically designed for a specific high-risk group
  • Advantage: efforts are more focused on individuals who are at higher risk for the development of behavioral health problems
  • Disadvantage: limited reach because they are not population-based
  • Pg. 3-8

Indicated interventions

  • Specifically target those who are: already involved in risky behavior (substance misuse); beginning to experience problems but have not developed a substance use disorder
  • Intensive and expensive
  • Still cost-effective because of possible prevention of a future costly disorder or other negative consequences
  • Pg. 3-8

A common misconception when implementing interventions is to focus on those in the community who are at a higher risk for substance use disorders, or to those who are already affected. By providing universal interventions, the benefits are far greater because of the Prevention Paradox: “a large number of people at a small risk may give rise to more cases of disease than the small number who are at a high risk.”

A mixture of prevention interventions (universal, selective, and indicated) is vital to provide help to the greatest amount of people in a community.

More Information about Evidence-Based Interventions

Author’s Note: While the information pertaining to evidence-based interventions, policies, and programs is vital, I have chosen to exclude this information from my summary. It is my aim to make this summary easy to understand and read, while maintaining the integrity of the information contained in the Report.

If you would like to read the information on EBI’s (Evidence-Based Interventions), policies, and programs, please see the Chapter link at the end of this post. Information for EBI’s begins on Pg. 3-8.

Prescription Drug Monitoring Programs (PDMPs)

While research on prescription drug monitoring programs (PDMPs) is in the preliminary stages, results from current studies have been shown to be inconclusive and mixed. However, data from Tennessee, Ohio, New York, and Kentucky show reductions in opioid prescriptions, and declines in doctor shopping after implementing comprehensive PDMP use mandates. Another study compared Florida’s establishment of a prescription drug monitoring system and “pill mill” policies to Georgia which does not have either policy. The findings from that study showed modest reductions in total opioid volume, mean morphine milligram equivalent per transaction, and total number of opioid prescriptions dispensed, but no effect on duration of treatment. These reductions were generally limited to patients and prescribers with the highest baseline opioid use and prescribing. Pg. 3-25

A study conducted in 2016 found that, following application of a PDMP, 1.12 fewer overdose deaths related to opioids per 100,000 people occurred in the year following application of the program. Also, 600 fewer overdose deaths would occur per year if every state implemented a strong PDMP. However, another study which looked at eight types of laws which included PDMP laws, but excluded prescriber mandate laws found that these laws did not affect opioid-related outcomes in disabled recipients of Medicare. Disabled recipients of Medicare made up almost 25 percent of overdose deaths from opioids in 2008.

More research is needed to ascertain the effectiveness of certain implementation strategies and use of PDMPs:

Multiple efforts to address prescription drug misuse within states occurring in concert with mandatory PDMP legislation may limit the ability to draw causal conclusions about the effectiveness of mandatory use of PDMPs. – Pg. 3-26

In the meantime, the CDC established the CDC Guideline for Prescribing Opioids for Chronic Pain. This guideline gives references based on research for opioid prescribing in patients 18 years of age or older. This guideline discusses how to choose the right opioid and amount, when to begin using opioids for enduring pain, and how to evaluate dangers and look at harms because of opioid use. This guideline is aimed at helping providers reduce misuse from opioids, and harms which are related in patients with chronic pain.

To view the PDF file of this chapter, please follow this link: https://addiction.surgeongeneral.gov/chapter-3-prevention.pdf

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