"Prevention is the best treatment" is an oft-cited maxim, and one that certainly applies to drug abuse. Anyone who can be influenced to avoid abusing drugs is spared their harmful health and social effects, including increased risk for lethal infections, family disruption and job loss, confusion and despair, the difficult struggle of treatment, and -- for many -- the ravages of addiction and the ordeal of climbing back after relapse. From society's point of view, drug abuse prevention helps keep a tremendous burden -- related to disease and premature death, lost capacity for productive work, and crime -- from being even worse.
The bulk of current interventions to prevent drug abuse fall mainly into two groups. One set is designed to reduce risk factors associated with higher likelihood of drug abuse and increase protective factors associated with lower likelihood of drug abuse. When implemented in conformity with proven prevention principles (see "Risk and Protective Factors in Drug Abuse Prevention"), this strategy, the product of more than a decade of research and clinical experience, is effective and inclusive enough to apply to most populations. Moreover, researchers continue to learn more about how risk and protective factors relate, and practitioners are ever more adept at applying this knowledge. These efforts will continue to yield incrementally -- perhaps even dramatically -- higher impact interventions well into the future.
Nonetheless, there are limitations to the risk-and-protective-factors strategy. One feature that ultimately limits its impact, for example, is the nature of the factors themselves. They tend to be fundamental or deeply entrenched characteristics or experiences of a person, family, or community. Some are hidden, such as sexual victimization; others are prominent in society, such as adolescent depression or ready access to drugs of abuse. As a result, traditional risk factors generally can be modified only by relatively broad and long-term interventions. Certain factors may not be susceptible to modification, such as a genetic predisposition to risk-taking. In addition, for the most part, traditional risk factors pertain to an individual's vulnerability to drug abuse, rather than the actual choice to use drugs. As important as it is to lower vulnerability, on a given day, even someone with a relatively low vulnerability may opt to use drugs.
The second important group of preventive interventions complements and extends the risk-and-protective-factors strategy by focusing on the dynamic of situations, beliefs, motives, reasoning and reactions that enter into the choice to abuse or not to abuse drugs. Important applications of this strategy include normative education to refute the common belief that "everyone takes drugs," and equipping young people with the skills to refuse drug offers without feeling they are losing face. This strategy is full of untapped promise, and today likely offers the best prospects for rapid development of more effective prevention. A few of the many issues whose elucidation may yield improved interventions include why even very young children tend to expect positive experiences from drugs; how individuals' styles for processing language and visual images affect drug-taking decisions; the roles of curiosity and impulsivity in such decisions; and what logical processes people typically follow when deciding to use or not use drugs.
A recent dramatic finding in neurobiological research may greatly increase our understanding of adolescent decision-making and our ability to help adolescents choose wisely regarding drug abuse. Scientists have long suspected that the adolescent brain is still developing physically, and researchers have now demonstrated that new neural tissue and connections continue to form throughout the transitional years between childhood and adulthood. Further investigation of this growth process undoubtedly will yield important insights relevant to some of the cognitive issues affecting the appeal of drugs and drug-taking decisions. The impact on drug abuse prevention could be tremendous, especially in light of the fact that adolescence often is a critical period for initiation of drug abuse. Most chronic drug abusers start experimenting with intoxication in adolescence or young adulthood. While populations are constantly changing -- and while prescription drug abuse by older individuals today is a serious and mounting concern -- it remains generally true that people who do not abuse drugs during the decisive years before age 25 are unlikely ever to develop a serious drug problem.
A tighter focus on decision-making regarding drug abuse should enable us to progress in a vitally important area: preventing escalation from early, experimental drug use to regular use, abuse, and addiction. We know that fewer than 10 percent of people who experiment with drugs become dependent or addicted. We also know that some of the factors that influence whether a person will become dependent or addicted are independent of the factors that influence whether he or she will initiate drug abuse. For example, research has suggested that, perhaps because of their particular brain chemistry, some individuals dislike the agitation cocaine can produce more than they like the euphoria it brings -- and so discontinue use after their initial experimentation. Interventions based upon such factors may curtail drug abuse before it reaches critical severity and thereby forestall most of its truly tragic health and social consequences.
NIDA's prevention agenda is to aggressively pursue research on risk and protective factors while also seeking to identify, develop, and integrate new science-based approaches into existing prevention programs. To accomplish these goals, NIDA recently launched the three-part Drug Abuse Prevention Research Initiative. (See "NIDA Conference Reviews Advances in Prevention Science, Announces New National Research Initiative.") Basic researchers will mine new neurobiological and other fundamental research discoveries for prevention applications. Basic, clinical, and applied researchers and practitioners will work together in Transdisciplinary Prevention Research Centers to synthesize knowledge from all the relevant scientific fields into powerful new prevention packages. Researchers and State and local practitioners will collaborate in Community Multisite Prevention Trials to rapidly assess proposed new prevention approaches and interventions in diverse communities and populations.
Exciting moments in science occur when the gradual accumulation of knowledge suddenly gives rise to new perspectives with the promise of new solutions to problems of living. In the area of drug abuse prevention, this is such a moment, and NIDA is moving swiftly to take full advantage of its potential.