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Changing Environments to Prevent Substance Abuse

Community Science brings an environmental approach to substance prevention. We understand that successful environmental prevention efforts must include policy change, address differences in culture and race, equity, and focus on efforts that change systems and structures that impede health and promote unsafe behaviors. Too often, efforts to address substance abuse prevention focus solely, or predominately, on changing individual behavior and attitudes. These include teaching young people drug refusal skills, providing mentoring support, and training in life skills. However, these individual strategies are difficult and costly to implement community- or population-wide and are not sufficient by themselves to result in community- and population-level reductions in substance abuse rates. Environmental strategies—those focused on changing the context around substance use and abuse—are important and necessary complements to individually focused strategies and are critically important to successful substance abuse prevention.

Environmental strategies improve the health and safety of the environment for the entire community. Based on the public health approach, these strategies target the broad population in order to maximize the public benefit of prevention efforts. Environmental strategies include changes in policies, community procedures, and practices; changes in the physical design of the environment; and reducing access and availability of alcohol, tobacco, and other drugs. Environmental strategies have been particularly successful in addressing underage drinking and impaired driving. For example, holding retail outlets (e.g., bars and restaurants) and beverage servers responsible for damages due to intoxicated patrons is associated with decreases in alcohol-related crashes and fatalities.

The success of environmental substance abuse prevention lies in weaving together a set of complementary and multi-faceted strategies that target the entire community. Communities should consider necessary policy changes that make the availability and use of substances more difficult (e.g., social host ordinances that hold homeowners responsible for underage drinking that occurs in their residence), changes in community practices and procedures that promote prevention (e.g., programs to train retail outlets in responsible beverage service), and changes to the physical design of the environment (e.g., improving lighting in parks where drug sales and use occur).

However, there is no one-size-fits-all approach to environmental strategies. Communities need to be selective and strategic in the choice of strategies to implement. The key to this is a well-planned and implemented assessment of how individuals are accessing illicit substances, the factors that promote availability and use of alcohol, tobacco, and other drugs in the community, and norms that encourage use and abuse. This assessment is critically important in determining the right set of environmental and other strategies to implement. For example, communities in medical marijuana states have different availability issues to address than those in states that have not passed this legislation. Understanding the community’s unique set of causal factors for substance abuse is integral to effective substance abuse prevention.

Substance abuse prevention efforts are most successful when individual-level and environmental-level strategies reinforce each other, resulting in a complementary alignment of community norms, practices, and policies. Whether it is underage drinking at house parties in suburban America, the use of “molly” (ecstasy) by college students during spring break, misuse and abuse of prescription drugs, or the rise of heroin overdoses, substance abuse prevention requires a comprehensive set of strategies that includes environmental prevention efforts in order to save lives and improve community health and safety.

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