Substance use treatment and prevention
Strategy overview
- Supporting public health and safety: Strategies to treat and prevent drug use and addiction seek to increase individual health and wellbeing and community safety. Local governments generally use three groups of practices to do so: health services (i.e. naloxone distribution, clinical treatment); legal interventions (i.e. diversion from jail to treatment); and community-wide initiatives, like public education and awareness. Long-term recovery programming often supplements treatment and prevention initiatives.
- Preventing substance use: Substance use prevention models are often divided into community-wide and targeted approaches for higher risk groups, like teens. Community-wide solutions can include legislation, like regulating alcohol outlet density or raising alcohol/marijuana taxes, along with public awareness and education campaigns. Adolescent-focused programming, meanwhile, is often delivered in middle and high schools; lessons center on health and wellbeing education, strategies to resist drug use, and how to engage with peers demonstrating unsafe behavior.
- Reducing harm to residents: For some residents, harm reduction practices are necessary before treatment and/or recovery is possible. Harm reduction strategies, like syringe services, drug disposal, and Naloxone distribution programs, can help to reduce the risk of overdose and moderate drug use. Many evidence-based programs also include additional supportive components, like health education and referrals to behavioral and mental health services.
- Connecting residents to treatment: Jurisdictions can play a major role in facilitating and/or removing barriers to accessing treatment for drug use and addiction. In a health setting, school-based, community, and public clinics can integrate drug use and behavioral health screenings into primary care. Meanwhile, in a legal setting, such as drug courts, offenders with a drug dependency are diverted from jail to clinical treatment and other supports. Many drug courts focus on connecting a specific population, like parents or adolescents, to specialized treatment tailored to their needs.
- A collaborative approach: Comprehensive strategies to prevent and treat substance use often rely on interagency collaboration. For instance, representatives from public health agencies, social services, law enforcement, the local school district, and others can both deliver key services themselves and/or rely on a referral network to ensure resident needs are met. Community groups and nonprofits may play a similarly important role.
Multiple comprehensive research reviews of foundational practices in treating and preventing substance use demonstrated strong evidence of reduced drug use and recidivism, and increased public safety.
2016 research reviews of individual and family treatment drug courts found the model is associated with reductions in drug-related and general recidivism; increases in completed addiction treatment; and increases in the likelihood of family unification.
A 2021 research synthesis of multiple rigorous evaluations found strong evidence that community-based safe syringe service programs can reduce injection risk behavior and can be associated with reduced drug use and increased neighborhood safety.
A 2018 research synthesis of multiple rigorous evaluations found strong evidence that integrating behavioral health — including drug screens — into primary care visits can reduce drug and alcohol use, increase adherence to treatment plans, and improve mental health outcomes.
Before making investments in substance use treatment and prevention programs, city and county leaders should ensure this strategy addresses local needs.
The Urban Institute and Mathematica have developed indicator frameworks to help local leaders assess conditions related to upward mobility, identify barriers, and guide investments to address these challenges. These indicator frameworks can serve as a starting point for self-assessment, not as a comprehensive evaluation, and should be complemented by other forms of local knowledge.
The Urban Institute's Upward Mobility Framework identifies a set of key local conditions that shape communities’ ability to advance upward mobility and racial equity. Local leaders can use the Upward Mobility Framework to better understand the factors that improve upward mobility and prioritize areas of focus. Data reports for cities and counties can be created here.
Several indicators in the Upward Mobility Framework may be improved with investments in high-quality substance use treatment and prevention programs. To measure these indicators and determine if investments in this strategy could help, examine the following:
Access to healthcare: Ratio of residents to primary care physicians. These data are available from the U.S. Department of Health and Human Services’ Area Health Resource File.
- Safety from crime: Reported property crimes per 100,000 people and reported violent crimes per 100,000 people. These data are available from the Federal Bureau of Investigations’ Uniform Crime Reporting Program.
- Safety from trauma: Number of deaths due to injury per 100,000 people. These data are available from the National Center for Health Statistics’ Mortality File and the CDC’s WONDER database
- Cultivate intra-government, community buy-in: Collaboration across government agencies, community groups, and service providers is crucial to comprehensively treating and preventing substance use on a community-wide scale. Build buy-in and strong working relationships, especially with law enforcement, public health agencies, and social service providers. Strong collaborative practices, like data sharing and referrals, can significantly increase program impact.
- Prioritize prevention efforts for adolescents: Nine in ten cases of drug addiction, research shows, start with use before age 18 and are particularly common during times of transition, such as starting high school. To address this decades-long challenge, prioritize launching evidence-based prevention programming in schools, recreation centers, and other community spaces serving youth. Include programming for both students and their families, who can play a major role in drug use prevention.
- Provide wraparound services: The impacts of most treatment and harm reduction efforts, like drug courts and syringe services programs, can be reinforced by offering wraparound services and referrals to medical care. Work with service providers to formalize supports like case management, behavioral health care, job training and placement, and more. Furthermore, evaluate specialized supports, like screenings for children exposed to substances before age three and/or trauma-informed therapy, to meet the needs of specific subgroups.
- Invest in recovery programs: For many individuals, treatment for substance use is often the first step in a long recovery process. To increase the efficacy and sustainability of treatment models, consider investments in a range of long-term recovery programs in areas including: health (like continuing care models), social support (i.e. peer support groups), and financial support (such as subsidies for transportation and housing).
Evidence-based examples
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Outcome Area |
This ranking reflects how these approaches are scored in one of the major government- or philanthropy-led clearinghouse resources. For more: https://catalog.results4americ... |
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Local regulations to limit the number of establishments in a given area that sell or serve alcohol
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Supportive neighborhoods Stable and healthy families |
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Incarceration alternative requiring supervision, drug treatment and testing, and sanctions for drug offenders
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Stable and healthy families Supportive neighborhoods |
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Incarceration alternative including substance abuse testing, judicial monitoring, and support services to parents of children in the child welfare system
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Stable and healthy families Supportive neighborhoods |
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Connecting at-risk youth to mentors who promote safe and healthy behavior
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High school graduation Supportive neighborhoods |
Evidence varies across specific models |
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Community-based programs that provide access to sterile needles, syringes, and other injection equipment
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Supportive neighborhoods |
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Curriculum to develop social skills, positive character traits, and nonviolent and drug-free norms among K-12 students
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High school graduation Supportive neighborhoods |
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