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.

Issue Areas: Health and well-being

Justice and public safety
Outcomes: Supportive neighborhoods
Target Population: Community-wide
Key Stakeholders: Mayor or County Executive's Office, Public Health Department, Local Judges, Police Chief's Office, Nonprofit Partners, Program Evaluation Team

What evidence supports this strategy?

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.

Is this strategy right for my community?

Providing substance use treatment and prevention services has been shown to improve outcomes predictive of upward mobility. These outcomes, identified by the Urban Institute, are access to health services, safety from crime, and safety from trauma.

City and county leaders can assess local conditions for each of these outcomes using the metrics below, identified by the Urban Institute. This assessment can be used to determine whether this strategy is appropriate for their community. (Note: these metrics are a starting point for self-assessment and are not intended to be comprehensive.)

All cities and counties with populations over 75,000 can receive a customized data sheet here.

Measuring access to health services in your community: Examine the 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.

Measuring safety from crime in your community: Examine 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.

Measuring safety from trauma in your community: Examine the 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.

How does substance use treatment and prevention impact economic mobility?

Preserving and improving health outcomes: At their core, substance use treatment and prevention strategies seek to preserve and improve public health. Research demonstrates that good health is a key lever in upward economic mobility, including improved labor market outcomes and reduced catastrophic health care costs.
Treatment, not jail: A strong evidence-based practice for delivering substance use treatment is through drug courts and related wraparound services, which divert residents from jail and into treatment. Research shows that avoiding incarceration and/or re-incarceration significantly increases the likelihood that participants will earn a steady income, complete education or workforce training programs, and secure high-quality employment.
Making neighborhoods safer: Substance use treatment and prevention strategies can help reduce drug-related violence and increase neighborhood safety. Safe neighborhoods, research shows, can increase rates of upward economic mobility through stabler employment, higher wages, and better health.

Best practices in implementation

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

	Outcome Area
Alcohol outlet density restrictions Local regulations to limit the number of establishments in a given area that sell or serve alcohol	Supportive neighborhoods Stable and healthy families	Promising Strong Proven
Drug courts Incarceration alternative requiring supervision, drug treatment and testing, and sanctions for drug offenders	Stable and healthy families Supportive neighborhoods	Promising Strong Proven
Family treatment drug courts Incarceration alternative including substance abuse testing, judicial monitoring, and support services to parents of children in the child welfare system	Stable and healthy families Supportive neighborhoods	Promising Strong Proven
Mentoring programs for delinquency Connecting at-risk youth to mentors who promote safe and healthy behavior	High school graduation Supportive neighborhoods	Promising Strong Proven
Syringe services programs Community-based programs that provide access to sterile needles, syringes, and other injection equipment	Supportive neighborhoods	Promising Strong Proven
Too Good for Drugs and Violence High school curriculum to develop social skills, positive character traits, and nonviolent and drug-free norms among high school students	High school graduation Supportive neighborhoods	Promising Strong Proven

Learn more:

Substance Abuse and Mental Health Services Administration: Preventing Drug Misuse and Addiction: The Best Strategy Rural Health Information Hub: Implementation Considerations for Rural Substance Use Disorder Programs New York State Dept. of Education: Evidence-Based Program Guidance For Substance Use Prevention Education in Schools National Center on Substance Abuse and Child Welfare: Family Treatment Courts resources National Drug Court Institute: Foundational training