As the California AOD prevention community moves
toward science-based prevention, we want more
than ever to understand "what works"
for useful outcomes. The focus for action remains
at the local (county, city, community) level,
where county alcohol and drug programs (county
ADPs) continue to enjoy broad discretion under
federal funding guidelines from CSAP and SDFSC
(DOE). However, new accountability and reporting
requirements are emerging. Local agencies are
under increasing pressure to be clear what they
are trying to prevent, and how they are going
about it. Credible methods and measurable results
are becoming a necessity.
Help is available through training and TA offered
by the Community
Prevention Institute and by CSAP and other
federal agencies that offer demonstrated prevention
methods and approaches such as WestCAPT.
However, county ADP agencies and other local organizations
still must decide which methods and approaches
they will use. What are the critical AOD issues
from local perspectives? How can effective local
responses be developed that will meet stringent
state requirements and federal guidelines?
The following perspective is offered to help county
ADP programs find answers to these questions,
and to engage other local agencies and community
based organizations (CBOs) that provide AOD prevention
services. A second article will address ways that
county ADPs and local communities can take effective
action on long-standing practical difficulties
and policy challenges that stand in the way of
realizing the perspective outlined below. A third
article will report on state-level and local efforts
to help overcome these difficulties and challenges.
What are we trying to prevent? While there is
no one right answer, the field needs to clarify
what approach(es) we want to pursue as a matter
of common interest, so our joint efforts can be
mutually supportive. Currently, most approaches
to community level AOD prevention follow a "problem-prevention"
perspective to reduce illness, harm, and loss.
This perspective is pursued through several disciplinesPublic
health, education, social welfare, public safety,
community planning, advocacy, and health service
delivery and operates through corresponding
local agencies, community organizations, and unofficial
groups. In practice, these community-level entities
are usually involved in some form of problem-reduction
(harm reduction), and in efforts to delay or reduce
AOD use. These efforts often mesh with other community
initiatives and policies that serve related objectives.
This "problem reduction" approach makes
sense for AOD-related community issues that drain
community resources and that involve a number
of groups, including innocent bystanders, and
community organizations. Four AOD problem-areas
of great concern to local communities are: driving
under the influence, disruptive public behavior
related to drinking and drug use, young people's
AOD experiences, and AOD-related crime and violence,
among other concerns.
This problem-oriented perspective has great potential
for improvement and broad application if (a) the
scope, or theory of problem-oriented prevention
is clear, and (b) the scale, or level, of application
is specified. This article summarizes prevailing
thoughts on both points.
A. Scope of problem-oriented community prevention
initiatives. Three basic theories for community-level
problem-prevention approaches are currently in
- (1) Prevent alcohol and drug (AOD) problems
directly. Community AOD problems are
viewed as problematic drinking and drug-use
behaviors and the settings and circumstances
that encourage or tolerate them. Action focuses
on curtailing the specific troublesome behaviors
and circumstances. For example: Intervene immediately
with young people engaged in especially dangerous
AOD use - take action at once to sanction behaviors
and to modify circumstances of those behaviors;
design community fairs to be alcohol-free (if
child- and family-oriented) or permit alcohol
only in well-managed "beer gardens";
create social host ordinances to discourage
problematic house parties; institute community-based
policing to provide direct contact with law-enforcement;
combat drug paraphernalia sales and vending
of precursor materials; encourage physician
involvement with aftermaths of AOD use through
brief intervention techniques such as SBIRT.
Direct action approaches tend to be program-oriented.
Prevention workers seek to change problematic
practices and places already in operation, mostly
through short-term programs or special activities.
Positive results usually can be seen quickly,
and outcomes usually are closely tied to project
outputs. However, questions arise how long problem-reduction
programs last, and whether AOD problems are
displaced rather than reduced.
- Prevent "root causes" that
cause AOD problems in the first place.
Community AOD problems are viewed as a result
of certain forces that have a particular impact
on the community. Reducing the impact of these
forces will therefore reduce concomitant AOD
problems. Examples: Provide early childhood
development services to distressed families
with AOD-related problems; provide economic
development opportunities in poor neighborhoods
to keep young people from entering the drug
trade; raise AOD retail prices, reduce accessibility,
and limit exploitative promotional activities
to reduce elevated levels of high-risk availability.
"Root-cause" prevention approaches
tend to be policy-oriented. Prevention workers
seek to change problematic settings and circumstances
through policy changes and fundamental changes
in practice. Definitive results often take a
while to appear, and it may be difficult to
attribute positive results specifically to AOD-related
initiatives since many other factors will also
- Engage in positive development programs
and policies that bypass AOD problems. Community
AOD problems are viewed as potential conditions
that can be avoided by positive community development
and person-oriented development initiatives.
Examples: Secular youth development programs
provide guidance and support for healthy living
that divert young people from involvement with
drinking and drug use; rigorous application
of mores and customs among religious communities
and traditional communities that use similar
approaches; community planning to design safe
and healthy communities that exclude opportunities
for high-risk AOD abuse. Positive development
programs accentuate positive development influences
(and some seek to exclude negative development
influences).Prevention workers assist communities
to institute positive norms, beliefs and expectations
(and sometimes to supercede, change, or exclude
problematic norms, beliefs and expectations).
Two complexities are involved in observing change
in AOD problems: (1) How are changes in community
AOD problems accounted for in relation to positive
development objectives? Is there an evaluation
of the extent to which the developmental initiatives
divert participants from future AOD problems,
or in other ways reduce community AOD problems?
(2) Do development initiatives treat norm change
as precursors to, or as products of, behavior-change
Each of these three approaches can claim evidence
of effectiveness. The three approaches can be
compatible with each other. Most communities can
benefit from multiple prevention initiatives using
all three theories. Selecting the approach(es)
to follow can be helped by consideration of the
scale at which prevention initiatives will be
There is no disagreement here with those who argue
that a problem-oriented perspective is not the
only nor necessarily the best one for dealing
with society's AOD-related difficulties. We welcome
vigorous debate on which prevention perspectives
best serve the field. Meanwhile, the problem-oriented
perspective is predominant and has great untapped
potential. So we are focusing on the making the
most of it while keeping an eye open to other
B. Scale of community-level prevention efforts.
The concept of scale is critical to making
effective use of these three theories in community
contexts. "Scale" refers to the size
of the prevention effort in relation to a person.
Community-level prevention efforts make use of
three scales: The individual level; the organizational
level; and the institutional level, described
- Low-scale, individual-sized efforts.
Small-scale efforts focus on beliefs and behaviors
of individuals or small groups in particular
types of settings and circumstances. Examples:
School-age prevention education programs at
the individual school site; oversight for identified
problem bars; cleaning up drug use and alcohol-related
problems in designated public parks; stopping
teenaged drinking parties in private homes;
creating a safe-place after-school program;
adoption of personal social host policies for
responsible alcohol service. Many model programs
recognized by CSAP and other federal agencies
operate at this level for selected individuals
and designated groups. Examples are Dare
to be You which has family, community and
school components, and Strengthening
Families, a family skills training program.
- Middle-scale organizational-level efforts.
. Middle-scale efforts focus on the polices
and practices among the community's organizations
and population sub-groups. Examples: Neighborhood
association policies on alcohol at block parties
and house parties; rental property management
association policies on AOD use reflected in
lease agreement and property oversight standards;
work site AOD use policies; school board policies
on drinking and drug use at school sites (in
contrast to treatment/referral programs for
individual students or staff); city policies
for drinking in public parks; fraternal organization
rules for responsible alcohol use at social
and community events. Community prevention initiatives
consider these programs and policies in their
surrounding community contexts. What do the
local problem contextsthe at-risk settings
and circumstances in which AOD problems occurcontribute
to people's AOD problems? What can be done to
reduce or eliminate the contribution of these
contexts to the participants' AOD problems?
- Large-scale, institutional efforts.
. Institutional efforts focus on public policies,
community-wide beliefs, and historical practices
among major community sectors (public agencies,
the business community, the residential community,
the faith community, health and human service
providers, etc.). Examples: Community standards
for promotions and advertising of alcoholic
beverages at youth-related events; work with
pharmacists and drug companies to render certain
pharmaceuticals distasteful or unattractive
for abuse; conditional use permit (CUP) regulations
on retail alcohol outlets; community-wide bans
on smoking in public places; community support
for alcohol-free holiday events such as sober
graduation and First Night alcohol-free New
Year's celebrations; acceptance of sober housing
facilities and respect for sober-living lifestyles
as a positive community resource.
Based on the AOD problems they wish to attack,
community designers can strengthen their local
AOD prevention initiatives by carefully selecting
the scale(s) at which the theory will be applied.
The local AOD prevention initiatives can "nest"
so that the lower-scale efforts are included in
larger-scale efforts, reinforcing each other in
a multi-scaled ecology that shifts toward healthier,
less-problematic community living. Planning one
community event, for example, can lead to a general
policy that applies to several community settings
This "nesting" orientation can also
be used to link local communities with a statewide
efforts. Consider California's exemplary tobacco
control efforts, for example, that use the "nesting"
strategy to work through "air cover"
statewide advertising campaigns; state and regional
support for prevention methods, program planning
and evaluation; and localized community education
and control activities (for an excellent example
of California's comprehensive tobacco control
efforts and their success, click
Community action to prevent AOD problems.
Community AOD prevention enjoys a wonderfully
wide palette of possibilities for action. How
can local agencies and organizations choose a
specific course of action that fits within available
resources? Two considerations are critical for
making effective choices:
- Establish clear documentation (data) to identify
the community's AOD problems in community contexts
of groups ,organizations, settings, and circumstances
as the basis for selecting AOD problems for
- Create a local decision-making process that
selects possible courses of action to address
the identified AOD problems.
The next installment of this series of articles
will address both considerations.
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