- 1a Past President , California Society of Addiction Medicine , San Francisco , CA , USA.
- 2b Private Practice, General & Addiction Psychiatry , San Francisco , CA , USA.
- 3c Co-Chair , Youth Education & Prevention Working Group, Lt. Governor's Blue Ribbon Commission on Marijuana Policy , California , USA.
- 4d Clinical Professor of Psychiatry , University of California San Francisco , San Francisco , CA , USA.
- 5e Technical Advisor , General & Addiction Psychiatry , Hanoi , Vietnam.
Abstract
Considerable money and effort have been expended in attempts to prevent drug use by youth, with disappointing results. Too often, prevention programs have singled out youth with simplistic messages of exaggerated risk and the same politically acceptable solution for all-abstinence. Historically, prevention efforts have been less effective by not being soundly based in science and failing also to address adult drug and alcohol use as part of the problem. The Institute of Medicine continuum of care model developed in 1994 offers a framework for a more sophisticated, three-tiered approach to prevention, defined as all services provided prior to a clinical diagnosis of a substance use disorder. By dividing prevention efforts into universal (delivered to broad populations without consideration of individual risk for developing substance use disorder), selected (targeting sub-groups of individuals identified on the basis of characteristics known to create an elevated risk for substance use disorder), and indicated (addressing individuals identified on the basis of manifest risk behaviors), prevention can be better tailored to meet different levels of need. Student Assistance Programs (SAPs) and community coalitions provide examples of how IOM's continuum of care model can be integrated into drug prevention programs for youth.
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