Communities Can Be ‘Trained’ to Prevent Substance Abuse

Communities That Care (CTC), a system of individualized, evidence-based substance-use-prevention programs, reduces risky behaviors such as alcohol use, smoking, and fighting in adolescents, according to the results of the Community Youth Development Study, published in the September 7 Archives of Pediatric and Adolescent Medicine.

Eighth-grade students living in communities that employed CTC strategies were about 33 percent less likely to begin smoking and drinking than peers living in control communities that had no such prevention programs, and were 25 percent less likely to engage in delinquent behavior—which can be a predictor of future substance use—than eighth graders living in control communities.

The CTC program is designed to take into account individual communities' needs in terms of behaviors that place adolescents at risk. Under the program, community leaders such as clergy, teachers, health workers, social workers, and other volunteers receive training that enables them to implement the prevention strategies based on community needs. These strategies can focus on a range of issues, such as preventing drug and alcohol use, ameliorating family conflict, reducing violence, and preventing HIV/AIDS, for instance.

Intervention communities received six training sessions delivered over the course of a year by certified CTC trainers. In addition, community leaders received training on how to implement a CTC system based on the needs of their community. In this study “communities” were freestanding incorporated towns that were not suburbs of larger cities. These towns were matched with regard to population, crime, and poverty rates before random assignment to control or Communities That Care conditions. This allowed researchers to assess the effects of CTC itself without risk of results from other initiatives that could have spilled over if they had selected large cities or suburbs of large cities for the trial.

“What makes Communities That Care unique is that it enables communities to identify their own special issues so that they can handpick the right prevention programs,” National Institute on Drug Abuse (NIDA) Director Nora Volkow, M.D., stated in a press release issued by the agency in September.

To evaluate the CTC program, researchers analyzed results from the Youth Development survey, which was administered in the classrooms of 4,407 fifth graders from 24 communities in Colorado, Illinois, Kansas, Maine, Oregon, Utah, and Washington beginning in 2003. The survey included questions about drug and alcohol use and delinquent behaviors such as shoplifting, property damage, and fighting. Students were surveyed annually for four years or through eighth grade.

Community leaders in 12 of the communities were randomly assigned to undergo CTC training and implementation. The 12 other communities did not implement the CTC prevention programs.

The researchers from the University of Washington and the University of South Carolina analyzed the results of the study and found that students from control communities were 41 percent more likely to engage in delinquent behavior between the fifth and eighth grades than were children in the same grade range who lived in CTC communities.

In addition, they found that students in the control communities were 60 percent more likely to start drinking between seventh and eighth grades than were their peers in CTC communities.

“This shows that a coalition of community stakeholders armed with tools solidly grounded in prevention science can prevent middle schoolers from starting to use tobacco, starting to drink, and starting to engage in delinquent behavior,” said lead author J. David Hawkins, Ph.D., in the press release. Hawkins is founding director of the Social Development Research Group at the University of Washington.

NIDA, the National Institute of Mental Health, and other NIH institutes funded the Community Youth Development Study.

An abstract of “Results of a Type 2 Translational Research Trial to Prevent Adolescent Drug Use and Delinquency” is posted at <archpedi.ama-assn.org/cgi/content/short/163/9/789?home>.