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How Policy Guides the Development of Effective Prevention

By: Robert Chapman, PhD

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When attempting to prevent underage and high-risk consumption of alcohol and tobacco, or the use of any illicit substance, attention is generally focused on specific prevention strategies and particular program activities. It is generally understood that the determination of exactly “which” strategy will guide prevention efforts or “what” program to implement is influenced by theory, ideology, administrative responsibility, and funding, among several influential factors. Only infrequently is public policy considered as a factor in prevention.

The federal government’s current “war on drugs” can trace its origins back to the Nixon administration when this war was declared. Legal precedents that have shaped how the criminal justice system approaches those who traffic, distribute, and use illicit substances was influenced by the strict sentencing guidelines established in New York state in the 1970s, guidelines that came to be known as the “Rockefeller Drug Laws,” named for the then governor of N.Y. We can even trace our earliest forays into attempts to control “drugs” back to the earliest years of the 20th century, including a constitutional amendment to prohibit the manufacture, distribution, and sale of alcohol. What all of these efforts to “prevent” the harm associated with various substances have in common is not only the role that public policy played in shaping how they were addressed legally, but how they shaped the very thinking of future generations of Americans and how they viewed these substances and, consequently, how they approached prevention.

This essay will outline the role policy plays in affecting prevention. It will consider both the “pros” and “cons” of policy’s affect on prevention, or more succinctly, its ability to either guide or inhibit effective prevention efforts. When considering the role policy plays in guiding the development of effective AOD prevention efforts it is important to place emphasis in this discussion on the operative phrase in its title..."guides the development of effective prevention." To guide means to pilot, to steer, or engineer. When policy informs prevention efforts or suggests ways to avoid difficulties or mistakes and overcome challenges and obstacles, then that policy indeed guides the development of effective prevention. If, however, policy ignores evidence-informed, scientific data and its recommended best practices, if it precludes the consideration of alternative strategies and shackles preventive measures by restricting them to the social science equivalent of "political correctness," then policy hampers creative and innovative thought and is therefore essentially the antithesis of developing effective prevention.

The 18th amendment to the U.S. Constitution is a good example of this. Prohibition was the public policy result of 100 years of lobbying against alcohol based on anecdotal evidence and ideological beliefs. Although there was, and remains, a clear link between alcohol dependence and any number of social, economic, familial, and health related problems, a public policy attempt to prevent these problems by legislating morality proved an ineffective prevention strategy. Interestingly, although the 18th amendment and prohibition were repealed in 1932, the legacy of preventing problems associated with psychoactive substance continues to this day as exemplified by a continuation of Nixon’s declaration of war on drugs.

Raising questions regarding the efficacy of public policy to control the availability of drugs is not the issue of this essay. It is better for heroin, cocaine, and all other types of currently illicit substances to remain just that, illicit. That said, the way current “drug policies” are written implies that drugs are bad and that those who use them are criminals. This is essentially what is referred to as the “dry moral model” when explaining substance use dependence…or in old terminology, “addiction.” When people break the law to use drugs, they are, by definition, criminal. If someone using drugs, whether that be anyone’s use of “illegal drug” or a minor’s use of alcohol, that individual becomes the focus of the criminal justice system. In short, “policies” determine how the substance used is viewed as well as how the individual using that substance is viewed…and dealt with.

This is an example of how policy hinders, that is to say, "inhibits" prevention. Policies that restrict prevention efforts to champion zero tolerance messages and programming, relegate such prevention efforts to the status of "feel good busy work" or conducting prevention for the sake of appearance rather than affecting change. When we establish policies, be they on the state or federal level or in the local public school, that identify drugs as “bad,” then by default, anyone who uses such substances is “bad” and is treated as such. As the old adage suggests, If the only tool I have is a hammer, then every issue I face is seen as a nail.

It is important to remember that “prevention” as an activity is designed to reduce the likelihood that harm will occur…to an individual or the society in which that individual lives. Policies that are developed by those who hold this understanding of prevention do guide the development of effective prevention. Take for example what are referred to as “Good Samaritan” or “Medical Amnesty” policies. Established years ago to relieve medical professionals from the threat of civil liability when rendering medical assistance to an injured individual in public, such policies now encourage individuals on a college campus to call for assistance when someone is suffering from the untoward consequences of alcohol or other drug use, and do so without concern for incrimination should he or she be under the influence or using when underage. The objective in such policies is to reduce the likelihood of harm, both physical harm to the individual using, legal harm to the good Samaritan, and social if not financial harm to the community.

Policies that showcase science and echo the basic tenets of most school mission statements and advocate personal, social, and cultural development, genuinely guide both the development of effective prevention as well as contributing to the general body of knowledge regarding how best to prevent high-risk and dangerous behavior on campus. To support the objectives of effective prevention, policies must be fluid and dynamic. They must remain open to change as science expands our knowledge about and understanding of persistent and challenging social problems such as the high-risk drinking of some collegians. Policies are the superstructure on which prevention is built and its principles are practiced. Archaic policies or those steeped in dogma and self-serving ideological principles do not support innovation and neither do they guide the development of effective prevention; they stifle it.