Effectiveness of Prevention Interventions with Youth at High Risk of Drug Abuse

A recent report describes three types of prevention programs: universal, selected, and indicated (Institute of Medicine 1994). Universal prevention approaches are those that serve the entire population who share a general risk to the disorder without regard to specific risk status. Selected prevention approaches serve those whose precursors of problem behaviors are elevated but who have not yet manifested the problem behavior to be prevented. Indicated prevention approaches serve those who have initiated the problem behavior to be prevented but have not yet developed a serious or chronic behavior problem and do not warrant at that time a clinical diagnosis of the disorder according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R or DSM-IV). The effects of universally applied prevention approaches for substance abuse and other problems are well documented in the literature (Hansen et al. 1990; Hawkins et al. 1992; Moskowitz 1989). Less attention has been given to the effects of prevention approaches with selected youth whose specific characteristics put them at higher risk. This chapter first examines several definitions of high-risk youth and chooses one based on youths’ exposure to consistently identified, longitudinal correlates or risk factors for substance abuse. This discussion is followed by a selective review of prevention program research studies chosen for their demonstrated effectiveness of program promise for reducing risk among high-risk populations