Intervening Early to Prevent Substance Use Disorders

A CHILD’S FIRST EIGHT YEARS CRITICAL FOR SUBSTANCE ABUSE PREVENTION

NIH releases summary of research on early childhood risk and protective factors

By Dr. Nora Volkow

The brain is an organ that adapts in both short- and long-term ways to its environment, and prevention science over the past few decades has shown clearly that a person’s early experiences during the first few years of life and even prenatally can have an enormous impact on an individual’s later risk or resilience for drug abuse and related psychiatric conditions. Thus NIDA is proud to announce the latest in our series of evidence-based guides for practitioners and researchers: Principles of Substance Abuse Prevention for Early Childhood

Infancy, toddlerhood, and the first years of school are hardly a time most people associate with drug use. But aspects of family, school, and community environments during this crucial window of human development can set the stage for the social, emotional, behavioral and academic problems that, a decade or more later, may take the form of increased risk-taking and experimentation with substances like alcohol, cigarettes, or illicit drugs. Early environments can even shape the developing brain in ways that make an individual more prone to developing substance use disorders. By the time a child reaches adolescence—the period of increased experimentation and onset of drug use—more effort is needed to shift the brain and behavior in a healthy direction. The new Guide describes the principles derived from research designing, implementing, and testing prevention programs aimed at the first 8 years of life (including prenatally) and the supporting data that have been gathered so far on 17 evidence-based prevention programs.

Intervening in the first years of a person's life can be an effective lever to set kids on a positive course

Central to intervening early is the idea of shifting the balance of risk and protective factors in a way that builds a foundation for optimal social development and resilience. For example, there is now substantial evidence that when parents are able to provide warmth, a supportive and stable home environment, adequate nutrition, and physical and cognitive stimulation during the early years of a child’s life, their child is more likely to develop strong self-regulation abilities. Emotional and behavioral control can then, during the teen years, translate to greater ability to resist risky impulses and unhealthy forms of peer pressure. Interventions that help caregivers provide a healthy, supportive environment show positive outcomes such as delayed initiation of drug use and reduced adolescent drug use. Although the science is too young to have much data beyond adolescent outcomes, positive benefits of early intervention have been shown to extend in a few cases to young adulthood.

Research has also revealed that many early risk factors for substance abuse are also, simultaneously, risk factors for other behavioral and emotional problems. Acting aggressively and disruptively in preschool, for example, relates to increased risk for conduct disorders, substance use, delinquency, and risky sexual behaviors during adolescence. Thus interventions designed to reduce early risk factors show benefits in a wide range of areas—including improved personal and social functioning, better performance in school, and less involvement with the juvenile justice system or mental health services.

Like all investments, prevention costs money, but interventions more than pay for themselves in reduced costs later on. Where benefit-cost data for specific interventions are available, they can range from modestly good investments (a few dollars for every dollar invested) to overwhelmingly good investments ($26 for every dollar, in the case of one classroom-centered intervention component, the “Good Behavior Game”). Thus a well-designed, well-implemented early childhood intervention can dramatically benefit the community and society as well as improve children’s and families’ quality of life.  

This new Guide reflects important new thinking about the roots of substance use and the ways to more effectively avert it. Intervening in the first years of a person’s life can be an effective lever to set kids on a positive course and hopefully reduce the terrible toll associated with drug use and addiction.

An online guide about interventions in early childhood that can help prevent drug use and other unhealthy behaviors was launched today by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health. The guide offers research-based principles that affect a child’s self-control and overall mental health, starting during pregnancy through the eighth year of life. It recognizes that while substance use generally begins during the teen years, it has known biological, psychological, social, and environmental roots that begin even before birth.

 “Thanks to more than three decades of research into what makes a young child able to cope with life’s inevitable stresses, we now have unique opportunities to intervene very early in life to prevent substance use disorders,” said NIDA Director Nora D. Volkow, M.D. “We now know that early intervention can set the stage for more positive self-regulation as children prepare for their school years.”

Principles of Substance Abuse Prevention for Early Childhood addresses the major influences on a child’s early development such as lack of school readiness skills, insecure attachment issues, and signs of uncontrolled aggression in childhood behaviors. Special attention is given to a child’s most vulnerable periods during sensitive transitions, such as a parents’ divorce, moving to a new home, or starting school. There is strong evidence that a stable home environment, adequate nutrition, physical and cognitive stimulation, and supportive parenting can lead to good developmental outcomes.

Two supplemental sections for policymakers and practitioners go into greater detail on how early childhood interventions are designed and how to select the right strategies for a community’s specific needs. “This guide is important reading for anyone who has an influence over a child’s life, from early development through the transition to elementary school,” added Volkow.

Principles of Substance Abuse Prevention for Early Childhood is the fourth in a series of evidence-based principles produced by NIDA, including: Principles of Drug Addiction Treatment; Principles of Adolescent Substance Use Disorder Treatment and Principles of Drug Abuse Treatment for Criminal Justice Populations. The guide concludes with a list of selected resources with information on research-based early childhood drug use prevention programs.