1. Definitions of Use • Substance use: ingestion of ATOD without the experience of any negative consequences • Substance misuse: ingestion of an illegal substance or the ingestion of ATOD with negative consequences • Substance abuse: continued use of ATOD despite negative consequences • Addiction/Dependence: compulsive use of ATOD regardless of the consequences

2. Progression of Substance Use • Use of ATOD typically progresses from no use through trial and experimental use, regular use, then misuse, and for some people abuse and dependence • Gateway model: people typically experiment with alcohol and/or tobacco first, progress to alcohol intoxication, move to marijuana use, and only advance to other substances after first gaining experience with tobacco, alcohol, and marijuana

3. Prevention Programs: Empirical Support • Promising approaches: level of certainty from available evidence is too low to support generalized conclusions, but there is some empirical basis for predicting that future research could support such conclusions • Best practices: have been show through research and evaluation to be effective in the prevention and/or delay of ATOD use/abuse • Model programs: prevention programs that have been rigorously evaluated and have repeatedly demonstrated positive outcomes

5. Prevention Programs: General Categories • Universal prevention: relatively non-intrusive, delivered by people who are not necessarily expert in prevention, aimed at the general public or subpopulations who have not be identified at-risk • Selective prevention: more intensive tailored programs for smaller at-risk subpopulations • Indicated prevention: most intensive programs delivered by experts to individuals who have a strong pattern of risk factors or early symptoms of a clinical disorder

7. History of Substance Use Prevention • Early 70s: knowledge-based training—universal, educative, present information about harmful consequence, non-theoretical, unsuccessful • Mid 70s: values-based training—universal, change values and teach decision making and evaluation of consequences, limited theory, limited success because of singular focus • 80s: resistance skills training—”just say no” to socials pressures, tended to be universal, more success yet effects were small, fragile and short-term

8. History of Substance Use Prevention (cont’d) • 90s: comprehensive approaches—focused simultaneously on several major determinants of SU, tried to do more than just curb SU, used multiple delivery agents, longer duration • 90s: intensive selective interventions—rely on theory to screen for high-risk individuals, only provided to those with strong pattern of risk • 90s into 21st century: comprehensive multilevelapproaches—involve a combination of universal, selective, and indicated prevention activities, target multiple levels of influence, and address multiple problems in a single integrated program