Prevention is a vitally important investment in a community and its people. Substance misuse costs the United States more than $740 billion annually in costs related to crime, lost work productivity, and health care, according to the National Institute on Drug Abuse. While the Substance Abuse and Mental Health Services Administration that investments in prevention can bring as high a return on investment as $18 per $1 spent, precious few resources are available for these kinds of life-saving prevention services.
With so few resources and such a large problem, it’s of vital importance that prevention programs and practices remain effective. To maximize the beneficial effects of these limited resources, it’s best to use prevention programs and strategies that research has proven are effective at changing behaviors and improving public health. These programs and strategies are called “evidence-based practices,” and using them makes the most of any investment in prevention and does the most good for those we serve.
Evidence-based practices include “programs, policies, or other strategies that have been evaluated and demonstrated to be effective in preventing health problems based upon the best-available research evidence, rather than upon personal belief or anecdotal evidence,” according to the Health Policy Institute of Ohio.
For those who want to get involved in preventing substance misuse and improving mental health, using evidence-based prevention programs is better than relying on guesswork, anecdotes, politics, or whatever program is new or popular. It ensures that resources are allocated well to solving a community problem.
In fact, according to NIDA, the costs of substance alcohol, tobacco, and other drug misuse costs $821 billion per year in crime, lost work productivity, and healthcare. By contrast, SAMHSA estimates that the U.S. could save up $18 per every $1 invested in effective, school-based prevention programs. Savings like these are hugely beneficial to the economies of local communities and our nation.
Using evidence-based programs also ensures that prevention programs and policies do no harm. Prevention services, like other healthcare services, can cause harm if they’re done improperly. Just as medical malpractice can worsen patient outcomes, negligent or poor prevention services can increase the risks of drug misuse or abuse.
Principles of Evidence-Based Prevention
Evidence-based practices aren’t limited to prevention. They’re used across the continuum of health services. Accordingly, whether a practice is evidence-based varies by discipline and agency. In prevention, it’s particularly important to pay attention not only to the track record of a program or strategy but also the norms of the communities in which that program was delivered and how those norms compare to those of your community.
In 2011, researchers working for the Centers for Disease Control and Prevention created a continuum of understanding evidence. In that continuum, they classified evidence under three categories
- Best available research evidence—The latest and best research on a program or strategy’s effectiveness
- Experiential evidence—A working professional’s insight, understanding, skill, and expertise accumulated over time. Certified prevention professionals have to prove that they have a deep understanding of the science underpinning effective prevention
- Contextual evidence—Is this strategy useful, feasible, and accepted by a particular community? Not all communities react equally to the same prevention program
By combining the best available research evidence with experiential evidence and contextual evidence, we can make an informed, evidence-based decision about prevention programs and strategies.
In addition to considering the types of evidence, it’s important to likewise consider the strength of that evidence and what that evidence says about the effectiveness of the program.
Whether a program is effective or not can help determine if it’s appropriate for a community based on the resources available. On the other hand, if evidence suggests that a program is harmful, it would be unethical to provide that prevention service. Effectiveness in the continuum ranges from harmful, unsupported (no effect), undetermined, emerging, promising direction, supported, and well supported.
Evidence-based prevention services are the best practice solutions any community can implement. They are recommended for their effectiveness. Emerging prevention services are typically innovative programs based on expert opinions but remain untested. Proper research and testing can help them become promising, effective, or evidence-based.
The strength of evidence measures how reliable the conclusions about effectiveness can be. It weighs the tools used to measure the effectiveness of a program or practice, how strong that evidence is, and whether evidence exists that outside factors played a part in the program’s outcomes.
With so many factors to weigh, it can be difficult to determine what the evidence says about a prevention initiative. Fortunately, there are several databases that can help find evidence-based programs, practices, and policies.
How to Use Evidence-Based Practices in Prevention
As you might guess from the emphasis on contextual evidence, how well a program fits the community is a vital consideration. Programs that are evidence-based notate who received the service—was the program delivered in a suburban, urban, or rural community? What preexisting attitudes were there toward substance misuse? What are the demographics of that community? Prevention providers have to know the cultural beliefs, societal norms, and local attitudes towards substance misuse and mental health if they’re going to find a program that is evidence-based with respect to the local community.
Fidelity, meanwhile, refers to delivering that prevention program or practice as it was intended to be delivered. In order for a program to be delivered with high fidelity, it must be delivered in the same way—or as close as possible—to how it was delivered when it was evaluated. Doing otherwise means you may not get the same, effective results.
How to Find an Evidence-Based Program
There are multiple databases and registries that list prevention programs and whether they’re evidence-based, ineffective, or somewhere in between. Terms, however, differ, so be sure to read each registry carefully.
To find an evidence-based program, we recommend:
- Evidence-Based Practices Resource Center, by SAMHSA
- Stop Underage Drinking: Research and Resources, by SAMHSA
- Model and Model Plus Programs, by Blueprints for Healthy Youth Development
- Resources and Programs, by Suicide Prevention Resource Center
- The Community Guide, by the U.S. Department of Health and Human Services
- What Works for Health, by the University of Wisconsin
Not All Prevention Programs Need to Be Evidence-Based
As mentioned, programs that are based on sound principles may not be evidence-based due to a lack of testing. This can often be because there hasn’t been time or resources to test that program yet. As HPIO points out, “rigid requirements to only fund evidence-based interventions may stifle innovation and authentic community engagement.”
While implementing evidence-based prevention principles is ideal, sometimes no evidence-based prevention service fits well with the community context, or it might exist outside your ability to implement it as intended. In such cases, it can be better to implement another solution based on an expert’s sound judgment or to adapt an existing solution to better fit your and your audience’s needs. Doing so can provide you with the flexibility you need to build a solution that works for those you serve. If you conduct an evaluation, you can start to collect evidence on the program or service and its efficacy.
The bottom line is that while it’s good to use evidence-based prevention services whenever feasible, sometimes it just isn’t feasible. In these cases, it’s best to implement an emerging practice or create a new program with an eye to ensuring it’s effective for the audience that receives it.
If you’re concerned about you or someone else, get help at findtreatment.gov.