Comprehensive primary prevention programs, practices, and approaches (upstream) are activities and services provided in a variety of settings for both the general population, and targeted sub-groups who are at high risk for substance abuse. Primary prevention is directed at individuals who do not require treatment for substance abuse.

Today, prevention is used to help prevent, delay, and/or reduce disability from chronic disease and illnesses, including substance abuse and mental illnesses, which take a toll on health, education, workplace productivity, community engagement, and overall quality of life.   Research has shown that a broad array of evidence-based strategies can effectively prevent substance abuse, promote mental health, and prevent related health and social problems by reducing risk factors and increasing protective factors.

Universal (Direct/Indirect)   

Universal prevention strategies address an entire population (e.g. national, local community, school, grade, neighborhood, pregnant women, gender groups, elderly, etc.) with programs, policies and practices aimed at preventing or delaying the abuse of alcohol, tobacco and other drugs. The mission of universal prevention is to deter the onset of substance abuse by providing all individuals the information and skills necessary to prevent the problem. All members of the population are seen to share the same general risk for substance abuse, although risk levels may vary greatly between individuals. Universal prevention is delivered to large groups without any prior screening for risk. The entire population is assessed as capable of benefiting from prevention.

  • Universal DirectInterventions directly serve an identifiable group of participants but who have not been identified on the basis of individual risk (e.g., school curriculum, after school program, parenting class). This also could include interventions involving interpersonal and ongoing/repeated contact (e.g., coalitions).
  • Universal IndirectInterventions support population-based programs and environmental strategies (e.g., establishing policies, modifying advertising practices). This also could include interventions involving programs and policies implemented by coalitions.


Selective prevention strategies focus on groups that are considered to be at greater levels of risk for substance abuse by due of their membership in a particular population segment (e.g. children of substance abusers or students who are failing academically). Risk groups may be identified on the basis of biological, psychological, social, or environmental risk factors known to be associated with substance abuse (IOM 1994) and focused sub-groups may be defined by age, gender, family history, place of residence, etc. An individual’s personal risk is not specifically assessed or identified and selection is based solely membership in the higher risk subgroup. The selective prevention strategy is presented to the entire subgroup because the subgroup as a whole is at higher risk for substance abuse than the general population.

  • Selected IndicatedActivities targeted to individuals in high-risk environments, identified as having minimal but detectable signs or symptoms foreshadowing disorder or having biological markers indicating predisposition for disorder but not yet meeting diagnostic levels. (Adapted from The Institute of Medicine Model of Prevention)


Indicated prevention strategies are designed to prevent the onset of substance abuse in individuals who do not meet the DSM-V diagnostic criteria for addiction, but who are showing early danger signs, such as falling grades and consumption of alcohol or other drugs. The mission of indicated prevention is to identify individuals who are exhibiting early signs of substance abuse and other problem behaviors associated with substance abuse and to focus on them with special programs.

Six primary prevention strategies

Information Dissemination – This strategy provides knowledge and increases awareness of the nature and extent of alcohol and other drug use, abuse, and addiction, as well as their effects on individuals, families, and communities.  It also provides knowledge and increases awareness of available prevention and treatment programs and services.  It is characterized by one-way communication from the source to the audience, with limited contact between the two.


  • Clearinghouse/information resources centers
  • Resource directories
  • Media campaigns
  • Brochures
  • Radio and TV public service announcements
  • Speaking engagements
  • Health fairs and other health promotion, e.g., conferences, meetings, seminars
  • Information lines/Hot lines

Education – This strategy builds skills through structured learning processes.  Critical life and social skills include decision making, peer resistance, coping with stress, problem solving, interpersonal communication, and systematic and judgmental abilities.  There is more interaction between facilitators and participants than in the information strategy.


  •   Parenting and family management
  •   Ongoing classroom and/or small group sessions
  •   Peer leader/helper programs
  •   Education programs for youth groups
    •   Education programs for youth groups
    •   Mentors


Alternatives – This strategy provides participation in activities that exclude alcohol and other drugs.  The purpose is to meet the needs filled by alcohol and other drugs with healthy activities, and to discourage the use of alcohol and drugs through these activities.


  •   Drug free dances and parties
  •   Youth/adult leadership activities
  •   Community drop-in centers
  •   Community service activities
  •   Outward Bound
  •   Recreation activities

Problem Identification and Referral – This strategy aims at identification of those who have indulged in illegal/age-inappropriate use of tobacco or alcohol and those individuals who have indulged in the first use of illicit drugs in order to assess if their behavior can be reversed through education.  It should be noted however, that this strategy does not include any activity designed to determine if a person is in need of treatment.


  •   Employee Assistance Programs
  •   Student Assistance Programs
  • Driving while under the influence/driving while intoxicated education programs

Community-based Process – This strategy provides ongoing networking activities and technical assistance to community groups or agencies.  It encompasses neighborhood-based, grassroots empowerment models using action planning and collaborative systems planning.


  • Community and volunteer training, e.g.,  neighborhood action training, impactor training, staff/officials training
  • Systematic planning
  • Multi-agency coordination and collaboration/coalition
  • Community team-building
  • Accessing services and funding

Environmental – This upstream prevention strategy establishes or changes written and unwritten community standards, codes, attitudes and norms thereby influencing alcohol and other drug use by the general population.


  • Promoting the establishment or review of alcohol, tobacco, and drug use policies in schools
  • Guidance and technical assistance on monitoring enforcement governing availability and distribution of alcohol, tobacco, and other drugs
  • Modifying alcohol and tobacco advertising practices
  • Product pricing strategies