ADC 605 Module 3 Universal, Selective and Indicated Prevention Example

Everyone, Some or a Few: Universal, Selective and Indicated Prevention for One County

Student Name

Psychology and Addiction Studies Program, Aspen University

ADC 605: Substance Abuse Prevention

Instructor Name

Month Day, Year

Everyone, Some or a Few: Universal, Selective and Indicated Prevention for One County

Tomas, the coalition staff member in an eastern Wisconsin county introduced in earlier papers, has been told the coalition will receive a modest state grant for the coming two years. Members disagree about how to use it: some want a program for every middle school student, some want to focus on students already in trouble and some want to reach young adults at the local technical college, where heavy drinking is common. The three levels of prevention offer a way to frame that argument; the county and its coalition, as before, are fictional.

Three Levels

Prevention is commonly classified by whom it targets. Universal prevention addresses an entire population, such as all students in a grade, without regard to individual risk. Selective prevention targets groups whose risk is higher than average, such as children of parents with addictions or students with particular personality traits, before problems appear. Indicated prevention targets individuals already showing early signs of a problem, such as heavy drinking, who do not yet meet criteria for a disorder.

Universal: School Programs

Faggiano et al. (2014) reviewed randomized trials of universal school-based programs to prevent illicit drug use in a Cochrane review. Programs that combined social competence, teaching general personal and social skills, with social influence, teaching students to recognize and resist pressures and correcting beliefs that drug use is common, produced small reductions in drug use. Programs relying on knowledge alone did not. The quality of the evidence was moderate to low in many comparisons, and effects were modest. But because universal programs reach every student, even small effects can prevent a meaningful number of cases across a county.

Selective: Targeting Personality Risk

Conrod et al. (2013) tested a selective program in secondary schools in London. Students completed a brief questionnaire on four personality traits linked to substance misuse: anxiety sensitivity, hopelessness, impulsivity and sensation seeking. Those scoring high on any trait were invited to two ninety-minute group workshops, led by trained teachers, that helped them understand their trait and manage it without alcohol. Over two years, high-risk students in intervention schools reported less drinking, less binge drinking and fewer drinking problems than those in control schools. Unexpectedly, low-risk students in intervention schools were also slower to begin drinking, suggesting a spillover effect through peers.

Indicated: Brief Interventions for Heavy Drinkers

Carey et al. (2007) conducted a meta-analysis of individual-level interventions to reduce drinking among college students. Interventions, often brief and including motivational interviewing or personalized feedback comparing a student's drinking with actual campus norms, cut how much and how often students drank, how drunk they got at their heaviest and how many problems drinking caused them, relative to students in comparison groups. Effects were largest soon after the intervention and diminished over time, though some persisted. Interventions that included personalized feedback tended to be more effective.

The Prevention Paradox

Universal programs illustrate what epidemiologists call the prevention paradox: a measure that brings small benefits to many low-risk people can prevent more cases across a population than a measure that brings large benefits to a few high-risk people, because most cases arise among the many at moderate risk. This argues for universal programs even though their effect on any individual student is small. Targeted programs, by contrast, are more efficient for the people they reach. A layered approach captures both advantages.

Screening Without Stigma

Selective programs require identifying who is at higher risk, which raises the danger of labeling. In Conrod and colleagues' trial, all students completed a brief questionnaire, and those invited to workshops were told only that they had been selected for a skills group, not that they scored high on a risk trait. Workshops focused on understanding one's personality and coping, framed positively. Parents must still consent to screening and participation, so the coalition would need to explain the approach to families clearly and respectfully.

Trade-Offs

Universal programs avoid labeling anyone and can shift school norms but have small effects per student and require classroom time for every student. Selective programs concentrate resources on those at higher risk and produce larger effects for them, but screening must be handled carefully; in Conrod and colleagues' trial, students were not told why they had been invited, which reduced stigma. Indicated programs reach those already at risk of harm but depend on identifying them and on their willingness to take part, and effects may need booster sessions to last.

Reaching Young People Outside School

None of the three levels reaches every young person through schools alone. Students who are frequently absent, have dropped out or attend alternative programs may be at the highest risk and the least likely to receive a school-based program. The coalition noted that the technical college program partly addresses older youth, and that partnerships with the county's alternative high school and youth employment program would be needed to reach others.

The Recommendation

Tomas recommended funding all three levels, weighted toward the selective program. The middle schools already deliver a health curriculum, so the coalition would support teachers in adding a tested universal program within existing class time at low cost. Most new funds would go to training teachers to deliver personality-targeted workshops, given the trial's strong effects and its spillover to other students. A smaller share would support the technical college's counseling center in offering brief motivational interventions with personalized feedback to students who report heavy drinking on a campus health survey, with a booster session at three months.

Conclusion

Universal, selective and indicated prevention reach different young people in different ways. Faggiano and colleagues show modest benefits from universal school programs combining social skills and social influence approaches, Conrod and colleagues show strong selective effects with spillover and Carey and colleagues show indicated brief interventions reducing college drinking. A layered approach weighted toward the selective program makes the most of the county's limited funds.

References

Carey, K. B., Scott-Sheldon, L. A. J., Carey, M. P., & DeMartini, K. S. (2007). Individual-level interventions to reduce college student drinking: A meta-analytic review. Addictive Behaviors, 32(11), 2469-2494. https://doi.org/10.1016/j.addbeh.2007.05.004

Conrod, P. J., O'Leary-Barrett, M., Newton, N., Topper, L., Castellanos-Ryan, N., Mackie, C., & Girard, A. (2013). Effectiveness of a selective, personality-targeted prevention program for adolescent alcohol use and misuse: A cluster randomized controlled trial. JAMA Psychiatry, 70(3), 334-342. https://doi.org/10.1001/jamapsychiatry.2013.651

Faggiano, F., Minozzi, S., Versino, E., & Buscemi, D. (2014). Universal school-based prevention for illicit drug use. Cochrane Database of Systematic Reviews, (12), Article CD003020. https://doi.org/10.1002/14651858.CD003020.pub3