regarding the wisdom of continued emphasis on (and dedication of resources to) primary and universal prevention (focused on prevention of use) at the expense of secondary and selective prevention (focused on prevention of abuse and dependence). As the committee notes throughout this report, more information is needed about the serious problems of drug abuse and dependence.
Experimenting with drugs, particularly alcohol and tobacco products, is woven into the developmental life cycle. Well over half of all youth try these two drugs, which are legal commodities for adults. However, most youth do not regularly use illegal drugs, and most of those who have used them do not make the transition to drug abuse or dependence. Thus, it is unclear whether drug use per se is the most appropriate target of intervention. Moreover, the effects of primary prevention are usually too small to have a significant overall impact on drug abuse and dependence in the society. Given limited resources and shrinking budgets at the federal and state levels, it may be more important to focus on abuse and dependence.
Those who argue for the importance of primary and universal prevention efforts note that all young people are at risk for experimenting with alcohol, tobacco, and illicit drugs. They believe it would be irresponsible not to provide them with preventive interventions, since there can be negative consequences associated with even infrequent use (e.g., alcohol-impaired driving). Further, the etiology of drug use is complex, and targeting prevention to a "select" sample of youth would yield far too many "false positives." Such an approach could lead to inappropriate labeling and the possibility of missing some adolescents who need preventive interventions. Finally, a universal orientation is thought to be more cost-effective and logistically feasible given the structure of school systems (i.e., it is less expensive to provide everyone with the intervention than to selectively recruit those most at risk).
Despite the debate about the relative value of universal and selective interventions, they do not have to be viewed as mutually exclusive. In fact, it is more fruitful to view them as mutually supportive rather than competing alternatives. For example, universal interventions can promote antidrug norms in the larger society, and selective interventions can then build on universal preventive messages. Moreover, preventive intervention messages designed specifically for high-risk youth can be delivered within the context of universal prevention programs, avoiding the risk of harmful labeling. Both universal and targeted interventions have promise for prevention science but require more careful examination.