More effort needs to be on drug prevention, not cure

The Substance Abuse and Mental Health Services Administration (SAMHSA) announced that it is ending the National Registry of Evidence-Based Programs and Practices (NREPP) and replacing it with an as-yet undefined effort to be administered by SAMHSA’s newly created Policy Lab.

We hope that this development will advance our nation’s efforts to prevent and treat substance abuse and mental illness. As behavioral scientists who have been working on these efforts for the past forty years, we highlight below some critical steps that are needed for this change to truly improve Americans’ health.

{mosads}In her recent statement, Assistant Secretary for Mental Health and Substance Use, Dr. McCance- Katz, focuses on deficiencies in the evidence base of some interventions in the NREPP system and the lack of treatments for those with serious mental illness and addiction.

We agree with others who have expressed concerns about the standards of evidence used to select programs for the NREPP registry. As scientists entrenched in this research, we have endorsed higher standards for dissemination of evidence based programs including the Society for Prevention Research Standards of Evidence and the Blueprints for Healthy Youth Development Standards, also adopted by the 2016 surgeon general’s report, Facing Addiction in America: Alcohol, Drugs and Health.

We understand that the 21st Century Cures Act requires SAMHSA to address treatment of those with serious mental illness. On the other hand, we hope that this will not mean a de-emphasis of the importance of tested, effective universal, selective, and indicated prevention programs.

Health-care expenditures are overwhelmingly directed to treating disorders that could have been prevented; far more investments in prevention are needed.

Many preventive interventions and policies, when rigorously tested in controlled trials using the above standards, have proven benefit in preventing substance abuse and mental illness.

These interventions continue to have benefits years after they are implemented. Most cost less than they save in reduced health care, educational, and criminal justice costs. While treatment will always be needed, prevention significantly reduces the likelihood of developing these serious problems.

As the 2009 Institute of Medicine Report on the Prevention of Mental, Emotional, and Behavioral Disorders Among Young People and the Surgeon General’s report cited above show, prevention programs have been demonstrated effective at preventing mental illness and substance abuse.

For example, cognitive-behavioral therapy has shown efficacy in reducing the incidence and severity of a schizophrenia diagnosis and the need for antipsychotic medication, compared to a minimally treated control group. Benefits were maintained for at least three years.

Also a simple, scalable program to increase positive classroom management by teachers among primary grade children has documented benefits in preventing suicide and opiate misuse in adolescence and young adulthood.

Two additional prevention programs — a parenting program and a middle school-based program — have demonstrated independent and important complementary effects on opioid misuse during adolescence and into adulthood by randomized controlled trials.

Finally, communities that are assisted in the selection and implementation of effective preventive interventions demonstrate significant reductions in substance use and delinquent behavior in middle school children with preventive effects lasting into young adulthood.

These examples represent but a few of the prevention strategies proven to divert the progression to serious mental illnesses and addictions.

Efforts to effectively prevent and treat mental, emotional, behavioral, and physical disorders depends on our ability to make use of the enormous amount of behavioral science knowledge generated in the past forty years. SAMHSA’s noteworthy achievements extend from their systematic application of this knowledge base, a practice that needs to continue for the nation’s benefit.

Leslie Leve Ph.D. is the president of the Society for Prevention Research (SPR) and professor in the College of Education at the University of Oregon. Diana H. Fishbein Ph.D. is the president of the The National Prevention Science Coalition to Improve Lives (NPSC) and professor in the Department of Human Development and Family Studies at The Pennsylvania State University.