NCJ Number
198594
Journal
Substance Use & Misuse Volume: 37 Issue: 8-10 Dated: June - August 2002 Pages: 901-921
Editor(s)
Stanley Einstein Ph.D.
Date Published
June 2002
Length
21 pages
Annotation
This paper presents alternative models for reducing alcohol-involved problems at the local level and a review of research evidence about the effectiveness of these approaches.
Abstract
The community is the “new frontier” for alcohol and drug problem prevention. Previously, the national and State levels were the primary location of efforts to reduce alcohol and other drug problems. However, new prevention initiatives at the community level suggest that effective strategies will often be quite different from national or State policies, and they will require a different perspective. This paper presents a systems perspective on the community, a perspective that requires changes in community structure for effective long-term prevention. In addition, this paper reviews the new science of complexity, differentiates between catchment and a systems approach to prevention, describes a public health model within a systems approach, reviews local policy as a means to produce system changes, and reviews recent findings from one community-based prevention effort that employed a systems approach. Previous health problem prevention has employed approaches that focus on individuals at risk, and are based on a “catchment area” perspective in which a community is viewed as a collection of target groups with adverse behaviors or associated risks. In this approach, prevention is intended to reduce or eliminate these behaviors by finding these individuals, then education or serving them in an appropriate manner to reduce the identified individual risk. In a community systems approach to health problem prevention, a community is viewed as a set of persons engaged in shared social, cultural, political, and economic processes. In this perspective, prevention is intended to modify the system in an appropriate manner to reduce health problems identified in the community. Alcohol and other drug-involved problems are outcomes of processes driven and sustained by the community at large. Because these problems are produced by the system and not simply attributable to a few individuals, prevention strategies focused on the community will be more effective than those focused on specific individuals at risk. To date there have been few community efforts to alter community-system environments and contexts which give rise to these problems. Thus, it has been business as usual for communities in terms of alcohol and other drug use and associated problems. The authors believe that different approaches and perspectives are needed in the future and provide the following recommendations to increase the effectiveness of community prevention efforts: 1) consider alcohol and other drug problems as outputs of the community system; 2) use the best scientific evidence in designing and implementing community strategies; 3) mixed, complementary system strategies are more likely to be effective than single, even intensive strategies; and 4) existing governmental capabilities should be favored over specially-funded initiatives. References