What Doesn’t Work in Primary Prevention?

Navigating through primary prevention programs, practices and frameworks can be overwhelming. There are so many choices.  Some programs address mental health, and contributing factors/determinants that lead to drug misuse. However they don’t necessarily have evidence of effectiveness to positively change substance use behaviors. Without that data, we cannot be sure that the outcomes we anticipate (preventing substance use) will be affected by the effort. A strategy that has proven to move the needle on a behavior through evaluation is the strongest way to ensure a positive result. Not all programs designed to address substance misuse are supported by evidence. Some have been found to be ineffective. Some programs and strategies have been proven to have harmful effects.

Human resources, time and funding is precious. That is why it is important that we use proven methods to build powerful opportunities for change. Before starting to determine the best strategy, assess the needs of the community. We must not overlook assessment evidence. Going with what we think is best and/or what is popular may be ineffective. For example,

• The assessment should identify the target population, providing clarity on who the focus should be. Strategies that do not have direct influence on the chosen population are not effective. Such as involving caregivers without their youth. Programs that are developmentally inappropriate for the focus population will not be successful in earning the appropriate results.
• Effective methods of strategy delivery are interactive and conversational. Moralistic approaches and strategies that fail to align with the cultural context of the audience are unlikely to effectively reach or engage the intended group. Placing individuals into uniform groups can contribute to stigma and diminish the overall effectiveness of an intervention. For instance, at-risk youth together without integrating the cultural balance of typical social interactions has been found to be less effective in prevention efforts. Prioritizing only high-risk or previously identified individuals can overlook those who might benefit from prevention but fall outside rigid inclusion criteria.

Types of Ineffective Strategies:

• Substance use experience simulations have been found to be ineffective, with research suggesting they may even have unintended negative effects. These simulations, such as Fatal Vision Goggles (“drunk” goggles) and crash reenactments (mock car crashes), are often popular community events but fail to impact the focus population in a meaningful way.
• Research has demonstrated that single-session assemblies or events, such as those featuring personal recovery stories or motivational speakers, are ineffective in achieving their intended impact.
• Distributing literature (fact sheets, brochures) to educate presents challenges, as the materials can be overly detailed or filled with jargon, which may be overwhelming. Prevention strategies that rely solely on printed materials, computer-based methods, or educational programs that focus only on increasing knowledge or awareness have not been shown to effectively reduce substance misuse.
• Advertising and public service announcements, on their own, have been shown to be ineffective in preventing substance use. A review of antidrug campaigns like “Just Say No” and “This is Your Brain on Drugs” found that most had no impact—or even increased the likelihood of substance use among students. In contrast, campaigns based on Positive Community Norms and grounded in Social Marketing principles have demonstrated effectiveness.
• Although myth-busting is intended to correct misinformation, it can inadvertently make myths more memorable than the facts. The “myths vs. facts” approach often reinforces false information by repeatedly exposing people to myths, making it harder to distinguish truth from fiction.
• Using scare tactics—such as shocking images or alarming statements—to provoke fear and drive behavior change has been shown to be ineffective. Fear-based messaging often fails to produce lasting impact and may even lead to unintended consequences.
• Exaggerating substance use norms can create misleading perceptions, leading individuals to believe that substance use is more widespread among their peers than it actually is. For example, presenting a statistic like “youth vaping increased by 50%”—even if the actual change was from 3% to 4.5%—can give the impression that vaping is common. Since perceptions of social norms influence behavior, these exaggerated messages can unintentionally encourage increased substance use.
• Using language that normalizes substance use—such as referring to it as “recreational”—can downplay potential risks and influence social norms. Terms that soften the harmful nature of substances may create the impression that there are minimal negative effects or little risk of losing control.
• Strict disciplinary measures are frequently used to discourage substance misuse or restrict use in specific settings. However, despite their popularity, these strategies have proven ineffective in preventing substance use among youth who have already started using.

For more information on this topic, click the link: https://pttcnetwork.org/what-does-not-work-in-prevention/