Teen substance use can harm brain development and increase the risk of addiction later in life.1 Nationally, over 14% of U.S. teens use alcohol or drugs.2 In Washington State, the 2016 Healthy Youth Survey found that 20% of 10th grade students drink alcohol and 17% use marijuana—and these students report lower grades in school than students who don’t use those substances.3
To reduce underage use of alcohol and drugs, the Washington State Division of Behavioral Health and Recovery (DBHR) launched the Community Prevention and Wellness Initiative (CPWI) in 2011. Sarah Mariani, DBHR’s behavioral health administrator, says preventing teen substance use has a positive impact across the lifespan. “We know that delaying onset of substance use reduces the risk of addiction,” she says.
In fact, young people who start drinking before age 15 are 6 times more likely to abuse alcohol as adults than those who start drinking after age 21.4 “While it can be hard to measure in the short term,” Mariani says, “we are saving lives 15 or 20 years down the line.”
Building Coalitions with Local Leadership
When CPWI begins working in a community, the first step is to establish a coalition of local stakeholders. To ensure a diversity of viewpoints, coalitions must include members from 8 different sectors, including health care and law enforcement. Mariani stresses that these partners are vital to the initiative’s success. “They know how to implement programs in a way that works for their community,” she says.
A CPWI coordinator then works with the coalition to create a strategic plan for the school district. All CPWI school districts have a full-time prevention and intervention specialist who teaches life skills and substance abuse prevention courses, but the initiative also goes beyond the classroom. Other key strategies include:
- Programs for parents to improve parent-child communication
- Policy initiatives to strengthen substance abuse policies in schools and ensure equitable and effective enforcement
- Public awareness campaigns, including toolkits communities can adapt based on local priorities
Thanks to this multifaceted approach, teens see the lessons they learn in school-based programs reinforced at home and in the wider community. “You need to reach a saturation level,” Mariani explains. “That way, no matter where kids go in the community, they’re seeing that healthy messaging.”
Prioritizing High-Need Communities
Each year, CPWI updates a risk profile for each school district in the state. The risk score is based on rates of youth substance use and related indicators like graduation and drop-out rates. “We rely on this data-driven process to find and prioritize the school districts with the highest risk,” Mariani says.
Many high-need communities are located in remote, rural areas. Mallory Peak, DBHR’s communications manager, says reaching these sites can be challenging. “While there are lots of services in the Seattle area, rural areas in eastern Washington and the San Juan Islands can be difficult to get to. But many of these communities have higher rates of substance abuse.”
To ensure that resources go where they’re needed most, CPWI takes a “no school district is too small” approach and works to build capacity in high-need sites. “We can’t leave these smaller communities constantly in the dark with no resources,” Mariani says. “We go in and create the training system and technical support system to build their capacity and make them successful.”
Success by the numbers
Since 2011, CPWI has built substance use prevention coalitions in 64 high-need communities in Washington.
Between 2008 and 2014, the first cohort of CPWI communities showed improvement in 2 key substance use outcomes for 10th grade students:5
- Alcohol use in past 30 days decreased by 34.2% (compared to 29.4% in other similar communities).
- Binge drinking in past 2 weeks decreased by 34.5% (compared to 32.8% in other similar communities).
Additionally, the CPWI communities saw more improvement in certain substance use risk factors (compared to other similar communities), including:
- More opportunities for prosocial involvement
- Fewer norms favorable to drug use
- Less perceived availability of drugs
Connecting Through Cultural Competence
CPWI aims to increase health equity by meeting the prevention needs of diverse cultural groups in each community. Coalitions address language barriers by offering parallel programming in multiple languages or using translation devices in mixed-language groups.
But Mariani stresses that cultural competence involves much more than language. “We need someone who’s part of the culture to do that implied translation of cultural elements that go along with the words,” she says. For example, a coalition may recruit a Somali parent to reach out to other parents in the local Somali community. This way, she says, “the prevention programming makes sense within the context of the culture.”
While the initiative’s primary focus is substance abuse prevention, Mariani sees an opportunity to expand their efforts in mental health promotion and suicide prevention. “It’s about reducing underage substance use, but also about having a healthy community,” she says. “And there's a lot of different components to that.” For example, she hopes to better integrate CPWI’s programs with primary care and mental health services in the future.
Peak explains that many of CPWI’s school-based programs emphasize both substance use prevention and mental health promotion. “We’re helping youth make empowered decisions not only about substance use, but also about their overall health,” she says.
For now, the initiative will keep expanding to more of Washington’s high-need communities. “Every time we get additional funding, we go to the site with the next highest risk score,” Mariani says. “If we can prevent or delay those kids from using, that’s a huge positive impact in their lives. This is why we do the work.”
5 Washington State University, Community Prevention and Wellness Initiative: Outcome Evaluation Report, 2016
Related Healthy People 2030 objectives:
- Reduce the proportion of adolescents who drank alcohol in the past month — SU‑04
- Reduce the proportion of adolescents who used drugs in the past month — SU‑05
- Reduce the proportion of adolescents who used marijuana in the past month — SU‑06
- Reduce the proportion of people under 21 years who engaged in binge drinking in the past month — SU‑09