This chapter summarizes the current state of the art with respect to school-based drug misuse prevention. The chapter begins by presenting an historical overview of prevention, including summarizing drug use trends based on national surveillance data. The chapter then includes a brief overview outlining the principles of social learning and self-efficacy theories of human motivation, both of which have played a central role in guiding the development of many current prevention models. Several real-world barriers to program implementation are also discussed. In particular, the chapter discusses procedures for ensuring that programs are culturally sound, including discussion of whether deep versus surface structure changes are required to effectively deliver prevention to ethnic or racial subgroups. The various steps required to achieve cultural sensitivity are illustrated using the keepin’ it REAL prevention program. The chapter then explores manipulation checks showcasing how program evaluations use mediation analyses to empirically confirm the active ingredients of drug prevention. The chapter also discusses the need for longitudinal follow-up to establish durable program effects and provides several evidence-based examples drawn from smoking and other drug prevention studies. The chapter closes by summarizing concerns with implementation, the role of teachers in program delivery, and capacity building, all of which influence program outcomes.

Whether unintentional or by design, built, social, and perceived environments influence the human experience. Behavior is not solely the product of a rational motivated actor, operating independently from his or her environment; rather, it is also a function of edifices, neighborhoods, and public spaces, as well as the inhabitants, community norms, and the social capital they generate. Likewise, addictive behaviors have as much to do with the environmental contexts surrounding individuals as with their unique biological factors, specific brain mechanisms, and psychogenic causes. Any attempt to address addiction at either individual or population levels would benefit from careful consideration of the social and contextual influences on cognitions, opportunities, motivations, and behaviors. Interventions informed by this understanding are more likely to be efficacious than those solely targeted toward individual biology, motivations, or attitudes. In this chapter, we discuss the relationship between physical and social environments (PSE), health, and the behavior of humans. We then focus on the influential role of the PSE on the consumption of alcohol, tobacco, and other substances; food, eating behaviors, and addictions contributing to the current obesity epidemic; and a selection of other behavioral addictions. The chapter closes by discussing methodological considerations and implications for professional practice.

Efforts to combat the problem of drug abuse have involved a combination of strategies including education, treatment, law enforcement, and mass media campaigns. Among these, approaches intended to prevent the onset and developmental progression of drug use among adolescents have received considerable attention in recent years. A particularly fruitful area of research has involved the development and testing of school-based prevention approaches targeting youth during the early adolescent years. This research has demonstrated that at least some approaches to drug abuse prevention can produce substantial reductions in the incidence and prevalence of adolescent drug use. Moreover, this research clearly indicates that ongoing intervention during junior high school can result in durable prevention effects that last at least until the end of high school. Finally, the effectiveness of school-based prevention approaches has been demonstrated for a relatively broad range of students including White, suburban youth, and inner-city minority youth.

A necessary precondition for the development of effective prevention approaches is an understanding of both the causes of drug use and its developmental progression. Together they provide essential information concerning the nature and timing of preventive interventions. Research delineating the etiologic determinants of adolescent drug use has highlighted the importance of an array of interpersonal and intrapersonal factors for promoting and sustaining drug use and has provided guidance to program developers concerning the appropriate focus of preventive interventions.