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Linda Rosenberg

Former President and CEO, National Council for Behavioral Health

An Ounce of Prevention: Celebrating National Prevention Week, May 14-20

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“Treatment without prevention is simply unsustainable.”

— Bill Gates

Though the origin of the phrase “an ounce of prevention is worth a pound of cure” is in doubt, no one who works in behavioral health has reason to question its meaning. As we prepare once again to observe National Prevention Week – May 14–20 – it’s worth pausing to remember why we call attention to the need for substance use prevention and mental health promotion. This year’s Prevention Week theme is “Making Each Day Count.”

“If we’re going to make a difference, we have to start today,” said Sara Howe, M.S., a certified health education specialist and National Council Board member. Sara has been involved in prevention since she was 15-years-old, when she attended an alcohol and drug abuse prevention program called Operation Snowball and a five-day residential youth leadership conference. Both are still sponsored by the Illinois Association for Behavioral Health, the organization she now heads. Sara was instrumental – together with Richard Nance and the National Council’s Addictions Committee – in developing our paper, Substance Use, Misuse and Addiction Prevention.

Alcohol and drug prevention have changed through the years from helping youth have better self-esteem to educating them about the dangers of drugs and alcohol to providing them with healthier alternatives. All of that was well-intentioned, but it wasn’t until the science of risk and protective factors took hold that the prevention field began to make strides.

Today, National Council members are taking the lessons of the past and moving them into a future when every week is prevention week.

First, we must make it clear that prevention is possible.

We must reframe the conversation. We must refute popular misconceptions that behavioral health disorders are character flaws and that people with addictions are “weak willed.”

The science is indisputable. Mental illnesses in adults, behavioral health problems in youth and addictions in people of all ages are preventable, treatable medical conditions from which people can and do recover.

Second, we must move our prevention efforts upstream.

In behavioral health, we too often pair discussion of prevention with terms like “suicide” and “overdose.” This pushes the view of prevention further away from upstream approaches. And upstream is where we need to be.

The facts are in. The earlier in adolescence that someone begins to use substances, the more likely they are to develop a substance use disorder later in their lifetime. Behavioral problems – including substance use, mental health problems, violence and risky sexual activity – are the leading causes of death for young people aged 15 to 24. Last year, more than 50,000 Americans died from drug overdoses and we saw the first decline in American life expectancy in more than 20 years.

Where is the urgency attached to these alarming statistics? We don’t wait for a person to have a heart attack before counseling them about diet and exercise or putting them on cholesterol-lowering medication. It’s less costly and more humane to keep a person healthy than wait for them to become sick.

Third, we must stop doing what doesn’t work and start implementing evidence-based family, school and community-based programs that address risk and protective factors.

There are any number of effective programs that can help markedly reduce substance misuse and problem behaviors, thereby reducing the risks for morbidity and mortality. However, these programs are underused. In fact, many schools and communities are still using prevention programs and strategies that have little or no evidence of effectiveness.

The research is irrefutable. Programs like the Nurse-Family Partnership, the Good Behavior Game and Communities That Care reduce maternal and child substance use, disruptive behaviors, arrests and suicidal ideation. Screening, Brief Intervention and Referral to Treatment (SBIRT) helps primary care physicians, school nurses, emergency room staff and care coordinators identify patients who may already be experiencing problems with substance use and provide brief interventions or refer them for further treatment.

Fourth, we must focus on prevention across the lifespan.

Too often, in behavioral health, we follow the money, and the money is focused on youth. But once we have prevented a young man from drinking before the age of 21, are we there for him at age 30, when he ends up on prescription painkillers after a car accident? What about at age 80, when his spouse dies and he becomes depressed, or worse, suicidal? We can’t sit back and wait for funding to catch up with the realities of peoples’ lives. We must work with our partners in health care and social services, in housing and criminal justice, to help people become resilient and stay healthy throughout their lives.

Finally, and most important, we must make it clear that prevention is cost effective!

If I give you $1 for prevention today, you won’t see a $5 return tomorrow. Prevention is for the long-term, but the data are unequivocal . SAMHSA estimates that prevention services save $14 to $18 for every $1 spent. This means that increasing the value of the Substance Abuse Prevention and Treatment Block Grant’s prevention set-aside by $96 million could save states at least $1.3 billion annually in costs to the treatment, criminal justice, primary care and child welfare systems.

What can you do? Tell Congress to provide adequate funding for prevention. The 20 percent block grant set-aside funds 68 percent of state prevention efforts; yet, in real dollars, the value of this vital resource has declined by 26 percent in the past decade.

Tell your senators and representatives that now is not the time to gut funding for the Office of National Drug Control Policy (ONDCP). President Trump and Health and Human Services Secretary Tom Price have declared their full support for fighting the opioid epidemic, and we must hold them to their word.

Tell your elected officials they must fully fund the Comprehensive Addiction and Recovery Act and the 21st Century Cures Act.

Speaking at a White House summit on the opioid epidemic in 2014, former ONDCP Director Michael Botticelli, himself in recovery from addiction, said, “Every overdose death in America is preventable.” Starting today, let’s focus on prevention and make every day count.