Preventing drug and alcohol problems is one of the most important public health issues facing the world today.

Nobody disagrees with that. But few agree on how, exactly, we go about doing it.

Why? For a lot of reasons, starting with the slipperiness of the whole concept of prevention.

The slipperiness flows from the fact that "prevention" exists in relation to other behaviors
not existing. Prevention activities are considered effective only in the absence of behaviors that, we're told or that we infer, would otherwise have occurred.

That's why proving that prevention works--or making a case for a particular approach to prevention--is tough. In a world as restless as ours, isolating the variables that produce behavior change is next to impossible.

We've locked in a couple in our work that are reasonably foolproof (and unfortunately, still all-too rare) but we'll get to them in a minute.

That's problem Number One. Problem Number Two stems from the way we define terms. And not surprisingly, one of the trickiest terms of all is "prevention" itself.

That's because over the years, "prevention" has come to include dozens of approaches to discouraging substance abuse
--from peer counseling in schools and "just say no" media campaigns to programs promoting sterile needle use and safer sex among IV drug users.

In the process, the notion of what prevention is
--and what it's intended to prevent--has gotten pretty muddy.

That's the purpose of this brief statement: to separate the dirt from the water and clear away some of the confusion.

We'll start by examining what prevention is and isn't, discuss what types work best in which settings, and conclude by describing how Do It Now fits into the unruly universe of prevention programs and philosophies.

Essentially, all substance abuse prevention programs and activities are aimed at a similar goal: to reduce the likelihood of chemical dependency problems.

But "prevention" isn't a program or a curriculum and doesn't necessarily imply a particular set of beliefs about the nature of chemical use and dependency.

Instead, it's an interdisciplinary process aimed at empowering people
--young, old, and middle-aged; black, white, yellow, red, and brown; gay, straight, and none-of-the-above--with the information, skills, and resources each needs to lead productive, satisfying lives.

At its most obvious, direct level, drug and alcohol prevention provides people with tools (information, life-skills training, or linkage with resources) that enable them to avoid chemical-related risks in their lives altogether.

Then there are other, less-obvious levels.

The public health field
has long recognized three different levels of prevention, each directed at a different segment of the population:

  Primary prevention is directed towards the general public and non-affected groups. Primary substance-abuse prevention is often geared toward promoting greater self-awareness and informed decision-making. Target groups include children and adolescents, or those in high-risk groups (e.g. children of alcoholics).
    Secondary prevention typically focuses on "risk reduction" involving those already affected by a problem. Secondary substance abuse prevention targets users, and may focus on use-related problems, treatment alternatives or self-help options.
  Tertiary prevention is generally rehabilitative and focuses on helping those who are already experiencing major health or behavioral problems related to chemical use.

Together, the three levels form a continuum that encompass our total public health response to substance abuse problems.

Each is valid in its own context; all are necessary to achieve the goal
--slippery though it may be--of "preventing" drug and alcohol abuse.

Thirty years ago, drug abuse prevention had a simple enough goal: to scare away as many potential users as possible and lock up those who couldn't be scared away.

The disease of alcoholism was the only form of chemical dependency that enjoyed any status as something other than moral weakness. And much of what was done in the name of "prevention" generally focused on depictions of alcoholism, its developmental sequence, process, and effects.

When it existed at all, drug education-prevention was simplistic, sensationalistic (yet still managing to be boring in the process), and clueless.

Films, slide shows, and videos were duly dragged out of closets, dusted off, and played to glassy-eyed students. Print information was usually worse--obsolete within months (some was probably obsolete before it was written) and chockful of dated statistics, cultural stereotypes, and factual inaccuracies.

The intended emotional impact of such information was fear; and the scarier the context and conclusion, the better it was thought to "work."

The problem was that it didn't.

With the explosion of youthful drug use that ignited in the 1960s, the ineffectiveness of scare campaigns became clear: Young people stayed away in droves, laughing off sensationalistic materials and ignoring warnings that didn't jibe with their own personal experience.

But this created a new informational vacuum: The youth culture knew that the old message was wrong--or, at best, irrelevant to their values and experience. Still, they didn't really have much--short of trial and error--with which to replace it.

That's where we came in.

Established in 1968 as an alternative, youth-oriented prevention project, Do It Now dedicated itself to encouraging healthy choices by developing accurate, unbiased information which incorporated the "look and feel"--and the language and values--of the youth culture itself.

We didn't portray use and abuse in moralistic terms, but in practical ones. We believed--and continued to believe today--that truth is not only stranger than fiction; it's also stronger than fiction, and more likely to produce the sorts of cognitive changes that precede real life change.

We call it "realistic information." And over the past three decades, we've distributed hundreds of millions of examples of it--in the form of pamphlets, booklets, posters, and other materials--to thousands of agencies, schools, and other organizations around the world. And they say it works.

Aside from their support, we could also point to thousands of instances of overdose, addiction, and other drug problems that didn't happen to prove it. But you wouldn't see anything if we did.

But thousands of readers who've taken the time to write or call over the years have told us they owe their lives--or their post-drug lives, at least--to things they couldn't see that they first started to see in the pages of our publications.

It's the essence of what our approach to prevention is all about.

And it makes doing what Do It Now does worth all the effort.

The cornerstone of the Do It Now Foundation message is the notion that each of us is fully responsible for the quality and direction of our own lives. We simply don't accept the premise that people are powerless victims, and we don't reinforce it in our publications.

Other key points in our philosophy include the value and necessity of both honest self-appraisal and self-acceptance.

We believe that the key to personal effectiveness is simply to begin where we are now: to tell the truth about who and what we are--freckles and all--and accept responsibility for making changes when we don't like what we see.

For this reason, we present information in a context of actions that readers can take on their own behalf to avoid problems--or reduce risk, if the potential for problems already exists. We question the value of materials presented without this context, which we believe only adds to the informational "noise" that's such a big part of life today.

Still, in affirming the uniqueness of each individual, we also acknowledge the universal traits, drives, and values that link us all.

And because we recognize that people vary in the way they formulate and experience their lives, we maintain the value of, and need for, a variety of approaches to prevention, which we do our best to provide in publications addressing the various informational needs and developmental stages of our audience.

Our current publications roster includes primary prevention-oriented materials for children and adolescents, secondary-prevention titles directed at users and high-risk populations, and individual- and family-oriented recovery materials.

We also offer a variety of materials for general audiences on topics ranging from sexuality and sexually-transmitted diseases to such behavioral-health topics as date rape, street gangs, and domestic violence (which often coincide with drug and alcohol abuse), and the health problems of older people.

Through the years, Do It Now Foundation has been honored to serve its national and international constituency with innovative and alternatively focused drug, alcohol, and behavioral health information.

And with your continued support, we hope to keep on doing it now
--and doing it well--for as long as that needs doing.