Surgeon General’s Report on Alcohol, Drugs, and Health

There are so many noteworthy aspects to the “first ever” Surgeon General’s Report on Alcohol, Drugs, and Health. For example, it is grounded in the best evidence available to date and it examines issues of neurobiology, prevention, treatment, recovery, and health care systems. It also has educational and promotional materials such as fact sheets and social media ideas and resources. If you have not reviewed it – now is the time. It’s my understanding that additional fact sheets are forthcoming including one on criminal/juvenile justice populations. As such, keep visiting the website for updates and let’s keep talking about this report and its importance to individuals, families, and communities impacted by substance misuse and/or disorders.

I want to take a moment to discuss the chapter on prevention. The efforts we make each day with youth and families to provide education; supports, and services are likely preventing further consequences of substance use and involvement with juvenile/criminal justice systems. The Surgeon General’s report indicates that the “vast majority of people who misuse substances in the United States do not have a substance use disorder” (p. 3-4). This suggests that prevention efforts to educate and intervene about the potential harmful effects of substance misuse while offering healthy behavioral options might be sufficient for the majority of people. This is not to suggest that treatment options should be ignored; but rather, taking the time to respond to a young person’s needs using a continuum of services and supports is likely to be most effective.

The Surgeon General’s report discusses three prevention interventions – universal, selective, and indicated. I would like to suggest that these prevention interventions are directly aligned with Reclaiming Futures 6-step model.

• Universal prevention strategies are designed for the entire population. Step 1.0 in the Reclaiming Futures model is screening. The goal of screening is to screen all youth involved with juvenile justice to help identify young people who may have substance use concern(s).
• Selective prevention strategies are aimed at those who may have substance use and/or mental health concerns. The goal of step 1.5 (Reclaiming Futures’ brief intervention) and 2.0 (initial assessment) are to intervene and assess young people who show substance use concerns based on the screening results.
• Indicated prevention strategies are for those involved with substance use at levels that suggest treatment is necessary. Using results from the screening, brief intervention, assessment and interaction with the young person, the goals of steps 3.0 – 6.0 are to coordinate services and work to assist the young person in initiating, engaging in, and transitioning from services.

Reclaiming Futures 6-step model is based on population and public health approaches and best practices in the prevention and treatment domains for both substance use and mental health concerns among young people involved in juvenile justice.

The Surgeon General’s prevention chapter discusses types of prevention, developmentally appropriate interventions, and cost benefits. Moreover, we must not forget the National Research Council’s (2013) publication Reforming Juvenile Justice A Developmental Approach and the entire chapter focused on prevention. Taken together, these two seminal reports communicate the importance of intervening at the appropriate time with the appropriate intervention, using evidence-supported tools and interventions while adhering to implementation fidelity. These reports detail the evidence that shows using these approaches improves health and wellness of young people, decrease crime/delinquency, and offer costs benefits.

Authors Note: Reclaiming Futures will be releasing an update to its 6-step model that adds step 1.5 for our brief intervention. Stay tuned for more information.