WHICH IS BETTER, SINGLE OR MULTIPLE DRUG PREVENTION?
As a prevention provider, you will need to determine if single or multiple drug prevention programs are better for your youth population and organization. Before I answer this question, let’s first be clear on what is meant by single and multiple drug prevention.
For this article, single drug prevention programs are defined as those targeting just one type of drug behavior or closely related behaviors. For example, a program designed to prevent the initiation of cigarette smoking, or one to slow the development of alcohol use would be considered a single drug prevention program. By contrast, a prevention program whose focus is to prevent the onset of alcohol, cigarette smoking and marijuana use together would be considered a multiple drug prevention program, because it targets two or more drug habits.
What are the Main Advantages and Disadvantages of Each?
Single drug prevention programs have the potential advantage of being able to focus more in depth on a specific drug. In doing so, they might be expected to have a greater chance of achieving positive outcomes on the drug targeted, and maybe even larger effects for that drug behavior, than a program with multiple behavior goals. However, if you decide to use only single drug prevention programs, you will probably be spending more since you’ll need a number of programs to address all of the varied substance use risks youth face today.
Programs addressing two or more drug behaviors, on the other hand, might impact a broader range of drug use, particularly since these habits are typically interrelated and can be linked together in a program. In doing so, multiple drug programs should be more cost-effective, permitting you to use fewer prevention programs and save money. The potential down side of multiple drug prevention programs is that they might provide offsetting messages and dilute an intervention’s effects, particularly in brief program formats, and could therefore be less effective than single focused programs.
What Evidence Exists to Help Us Choose?
There are many published studies showing both single and multiple drug prevention programs can produce positive behavior change among young people. However, there is very little empirical evidence to help us answer the question of which are superior, single or multiple drug prevention programs? My research group conducted what appears to be the only investigation directly comparing a single and multiple drug prevention program (Werch, et al, 2005a).
In this study, we found that middle school age youth who were given a brief alcohol prevention program outperformed youth who received a similar brief program targeting alcohol, cigarette and marijuana use on two alcohol risk/protective factors. Given this was a single pilot study with only limited positive results, we can’t say definitively whether single drug programs in general might outperform those addressing multiple drug behaviors.
We’ve also conducted several other studies evaluating the effects of even broader focused prevention programs targeting health promoting behaviors along with substance use. In one study, we found that a brief multiple behavior program resulted in positive effects on alcohol consumption and initiation, cigarette smoking, and physical activity among high school adolescents, compared to youth receiving a minimal intervention control (Werch, et al, 2005b).
In another evaluation study, college students receiving a brief multiple behavior program showed improvements on alcohol and marijuana consumption behaviors, stress management, and health-related quality of life, compared to students in a standard care control (Werch, et al, 2008). Together, this research suggests that particularly broad multiple behavior programs can not only be brief, but effectively influence diverse health risk and health enhancing habits of young people.
In conclusion, when planning drug prevention, more is not necessarily better, but it can be. It may be that just adding additional substance use content to an originally single drug program like we did in our initial study (Werch, et al, 2005a), particularly in a brief intervention format, is not the best approach to developing effective multiple drug programs.
However, planning even broader programs that link prevention and health behavior goals appears to be a successful approach for achieving multiple behavior outcomes. Our research has shown that connecting drug behaviors to each other and to health enhancing habits by showing how they affect each other is an effective strategy even in brief program formats.
Prevention providers and researchers should continue to creatively develop and evaluate brief multiple behavior programs linking prevention and health goals to see what works best in achieving both broad and large positive behavior outcomes among youth.
Werch, Chudley E., Moore, Michele J., DiClemente, Carlo C., Owen, Deborah M., Carlson, Joan M., & Jobli, Edessa (2005a). Single vs. multiple drug prevention: Is more always better? A pilot study. Substance Use & Misuse, 40(8), 1085-1101. doi: 10.1081/JA-200030814.
Werch, Chudley E., Moore, Michele J., DiClemente, Carlo C., Bledsoe, Rhonda, & Jobli, Edessa (2005b). A multi-health behavior intervention integrating physical activity and substance use prevention for adolescents. Prevention Science, 6(3), 213-226. doi: 10.1007/s11121-005-0012-3.
Werch, Chudley, Moore, Michele J., Bian, Hui, DiClemente, Carlo C., Ames, Steven, Weiler, Robert M., Thombs, Dennis, Pokorny, Steve B., & Huang, I-Chan. (2008). Efficacy of a brief image-based multiple behavior intervention for college students. Annals of Behavioral Medicine, 36(2), 149-157. doi: 10.1007/s12160-008-9055-6. NIHMSID214864.