Wellness Models for Substance Use Prevention

This article will describe the connection between wellness and substance use and prevention. Wellness models from the Substance Abuse and Mental Health Services Administration (SAMHSA) and Prevention Plus Wellness (PPW) will be illustrated and compared.

What is wellness?  One commonly cited definition comes from the World Health Organization (WHO) which describes wellness as: “A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity” (WHO, 1948).

While there is currently a lack of consensus on the definition and dimensions of wellness, it is generally agreed that wellness is a multi-faceted and wholistic construct.

What does wellness have to do with substance use and prevention?  Wellness, including healthy behaviors, are known to be essential to successful and sustained substance misuse treatment and recovery as well as prevention.

According to SAMHSA, people with serious mental or substance use disorders are dying decades earlier, mostly from preventable, chronic medical conditions (https://mfpcc.samhsa.gov/ENewsArticles/Article12b_2017.aspx).

To help address health disparities resulting from substance use and mental disorders, SAMHSA launched its Wellness Initiative to encourage individuals, families, and behavioral health and primary care practitioners, as well as peer-run, faith-based, and other community organizations, to improve mental and physical health by making positive lifestyle changes.

From a prevention perspective, youth and young adults are exposed to multiple concurrent health risks including substance use and those associated with chronic disease (https://pubmed.ncbi.nlm.nih.gov/26656404/). These risks interact with each other to either excaserbate or improve and protect health.

So much is this the case that at Prevention Plus Wellness one of our favorite tag lines is: “The opposite of substance use isn’t non-use, it’s wellness!” (PPW, 2021).

SAMHSA’s Wellness Initiative & Prevention

Building upon the World Health Organization’s definition, SAMHSA envisions wellness not as the absence of disease, illness, and stress, but as the presence of a positive purpose in life, satisfying work and play, joyful relationships, a healthy body and living environment, and happiness.

SAMHSA’s Wellness Initiative identifies eight dimensions of wellness, along with their basic needs, including (https://store.samhsa.gov/sites/default/files/d7/priv/sma16-4958.pdf):

  1. Physical: Recognizing the need for physical activity, healthy foods, and sleep.
  2. Intellectual:Recognizing creative abilities and finding ways to expand knowledge and skills.
  3. Financial:Satisfaction with current and future financial situations.
  4. Environmental:Enjoying good health by occupying pleasant, stimulating environments that support well-being.
  5. Spiritual:Expanding one's sense of purpose and meaning in life.
  6. Social:Developing a sense of connection and belonging; and having a (good) support system.
  7. Occupational:Personal satisfaction and enrichment from one's work.
  8. Emotional:Coping effectively with life and creating satisfying relationships.

SAMHSA further delineates wellness as “personally defined” which means that substance use prevention programs should allow participants to address their individual needs depending upon their goals, beliefs, values, culture, personality, preferences, and life experiences. 

This could include, for example, permitting youth to set their own substance use and health behavior goals depending upon their values and future self-image preferences for a healthier lifestyle.

Similarly, according to SAMHSA, wellness actively involves the participant in decision-making.  This means that the prevention and other behavioral health specialist serves as an educator, coach, facilitator, and consultant.

For example, recommending a range of health behavior options is important, but so is allowing participating youth or young adults to ultimately decide for themselves which behavior goals to set and monitor to improve their wellness.

SAMHSA further defines wellness as recognizing and building upon the strengths of participating youth.  Strength-based strategies that emphasize desired positive self-images and health-promoting behaviors and other pro-social activities are good examples of this principal. 

The goal of wellness, from SAMHSA’s perspective, is to increase overall quality of life, healthy behaviors and personal control.

Here again, asking participating youth receiving prevention programs to set goals to avoid substance use and increase one or more healthy behaviors, such as physical activity, nutrition, sleep or stress control, is a great way to improve mental and physical well-being, quality of life and self-control skills.

Dr. Margaret Swarbrick, who created the wellness model upon which SAMHSA developed their Wellness Initiative, points out, "Wellness is a conscious, deliberate process whereby a person makes choices for a self-defined lifestyle that is both healthier and more satisfying (Swarbrick, 1997, 2006)" (Swarbrick et al., 2011, p. 329).

This approach emphasizes having positive goals, learning self-management skills, and developing healthy habits (Swarbrick et al., 2011, p. 329; Swarbrick, 2014, p. 11) (https://mfpcc.samhsa.gov/ENewsArticles/Article12b_2017.aspx).

Prevention Plus Wellness Model

PPW is a brief motivational wellness-based strategy which integrates substance use prevention with healthy behavior promotion for all youth and young adults as well as those at risk for developing substance use disorders (https://preventionpluswellness.com/pages/ppw-logic-model).

Like SAMHSA’s Wellness Initiative, PPW is a wellness-focused model emphasizing:

  • Strength-based strategies that highlight desired positive self-images and health-promoting behaviors.
  • The goal is to increase overall quality of life, healthy behaviors, and personal control.
  • Allows a conscious, deliberate process where youth make choices for a self-defined lifestyle that is both healthier and more satisfying and productive.
  • Wellness is viewed as empowering and prevention oriented and as such offers an approach emphasizing positive goals, learning self-management skills, and developing healthy habits while avoiding harmful substance use.
  • Wellness integrates behavioral and physical health by recognizing the mind and body are interconnected and that behavioral health is inseparable from physical health.

The PPW Model, however, is less broad in its wellness dimensions compared to the SAMHSA Model.

PPW emphasizes the physical dimension of wellness and related needs by promoting youth get regular physical activity, eat healthy breakfasts and other foods, and get plenty of sleep while avoiding substance use.

PPW strategies also address the emotional wellness dimension by underscoring the use of stress control and relaxation strategies to help cope with daily stress ubiquitous among youth and young adults.

In addition, the PPW Model targets environmental, social and spiritual wellness dimensions by promoting participation in sports and physical activities, spiritual and racial justice-promoting activities, and environmental strategies like parent training and media campaigns to support youth wellness efforts.

In conclusion, wellness as a concept and strategy goes beyond illness to emphasize wholistic well-being.  For substance use prevention and behavioral health professionals, SAMHSA’s Wellness Initiative and the PPW Model provide roadmaps for expanding prevention theory and practice to achieve broader health and lifestyle outcomes for youth and young adults. 

It is said that “wellness is a journey not a destination.”  That indicates that wellness-focused prevention programs should be provided to youth from childhood into adulthood to guide young people to be the best version of themselves and achieve maximum mental and physical health and quality of life given each person’s unique circumstances.

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