Substance Use in Youth: What Could an Ounce of Prevention Be Worth?

* Abbreviations: CPSTF — : Community Preventive Services Task Force USPSTF — : US Preventive Services Task Force Risk for substance use disorders begins early in life. Approximately 65% of adults in treatment of opioid use disorder report that their first use occurred before the age of 251; for adult daily smokers, the estimate is 90%.2 As experimental use of substances transitions to regular use and problematic use, and ultimately to a use disorder, abstinence becomes increasingly difficult to achieve; many risks, including unintentional injury, damaged relationships, and even lasting alterations to a youth’s developing brain, have likely already occurred. For these reasons, preventing substance use among children, adolescents, and young adults is critical. For substance use prevention efforts to have meaningful population health impacts, clinical preventive services (typically defined as interventions deployed in health care settings that are used to either prevent illness or detect it in a more treatable stage) cannot be the sole, or even primary, pathway to improved population-level substance use outcomes. Such clinical services, even when evidence-based themselves, need to be deployed in the context of public health–minded communities and sound policy environments, with attention given to both the … Address correspondence to Caroline Kistin, MD, MSc, Division of General Pediatrics, Boston Medical Center, 801 Albany St, Boston, MA, 02119. E-mail: caroline.kistin{at}bmc.org