Primary, Secondary, and Tertiary Prevention of Substance Use Disorders through Socioecological Strategies

Rapidly rising drug overdose rates in the United States during the past three decades underscore the critical need to prevent overdose deaths and reduce the development of opioid and related substance use disorders (SUDs).Traditional public health models of prevention emphasize the biological and physical risks of SUDs, often neglecting to consider the broader environmental and social factors that influence health and well-being.Taking a socioecological approach, the authors aim to illustrate the complex interplay among individual, interpersonal, societal, and structural factors that contribute to the development of SUD and overdose risk.The authors propose evidence-informed strategies and interventions across primary, secondary, and tertiary levels of prevention.By doing so, the authors hope to encourage policy makers, funders, service providers, and community leaders to broaden their approaches to SUD prevention and consider how they can create and advocate for a health-promoting environment by addressing the social and structural factors that drive rising SUD and overdose trends. Glossary of Terms and Concepts Biomedical Model of HealthFocuses on the biological and physiological factors of disease and illness Harm ReductionAims to minimize the negative health, social, and legal impacts associated with drug use Individual Level of InfluenceThe biological, behavioral, and psychosocial factors within an individual that influence health and disease Interpersonal Level of InfluenceThe relationships, social dynamics, and ways of interacting between individuals, including family relationships, that influence health and disease Macro Level of InfluenceThe policies, culture, norms, laws, and systems that exist across groups of people and institutions that influence health and disease Primary PreventionApproaches that aim to prevent disease conditions from developing Secondary Prevention Approaches that seek to identify a health condition as early as possible to halt or slow its progression Socioecological Model of HealthFocuses on the interaction among the individual-, interpersonal-, and macro-level (e.g., community, social, and political) factors that influence disease and illness, and improve overall well-being Structural VulnerabilitiesThe intersecting structural and social factors (e.g., socioeconomic, political, racial, and cultural) that create and perpetuate inequalities, increase risk of experiencing negative health outcomes, and reduce opportunities for overall well-being Tertiary PreventionApproaches that strive to minimize acute negative consequences, such as death, among those who have a disease, while promoting recovery and the management of long-term effects to improve overall well-being