Are Some Combinations Better Than Others? an Empirical Examination of Comprehensive Prevention Implementation for Underage Drinking and Prescription Drug Misuse

The Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Substance Abuse Prevention’s (CSAP) flagship substance abuse prevention initiative is the Strategic Prevention Framework Partnerships for Success (SPF-PFS). SPF-PFS addresses underage drinking, prescription drug misuse, and other issues across over 600 communities within grantees in 47 states, 8 territories/jurisdictions, 13 tribal organizations, and the District of Columbia. CSAP encourages SPF PFS grantees to support community subrecipients in “implementing a comprehensive prevention approach, including a mix of evidence- based programs, policies, and/or practices that best addresses the selected prevention priority(ies).”

This presentation will assess outcomes of the combinations of interventions that community subrecipients implement using Qualitative Comparative Analysis (QCA). The QCA model allows us to see what mixture of intervention types are necessary and/or sufficient to produce positive community impact on substance use and related predictors and consequences. Project directors from subrecipient communities used the web-based Community Level Instrument to describe their interventions by service type, SAMHSA strategy type, IOM category, ecological intervention target, evidence-base, and population sub-group targets. State-level grantees provided aggregate level community outcomes information for each of their subrecipient communities on alcohol and prescription drug consumption, intervening variable and consequence outcomes.

About 30% of community subrecipients used only a single CSAP strategy and 34.5% implemented interventions that combined two CSAP strategy types (most commonly information dissemination with prevention education or environmental strategies). The QCA analyses showed the presence of environmental strategies in 3 recipes for successful outcomes on alcohol use, but these recipes excluded information dissemination or prevention education activities. For prescription drug misuse, activities using each CSAP strategy type appeared in recipes for successful outcomes, but information dissemination may not have successful results when combined with environmental strategies. Discussion will focus on how states, jurisdictions, tribes, and communities can develop guidance for intervention selection and use the QCA findings to 1) support the selection of particular combinations of types of interventions and 2) consider modifications to current program selection.