Volume 11, Issue 2 (2020) Substance Use Prevention in the Era of COVID-19

Introduction to Substance Use Prevention Special Issue: Building an infrastructure for substance use prevention through the lens of village health

Guest Editor: Lora Peppard, PhD, DNP, PMHNP-BC

Nothing has challenged our conventional way of thinking about prevention quite like 2020. Over the course of the year, we have had to struggle with preventing the onset of COVID-19 symptoms but also preventing the mental, behavioral, and physical impact of coping with COVID-19 as a chronic stressor. In doing so, we witnessed the emergence of a full spectrum prevention approach to address COVID-19 as an immediate harm. Interventions from primary prevention to prevent onset of symptoms, secondary prevention to identify and appropriately treat symptoms, and tertiary prevention to mitigate further harm from established disease united to manage the COVID-19 pandemic. Communication channels were either developed or enhanced to manage the flow of information among levels of government and organizations and ultimately to individuals. Macro and micro level measures were established, and communities have been forced to analyze the big picture of prevention while addressing areas of deficiency. Mechanisms for sharing important data and resources materialized. Virtual methodologies for assessing and delivering healthcare across the board took off while guidelines relaxed to accommodate and reimburse virtual delivery of care. An infrastructure for preventing and managing COVID-19 was practically built overnight.

Concurrently, risk factors for substance use, substance misuse, and the negative sequelae associated with misuse skyrocketed. Critically, growing substance use risks related to the COVID-19 pandemic converged upon an existing substance use epidemic characterized primarily, but not limited to, harms associated with opioid use. We witnessed a resurgence of overdoses in many communities accompanied by an alarming increase in alcohol purchases when stay at home orders went into effect. At a time when the need for access to treatment and recovery supports were at their greatest, agencies providing this essential care were faced with service disruptions while they worked rigorously to establish virtual mechanisms for support. In addition to substance use, the COVID-19 pandemic led to significant rises in frequently co-occurring conditions, including anxiety, depression, and suicidal ideation. As state-wide restrictions were implemented to protect the public from COVID-19 transmission, trauma and domestic violence were given new opportunity.

Existing systems to monitor the health and well-being of children through schools and healthcare practices were no longer available when schools closed and wellness checks were put on-hold. Prevention of substance use and its many risk factors and negative effects took on new meaning, with many organizations and individuals feeling a desperation to manage it. Rising against this emergency, individuals and organizations responded with new ideas for identifying and connecting individuals to treatment and recovery resources and maintaining some level of meaningful engagement. Innovative ways of using data to prevent opioid overdoses were deployed, and robust evidence-based practices for full spectrum substance use prevention were adapted as coalitions and other organizations pivoted to continue offering best practices in different ways.

The purpose of this special issue is to shine a light on perhaps some new and synergistic ways of thinking about substance use prevention from a systems lens, in pursuit of something I have affectionately termed “village health.” The African proverb, “It takes a village to raise a child” reflects the idea that entire communities of people must interact and come together to nurture, nourish, protect, guide, and support a child’s experience and growth to set them up for success in life. When applied to health, this concept of a “village” of individuals, organizations, and strategies coming together to promote the best health outcomes in a community translates well and reflects an organized system wrapping its arms around an individual as they journey through managing a health issue. One village’s approach to raising a child in Africa can look very different from another village’s approach in the same country, and even more different than an approach found in a village in India, Peru, or the United States. Thus, village health is defined as a full spectrum public health approach to prevention that employs population health strategies with a distinct focus on identifying and integrating cultural variables into the development, implementation, and evaluation of these strategies. All of the contributing authors for this issue highlight and address gaps in our existing substance use prevention infrastructure while tickling our brains with important characterizations of both the problem of substance use and how to address it as a village.

Ultimately, we all share a common goal of wellness. Our expedition through the pandemic of 2020 has highlighted the great need and benefits of functioning as “villages.” As you read the articles in this issue, I challenge you to think about your own communities and those you may touch through work or other avenues. Ask yourself, “What is the impact of the existing prevention infrastructure in this community? Is the community implementing any of the strategies mentioned in this article? Does the community have healthy communication and data sharing systems in place to nourish the prevention infrastructure? How effective are the strategies for preventing onset of substance use as well as managing risky and severe use? How long are individuals entering recovery staying in recovery? Are the village’s arms truly wrapped around these individuals throughout their life span at any stage of use?”

If the primary substance use prevention net in a community is not effectively preventing initiation of substance use for a child, adolescent, or young adult, I think we can all agree that having a second and third net woven with robust, coordinated, integrated evidence-based strategies in a pattern that is appealing and representative of that community is priceless. As you read these articles on substance use, the authors of this special issue and I invite you to keep in mind that multiple touch points for prevention and intervention exist in an individual’s life. Providing multiple touch points early on in an individual’s life can absolutely steer them in the right direction, but wonderful and powerful strategies are also available if they lose their way at some point in time and need a nudge back towards a healthy trajectory. Not all of the articles included in this special issue are research, and not all of them address children. Many of them discuss the value or effectiveness of existing evidence-based practices for substance use prevention in other stages of life, offer perspectives on new resources, or describe adaptations made to evidence-based practices during the pandemic. A village does not stop raising a child when they graduate high school. No, a village takes care of its members irrespective of age and will always support them in setting their paths straight while reinforcing those paths during times of crisis, such as the COVID019 pandemic. Please join me in assessing and strengthening the substance use prevention infrastructure in your communities. It truly does take a village…


Perspective from the Field

Supleam Doctrina (Additional Scholarship)