Can prevention science help reduce substance abuse and gun violence?
In recent months, stories about school shootings and the opioid crisis have dominated the headlines. Diana Fishbein, PhD, director of translational neuro-prevention research at UNC Frank Porter Graham Child Development Institute (FPG), contends that 30 years of prevention science research can offer solutions.
Fishbein, who is also founder and director of FPG’s FRONTIER (Fostering Research on Neuro-Prevention Translation via Infrastructure, Education and Relationships) program, says that well-tested prevention strategies can reduce negative outcomes such as substance abuse and violence. Prevention scientists generate evidence-based programs and policies that target vulnerability factors and enhance protective factors to improve the health and wellbeing of individuals, families, and communities.
Fishbein’s work focuses on how the social environment affects neurodevelopment, which, in turn, affects the ability of a child or adolescent to meet their developmental milestones and develop along a normalized trajectory, leading to healthy outcomes. Although individuals who abuse substances are most often not violent, a common thread among young people who perpetuate violence or become substance abusers is a history of trauma. Risk factors include adverse childhood experiences, such as maltreatment, neglect, family dysfunction, domestic violence, community violence, racism, discrimination, and poverty.
The risk factors may even exert their effects before a child’s birth. For example, research suggests that significant stress in a pregnant mother can have a detrimental impact on fetal neurodevelopment and subsequent ability of cognitive functions to exert control over emotional responses. As such, adversity early in life—such as a pregnant mother’s experience of domestic violence or other severe stressors—can increase vulnerability of the offspring to dysregulated behavior, including violence.
Fishbein says it is essential that parents receive the support they need early in their children’s lives to nurture their healthy development. If children begin to show signs of behavioral problems and conduct disorders, community leaders need to utilize interventions—such as the PAX Good Behavior Game, LifeSkills Training, and Triple P—that have been shown through randomized controlled trials to reduce risk for violent behavior. These parenting, school, and community-based programs help children strengthen control over impulsive reactions, foster healthy relationships, and learn ways to manage stress.
These programs also help reduce the social isolation of children, which is critical since many of the young people who perpetuate shootings are only connected to peers through the internet. While mental illness is often scapegoated as the reason young people become shooters, Fishbein says the reality is that only about three percent of mass shooters are diagnosed with mental illness. Instead, most of these children are behaviorally dysregulated, which typically stems from trauma, dysfunction, and childhood histories that have led to their isolation.
Prevention science shows that there are reliable warning signs that demand our attention to prevent shootings. Young people often express their violent desires to peers, either in person or on the internet. Students can be taught to report these signs so adults can intervene. Other indications of risk include callous and unemotional acts, such as hurting animals, being impervious to negative consequences, expressing a liking for conspiracy theories, hatred toward groups of people, and family dysfunction.
In a recent op-ed in the Raleigh News and Observer, Fishbein and FPG translational research program and policy coordinator Melissa Clepper-Faith, MD, MPH, wrote that “research shows the development of substance/opioid use disorders is preceded by a variety of psychological and behavioral problems, including academic failure, conduct issues, impulsivity, anxiety, depression and stress-related disorders—and that these problems are often rooted in poverty, family dysfunction, inequities, and lack of community supports.”
Fishbein prioritizes primary prevention—promoting structural and systemic change in organizations and systems such as child welfare, health care, and education—to help promote conditions conducive to healthy development. “I’m more invested in normalizing prevention than relying solely on individual programs because those are not going to have a population-level effect,” she says. To that end, she regularly does presentations, both nationally and internationally, to share ways to embed prevention into daily practices.
She crafted an opioid use prevention policy blueprint about interrupting pathways to substance use disorders for the Office of National Drug Control Policy and is collaborating on integrating this information into a national strategy. Fishbein also led the development of local guidance for state officials who will soon receive $750 million as part of a $26 billion national settlement with pharmaceutical companies to combat the opioid crisis through treatment, law enforcement, and prevention programs. The goal is to encourage local officials to build a strong prevention infrastructure with the funds as part of a comprehensive strategy. She is working with county level organizations and agencies to adopt this plan across North Carolina and the country.
Fishbein is organizing a North Carolina statewide trauma summit that will stimulate a tri-directional conversation between researchers, community stakeholders, and policymakers. The summit will also focus on what can be done from a policy perspective to prevent childhood trauma.
In September, FPG’s FRONTIER program, along with the NPSC, a non-profit Fishbein directs, will co-host a congressional briefing entitled “Invest in the Future: Child Tax Credits Promote Healthy Brain Development.” Fishbein and colleagues will present research showing that family support policies, such as the child tax credit, have a positive impact on brain development in infancy and childhood.
“FPG is uniquely qualified to help ensure high quality implementation of preventive interventions and then monitor and oversee this process, providing training, technical assistance, and evaluation,” says Fishbein. “We are lifting up FPG as a central resource for local officials who will soon be grappling with how to expend these settlement funds wisely so that we see the benefits of prevention, including their cost effectiveness.” Aysenil Belger, PhD, FPG’s director agrees with Fishbein and believes the Institute is also committed to doing the necessary work of evaluating and adapting evidence-based solutions for implementation in unique environments, circumstances, and contexts. “This work,” says Belger “is not a one-and-done effort but must be continuously considered.”
Fishbein says that prevention science could offer the knowledge and tools needed to help prevent young people from becoming mass shooters and succumbing to opioid use disorder. “By widely scaling programs and championing change in systems and policies that have been shown to reduce trauma, we can create supportive environments for young people,” she says. “These science-based solutions should be adopted by policy leaders and advocated for by the public.”