Levels of Prevention
Sandra Owen , Clinical Faculty, Georgia State University

Introduction: The three levels of prevention provide a foundation for the planning of alcohol and other drug prevention programming and education. Targeting levels of prevention with specific drug risk behaviors ensures effective intervention by promoting protective factors and reducing risk behaviors.


Levels of Prevention

      Primary             Secondary             Tertiary

Intervenes:   Before risk behavior           At initiation of                    At initiation of
                    starts                                 experimentation                  established risk
                                                              risk behavior                      behavior

Purpose:          Educate to prevent              Educate to eliminate            Educate to reduce
                    risk behavior                       experimentation                  established risk
                                                              risk behavior                      behavior

Strategies:    Setting personal goals         Understanding                     Participating in
                     Establishing refusal            consequences of                   rehabilitation
                     skills and decision               experimentation                  services including
                     making skills.                      risk behavior.                     counseling
                     Participating in                   Establishing positive           Establishing positive
                     meaningful activities           relationships with                relationships with
                     Accepting self                    trusted adults                     trusted adults
                     responsibility for               Participating in                   Participating in
                     prevention                          positive peer                      positive peer
                                                              drug prevention                   drug prevention
                                                              education.                           education.
                                                              Establishing refusal             Establishing refusal
                                                              skills and decision                skills and decision
                                                              making skills.                       making skills.
                                                              Accepting self                    Accepting self
                                                              responsibility for                responsibility for
                                                              prevention                           rehabilitation.
                                                              Setting personal goals          Setting personal goals



Protecting Youth from High-Risk Behaviors: Search Institute Research

External Assets

The first 20 Developmental Assets focus on positive experiences that young people receive from the people and institutions in their lives. Four categories of external assets are included in the framework: 

Internal Assets

A community's responsibility for its young people does not end with the provision of external assets. Caring adults must make a similar commitment to nurturing the internal qualities that guide positive choices and foster a sense of confidence, passion, and purpose. Young people need this wisdom to make responsible decisions about the present and future.  The framework includes four categories of internal assets:


Assets have tremendous power to protect youth from many different harmful or unhealthy choices. To illustrate this power, these charts show that youth with the most assets are least likely to engage in four different patterns of high-risk behavior, based on surveys of over 217,000 6th- to 12th-grade youth in 318 communities and 33 states during the 1999-2000 school year.


0-10 Assets  11-20 Assets 21-30 Assets 31-40 Assets
Problem Alcohol Use 49%  27% 11% 3%
Violence 61% 38% 19% 7%
Illicit Drug Use 39% 18% 6% 1%
Sexual Activity  32% 21% 11% 3%

The same kind of impact is evident with many other problem behaviors, including tobacco use, depression and attempted suicide, antisocial behavior, school problems, driving and alcohol, and gambling.

Promoting Positive Attitudes and Behaviors

In addition to protecting youth from negative behaviors, having more assets increases the chances that young people will have positive attitudes and behaviors, as these charts show. 


0-10 Assets 11-20 Assets 21-30 Assets 31-40 Assets
Exhibits Leadership 50% 65% 77% 85%
Maintains Good Health 26% 47% 69% 89%
Values Diversity 36%  57% 74% 88%
Succeeds in School  8% 17% 30% 47%