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NIDA: LST Shields Teens from Prescription Opioid Misuse

NIDA Notes - The LifeSkills Training (LST) prevention intervention, delivered in 7th grade classrooms, helps children avoid misusing prescription opioids throughout their teen years, NIDA-supported researchers report. Coupling LST with the Strengthening Families Program: for Parents and Youth 10–14 (SFP) enhances this protection.

Dr. D. Max Crowley from Duke University, with colleagues from Pennsylvania State University, evaluated the impacts of LST and two other school-based interventions on teens’ prescription opioid misuse. The researchers drew the data for the evaluation from a recent trial of the PROmoting School-community-university Partnerships to Enhance Resilience (PROSPER) prevention program. PROSPER is led jointly by Richard Spoth at Iowa State University and Mark Greenberg at Penn State University, with research funding from NIDA.

The new evaluation also disclosed that communities that implemented LST in the PROSPER trial more than recouped its cost in reduced health, social, and other expenditures related to teen prescription opioid misuse. The researchers recommend that communities consider implementing LST plus SFP to help control the ongoing epidemic of youth prescription opioid misuse. LST was the only intervention of the three tested that was effective by itself, and it was the most effective when the interventions were combined with SFP.


Figure. Evidence-Based Prevention Programs for 7th Graders Lower Risk for Prescription Opioid Misuse Before 12th GradeResearchers calculated that participating in Life Skills Training (LST) in 7th grade reduced a child’s likelihood of initiating prescription opioid misuse before 12th grade by 4.4 percent. Of the 6 prevention approaches used in the PROSPER study, LST plus Strengthening Families: for Parents and Youth 10−14 (SFP) reduced children’s risk of prescription opioid misuse the most.
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Dr. Crowley and colleagues determined that LST’s impact on teens’ prescription opioid misuse made it a good financial, as well as health, investment for PROSPER communities. They reached this conclusion by:

  • Estimating the cost to prevent each case of prescription opioid misuse (by dividing the total cost of LST materials, training, etc., by the number of cases prevented).
  • Comparing that number to $7,500, which they estimated, based on previously established figures, is the average expenditure incurred by communities for each single case of teen prescription opioid misuse.

These calculations indicated that PROSPER communities that implemented LST laid out $613 and saved $6,887 for each child that the program prevented from misusing prescription opioids. The corresponding estimates for LST plus SFP indicated expenditures of $3,959 and savings of $3,541 per case averted. Even though communities saved less per benefited child with LST alone, the researchers note, their health benefits were greater and their total savings may have been greater with LST plus SFP, because more cases were prevented.

Numerous studies have shown that LST shields children against other substance use and problem behaviors in addition to LST (see LST’s Broader Impact on Substance Use). These benefits presumably would further increase communities’ economic advantage in implementing the program.

Dr. Crowley says, “This work illustrates that not only can existing universal prevention programs effectively prevent prescription drug misuse, they can also do so in a cost-effective manner. Our research demonstrates the unique opportunities to combine prevention across school and family settings to augment the larger prevention impact.”

LST’s Broader Impact on Substance Use

A study by researchers from Iowa State University led by Dr. Richard Spoth yielded results consistent with those of Dr. Crowley’s team, providing further support for LST as an effective tool for preventing substance use among youth. Dr. Spoth and colleagues randomized students from 36 Iowa schools into three experimental groups: LST alone, LST plus SFP, and a control group. Dr. Spoth’s team periodically collected questionnaire data from the study participants from 7th grade through age 22.

The researchers’ findings revealed significant effects of LST on outcomes when the students reached young adulthood, including fewer alcohol-related problems and lower cigarette and substance use. LST’s effects were more pronounced for those youth who were at higher risk for substance use. In light of these results, Dr. Spoth and colleagues conclude that LST may delay initiation of substance use and thereby decrease substance use and related problems in early adulthood.

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