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Recommendation 5b: Substance use prevention efforts should be “horizontal”, building healthy environments and strengthening individual capacities that protect against a broad range of difficulties. This includes use of licit and illicit drugs, as well as unhealthy eating, depression and anxiety, social isolation, school failure and dropout, risky sexual behavior, bullying and other antisocial behavior, and suicidality.

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     Narrowly targeted prevention programs are wasted on children who are not destined to develop the specific problem targeted by the program. For efficiency and impact, the Commission recommends that prevention initiatives be combined rather than implementing, say, a program discouraging smoking, another separate program promoting healthy diets and exercise, and yet another focused on making classrooms more socially supportive.

     Moving to a horizontal prevention model will require significant changes in funding, management, and accountability in a field where efforts are often balkanized. For example, “alcohol prevention people” sometimes see themselves as doing something fundamentally different than “bullying prevention people.” However, the benefits to children of making substance use only one of a range of outcomes expected of prevention efforts more than justifies the dissolution of such bureaucratic boundaries and the creation of a horizontal prevention funding streams.

     Implementing horizontal prevention programs on a broad scale now will not cause the current opioid epidemic to dissipate. Prevention is a long-term investment that societies should make in youth today for benefits a decade or more down the line when the most acute drug epidemic of the day could concern alcohol, stimulants, opioids, psychedelics, or some other drug that no one has heard of yet. Indeed, the crisis we may avert may not even be in the drug domain; the benefits of the investment in prevention might be less self-harm, depression, obesity, violence, or other adverse outcome that we should rejoice for the next generation to avoid no matter what its specific nature.