On April 22, the Department of Justice (DOJ) announced the termination of 365 awards that “no longer effectuate Department priorities.” Among these cuts were $88 million in Office of Justice Programs (OJP) funded programs administering substance use and mental health services. During Preisdent Trump’s first term, we witnessed a shift away from behavioral health models toward scare tactics and increased law enforcement activities — strategies known to be ineffective at preventing substance use. This term appears to be following that same trajectory.

America has a long history of reactively and emotionally addressing substance use in ways inconsistent with research and best practices. Large swings in political views and funding are not new and have detrimental effects on prevention efforts and communities. This latest rollback represents a reversion back to failed, punitive models, which threatens to unravel decades of progress in promoting community health and wellness.

Substance Use Prevention

Today’s substance use prevention activities are not the mass media scare campaigns seen during the 1960s to the 1990s or as simple as “Just Say No.” Substance use prevention takes a public health approach to promoting wellness and preventing substance use problems.

Unlike early iterations of “prevention,” the ultimate goal of prevention activities today is to promote wellness. Promoting wellness is not the same as advocating for the absence of a disease or illness but the presence of purpose in life, involvement in satisfying work and play, having joyful relationships, a healthy body and living environment, as well as general happiness. The Substance Abuse and Mental Health Services Administration (SAMHSA), drawing on Swarbrick’s wellness approach, describes wellness as having eight different dimensions – emotional, spiritual, intellectual, physical, environmental, financial, occupational, and social.

Effective prevention programs work across these dimensions to reduce factors that put people at risk of developing behavioral health disorders (i.e., risk factors) as well as promote or strengthen factors that protect people from these disorders (i.e., protective factors).

The Cycle of Prevention Activities

The way we have responded to substance use has always been reactionary and punitive. Responses to substance use in the U.S. has stretched back over a century and followed a repeating cycle of panic, punishment, and progress. A new drug “hits the streets,” a news article highlights the death of a young, innocent victim, or a new political ringleader will enter the scene spouting “tough on crime” rhetoric that causes a moral panic among the masses and calls for increased punishment. Those sentiments take hold for several years and lead to prison overcrowding and an increase in arrest rates. Eventually, scientific advancements push responses to substance use back into the behavioral health realm. Then, a political campaign or story regresses the U.S. back to failed models of addressing substance use with punishment and the cycle repeats.

The 1950s/1960s are generally seen as the beginning of the modern era of prevention — an era dominated by fear-based approaches. School talks aimed at “scaring kids straight” and media campaigns and movies painted exaggerated horror stories about drug use. But scare-based tactics never work, particularly when youth can see that the lessons don’t reflect their lived experience. By the 1970s, the “War on Drugs” had been launched, and President Nixon had called drugs America’s “public enemy number one” and ushered in a wave of punishment over support. One of the most popular mantras of prevention originated in the 1980s with Nancy Reagan’s famous phrase: ‘Just Say No.’ It was catchy, simple, and widespread, but ultimately ineffective.

In the 1990s, science began to shape prevention and we saw large drops in youth substance use rates ever since. Researchers began to examine risk and protective factors associated with substance use. These studies led to a more structured approach to prevention. New, evidence-based school curricula focused on building life skills, resilience, and relationships were implemented. Community coalitions like the Communities That Care model gained traction. This progress continued in the early 2000s, when prevention finally got a seat at the table in public health. Prevention efforts became evidence-based and multi-layered. Programs began to see substance use as due to a complex interaction between systems and started addressing the risk at the family-, peer-, school-, and individual-level, such as the Seattle Social Development Project.

But this progress is often undermined by political agendas.

The punitive spirit of the War on Drugs remains deeply embedded in U.S. policy. The first Trump administration marked a clear pivot away from behavioral health and back toward criminal justice responses. Law enforcement became the answer while programs focused on research and wellness were deprioritized. Youth substance use trends began to stabilize despite the steady decline they had been on since the 1980s, marking an early sign that prevention was losing its momentum. The Biden-Harris administration brought in a new wave of the War on Drugs by naming a specific adulterated substance, fentanyl combined with xylazine, as an “emerging threat to the United States,” a term traditionally held for matters of homeland security.

Why This Matters Now

This new Trump administration brings new challenges and likely worse consequences as we witness an unprecedented time of widespread cuts to federal funding. Many communities rely heavily on these programs to help their fellow residents promote wellness in their area. Without these programs, improvements in trends in substance use will likely plateau, then potentially worsen. The challenge is that the consequences of cutting prevention are long-term, not immediate. As a result, many will turn to this time period in the next year to point out that there was no visible crisis or dramatic increase in substance use but that is based on a deep misunderstanding in evaluation research. The kids that would have relied on these programs will reach adulthood in the next few years which will be when we see the effects of not having these programs. People who relied on federally funded programs for treatment and support will experience worsening symptoms and rates of fatal overdoses will rise. Our schools will likely witness lower rates of attendance and a higher number of students dropping out or failing. Issues of overcrowding in jails and prisons will continue to worsen as increases in law enforcement activity will lead to greater arrests.

The defunding of mental health and substance use programming is a mistake. When prevention works, it’s invisible — no one sees the overdoses that didn’t happen, hears the fights that were avoided, or reads headlines about the crisis that never occurred. The invisibility of its effects does not mean it is not important.

Mobilizing the Community

We are at risk of repeating history by cutting prevention and returning to failed punitive models. Communities must lead where the federal government is failing. The momentum for prevention has always lain in the power of the community. The earliest substance use prevention movements started with everyday people who cared. Mothers Against Drunk Drivers (MADD) and other grassroots organizations started taking an active role in prevention in the 1980s, and ever since we have seen more communities taking the reins when it comes to promoting wellness in their area. Prevention is not an activity reserved solely for those in power; it is the duty and responsibility of every individual. Prevention is more than a policy or program; it is a promise to keep showing up for each other. If you are not sure where to start, start by telling your story and making space for others to lead. Prevention is strongest when it is shared.