For those who show heavier patterns of drinking, frequent binge drinking, regular nicotine intake, or early onset of substance use, interventions are required to prevent serious consequences of problem use and alter the path toward substance use disorder (SUD).2 Such interventions include practices shown to delay substance use initiation in adolescents and reduce substance misuse and its associated consequences in young adulthood. Effective prevention practices address factors that place young adults at increased risk for substance misuse-or protect them from substance misuse-and often focus on youth who may be more vulnerable due to their life circumstances, sexual orientation, and preexisting health conditions.

This guide was created to promote the early identification of children and adolescents with mental health and substance use problems as well as to provide guidance, tools, and resources for early identification--including a compendium of the most developmentally, culturally, and environmentally appropriate screening instruments. SAMHSA developed the guide using the input of the members of the Federal/National Partnership* (FNP) Early Identification Workgroup, chaired by representatives from the Centers for Disease Control and Prevention (CDC) and the Health Resources and Services Administration (HRSA).

Motivation is key to substance use behavior change. Counselors can support clients' movement toward positive changes in their substance use by identifying and enhancing motivation that already exists. Motivational approaches are based on the principles of person-centered counseling. Counselors' use of empathy, not authority and power, is key to enhancing clients' motivation to change. Clients are experts in their own recovery from SUDs. Counselors should engage them in collaborative partnerships. Ambivalence about change is normal. Resistance to change is an expression of ambivalence about change, not a client trait or characteristic. Confrontational approaches increase client resistance and discord in the counseling relationship. Motivational approaches explore ambivalence in a nonjudgmental and compassionate way.

Misuse of alcohol, tobacco, and other drugs is a problem throughout the United States. Communities vary greatly in the specific problems they face, the groups affected by those problems, and the events that rouse people to take action. In addition to having different problems and priorities, some communities have more resources and experience with locally based prevention activities than others. Yet, with a "can do" approach and a bit of guidance, any community can have success in implementing strategies and programs to prevent substance use. This is where Focus on Prevention can help. The U.S. Department of Health and Human Services (HHS), Substance Abuse and Mental Health Services Administration (SAMHSA), has developed this guide as a starting point to help a wide range of groups and communities move from concerns about substance use to proven and practical solutions.

All across the United States, individuals, families, communities, and health care systems are struggling to cope with substance use, misuse, and substance use disorders. Substance misuse and substance use disorders have devastating effects, disrupt the future plans of too many young people, and all too often, end lives prematurely and tragically. Substance misuse is a major public health challenge and a priority for our nation to address. The effects of substance use are cumulative and costly for our society, placing burdens on workplaces, the health care system, families, states, and communities. The Report discusses opportunities to bring substance use disorder treatment and mainstream health care systems into alignment so that they can address a person's overall health, rather than a substance misuse or a physical health condition alone or in isolation. It also provides suggestions and recommendations for action that everyone-individuals, families, community leaders, law enforcement, health care professionals, policymakers, and researchers-can take to prevent substance misuse and reduce its consequences.