We write often on this blog about how to treat addiction, but not so often about ways to prevent addiction or avoid getting addicted in the first place. It’s a complicated subject for three main reasons:

1. Every Addiction Is Different
2. Every Person Is Different
3. Every Setting or Situation Is Unique

On the surface, eating addiction and opioid addiction look like two different problems with unique solutions. However, recent research has shown that they are, in fact, closely related. In the case of eating addiction, cues trigger the displacement of stressful energy to the rituals of consumption. In the case of opioid addiction, cues trigger the displacement of stressful energy to the rituals of drug use.

While it’s true that every person is unique, our stress responses are remarkably similar across the species. If we get stress we can’t handle and can’t run away from, we displace the excess energy to activities that have proven to relieve stress in the past. We see animals in the zoo pacing their enclosures, pawing the ground, or chewing off their fur. In humans, we also see hair pulling, skin picking, and pacing. We also see the problematic use of nicotine, alcohol, drugs, pornography, and gambling. These are very different types of addiction with very similar causes for the behavior.

As far as the setting and situation, they are again all unique. Is there a way to prevent addiction that works as well in India as in the U.S.? Are these methods accessible to those without health insurance or the ability to pay? Is there an intervention that works in the critical moment of need when the decision to give in to a craving is made?

These are the key factors for consideration in designing a preventative intervention that actually works. So let’s see what the experts say about strengthening addiction prevention.

In 2019, the National Institutes of Health (NIH) launched the HEAL Initiative (Helping to End Addiction Long-term) with nearly one billion dollars of funding and the following goals: “improve treatments for chronic pain, curb the rates of opioid use disorder (OUD) and overdose and achieve long-term recovery from opioid addiction.” Buried in the launch announcement is this paragraph on addiction prevention:

The NIH HEAL Initiative supports a range of programs to develop new or improved prevention and treatment strategies for opioid addiction and co-occurring mental disorders. The initiative also supports solutions to mitigate suicide risk and expand suicide prevention efforts for people who misuse opioids, have an opioid use disorder, or experience acute or chronic pain.

For the record, it is very disingenuous for the federal government to say they are increasing efforts to expand suicide prevention for people who misuse opioids, and then defund the very successful Narcan distribution program that bent the curve on overdose deaths. If you or someone you know is having thoughts of self-injury, the government continues to fund the 988 Lifeline for help finding someone to talk to.

Their efforts at addiction prevention include “a clinical decision tool that prompts primary care providers to assess patients for both opioid use disorder and suicide risk and connect them with appropriate resources.” This sounds very promising; good screening leads to the discovery of risk for addictive disorders. How about a “decision tool” that patients could use themselves to assess their own risk and get recommendations?

The NIH does provide a suicide screening tool that it also customizes into three tools for children and three for adults. The three different tools are for use 1) in the emergency room, 2) for inpatient care, and 3) for outpatient care. The one-size-fits-all tool has only five questions and is available as a one-page PDF here.

The NIH also provides a “Patient Resource List” to share with patients who screen poorly or ask about suicide prevention materials. Is it hundreds of pages long? No. Does it address each of the major reasons people state for wanting to injure themselves? No. The NIH document is so short — five resources — that I can provide the entire list right here:

• Suicide & Crisis Lifeline: Text, call, or chat 988
• Crisis Text Line: Text HOME to 741-741
• Suicide Prevention Resource Center
• National Institute of Mental Health
• Substance Abuse and Mental Health Services Administration

Really? This is your “decision tool,” NIH? You are recommending physicians hand this list to someone interested in self-injury prevention? It’s amazing how little you get for $945 million these days.

In the journal, Prevention Science, a group of researchers affiliated with RTI Research Institute in Research Triangle Park, North Carolina, provided a great deal of detail about the projects in addiction prevention being funded by the HEAL Initiative. They provide this surprisingly optimistic objective considering the lackluster results:

At the conclusion of [the HEAL Initiative] studies, we anticipate the availability of multiple evidence-based programs to prevent opioid misuse and use disorder for persons who experience particular sources of risk and for delivery in settings where prevention has traditionally been lacking.

Wow! We’re going to get “multiple evidence-based programs to prevent opioid misuse.” So far, the most successful evidence-based programs for preventing opioid misuse are Parent-Child Interactive Therapy (PCIT) and Contingency Management. They’re both “expensive,” though far cheaper than doing nothing.

• PCIT involves in-home visits from a trained therapist during pregnancy and infancy to help parents learn to lower their stress levels and communicate effectively with their newborn.

• Contingency Management involves giving people token prizes for staying abstinent, staying in therapy, or staying in treatment. It is currently the most effective method for getting people with OUD off drugs.

If only we could make a decision tool that would allow therapists to visit with clients over the phone, whether on an emergency basis or just checking in. If that tool could help in the moment of need by providing ideas for surfing an urge without giving in. Maybe the app could teach better ways of dealing with stress? Maybe it could incorporate small prizes or rewards for regular use and for achieving milestones?

Does such a “decision tool” already exist? It’s certainly not a five-link PDF. We will keep searching here at AddictionNews for a decision tool that’s actually proven to prevent or lessen addiction, and we’ll bring it to you when we find it.

Written by Steve O’Keefe. First published November 2, 2026.

Sources:

“NIH funds $945 million in research to tackle the national opioid crisis through NIH HEAL Initiative,” National Institutes of Health, September 26, 2019.

“Ask Suicide-Screening Questions (ASQ) Toolkit,” National Institute of Mental Health, retrieved October 29, 2026.

“Introduction to Helping to End Addiction Long-Term Prevention Cooperative: Overview and Strategies,” Prevention Science, March 4, 2023.

Image Copyright: aksanakoval.