Adaptive Intervention Designs in Substance Use Prevention

An adaptive preventive intervention design approach is an intervention design that uses baseline or ongoing information about an individual to make subsequent preventive intervention decisions. Often, the individuals and families served by substance use preventive interventions are widely heterogeneous both in background (e.g., initial risk prior to intervention) and in response to the intervention (e.g., intervention adherence or engagement, or change in risk). Adaptive preventive interventions have the potential to reduce the risk of substance use and abuse for a greater number of individuals, relative to one-intervention-for-all approaches to prevention, because they respond to this heterogeneity. An important framework in prevention science distinguishes between universal, selective, and indicated intervention tiers or components. The first contribution of this chapter is to illustrate different types of adaptive preventive interventions and describe how they fit within the universal, selective, and indicated framework. Specifically, we will illustrate, via four examples, how adaptive preventive interventions may lead to a sequence of interventions within or across these categories. The second contribution of this chapter responds to the growing interest in the use of sequential multiple assignment randomized trial (SMART) designs as a tool for addressing open scientific questions that prevention scientists confront when developing adaptive preventive interventions.