Reframing Substance Misuse Prevention: a RE-AIM Analysis of Federal Infrastructure and Future Directions

Substance misuse prevention is a significant component of public health policy in the USA. Currently, federal prevention efforts rely primarily on a coalition-based framework supported through four mechanisms: (1) the Substance Use Prevention, Treatment, and Recovery Block Grant, (2) the Drug-Free Communities Program, (3) the Partnerships for Success initiative, and (4) Community Anti-Drug Coalitions of America. Using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, this article critically analyzes the performance of this system and considers scalable alternatives. Findings indicate that while coalitions mobilize local stakeholders, the model is resource-intensive, inconsistently implemented, and limited in its capacity to achieve sustained, population-level impact. Proposed alternatives include integrating prevention science into professional education, mandating EBPP delivery in universal settings such as schools, embedding routine screening and early intervention, creating a national repository of free prevention programs, and expanding the use of digital applications and wearable technologies. Implications include restructuring federal funding priorities, embedding prevention within existing infrastructures, and advancing research on cost-effectiveness, sustainability, and equity.