What Prevention and Treatment of Substance Dependence Can Tell Us About Addressing Violent Extremism

Our goal is not to suggest that substance use and violent extremism are one and the same but to use the existing similarities as jumping-off points for seeking new ways to prevent hate and radicalization to violent extremism and to improve interventions that can facilitate disengagement and deradicalization. This Perspective concludes by reviewing these implications.

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Implications
Substance dependence and violent extremism manifest themselves in unique ways, but both share several factors that increase individual vulnerability and perpetuate patterns of harmful behaviors. To the extent that such similarities exist, there might be unique opportunities to apply lessons from addiction research and treatment to efforts to counter hate and violent extremism.

Implications for Prevention
There is a long history of research that seeks to prevent substance misuse by acting on what appear to be fundamental causal drivers of such behavior. Three themes from this research are relevant to violent extremism and could assist with primary prevention efforts that focus on shrinking the pool of individuals who potentially are vulnerable to extremist recruitment. First, there is convincing evidence that intervening early has long-term effects on substance use. One of the best examples is the Good Behavior Game (GBG), a classroom intervention for first graders that can reduce substance abuse and dependence in young adulthood. The GBG has also been shown to reduce the risk of committing violent crime from those who engage in the game(6). Coupling GBG-type interventions with efforts that expose children to peers of other races, ethnicities, religions, or socioeconomic status could yield similar promising results in preventing violent extremism.

Second, among adolescents, externalizing mental health symptoms (e.g., disruptive behaviors and hyperactivity) predicts future substance use(7), and thus treating externalizing symptoms might be effective at preventing substance use. Identifying and addressing mental health problems early could prevent violence and extremism, but it is unclear whether evidence-based mental health treatment for those in need will independently alter or change their beliefs in hateful ideologies. Finally, identifying structural characteristics of neighborhoods that contribute to substance misuse and extremism and addressing them directly might also be a critical prevention strategy, but additional research is needed to examine the effects of geographically targeted initiatives on both sets of outcomes.(8)

Implications for Disengagement and Deradicalization
Prevention of substance misuse also includes secondary prevention efforts that focus on early detection. Because addiction is a chronic condition, health care providers are encouraged to routinely screen for it as they do for other chronic conditions.(9) For addiction, this often is done in health care settings but also by family and friends. Our research also suggests that more efforts are needed to help at-risk parents and families recognize and react to signs of extremist radicalization.

Much of substance misuse mitigation focuses on tertiary prevention; that is, intervening once the chronic condition has already taken hold. Efforts to help individuals disengage from extremist social networks and ultimately deradicalize are new but could benefit from integrating approaches that have been successful for treating substance use disorders. Among those with substance use disorders, a person’s “readiness to change” is instrumental for treatment to be effective.(10) Motivational interviewing is a low-touch, evidence-based intervention that might increase individuals’ readiness to change(11); it is a nonconfrontational approach that could be helpful for individuals in extremist groups or with associated ideologies to bridge to more-intensive deradicalization efforts. In addition, conceptualizing addiction as a chronic condition demands that it should be covered similarly to other chronic conditions: Evidence-based substance abuse treatment should include continuous care regimes with no limits or restrictions, especially when individuals relapse. The struggles that people face after deradicalizing are as significant as they are for those in substance use recovery: Continuous supports, which might include economic and mental health supports, could be needed to discourage return to participation in extremism. Finally, those seeking treatment for addiction routinely are asked to leave their drug-using social networks behind and expand relationships with non–drug-using family and friends.(12) The same advice goes for those leaving violent extremism; our research indicates that staying “clean” from hate and extremism also requires a supportive network of like-minded individuals.(13)

Conclusion
Although research on the neural, psychological, and social processes that underlie violent extremism is not as well developed as the study of substance dependence and related treatment, current evidence suggests that these behaviors might share similar underlying causes and possibilities for mitigation. While violent extremism is less prevalent than substance dependence, political polarization in the United States appears to be on the rise along with perceptions of grievances associated with that polarization. Sadly, this might give us more opportunities to study the draw toward vengeful retaliation and violent extremism in the future.

In the meantime, it would be wise to look back at attempts to fight terrorism and attempts to counter substance dependence. In both cases, punitive approaches that further stigmatize or marginalize these individuals often seem to backfire, causing the problem to worsen. And, in both cases, new approaches that incorporate community-centeredness, harm reduction, and radical forgiveness show promise at addressing what have been persistent, recalcitrant problems. Of course, there must be negative consequences for harmful behavior, but it seems that too much punishment (or not enough support) might feed the cycle of vengeful retribution that is critical in driving domestic extremism.

1. Snair, Justin, Anna Nicholson, and Claire Giammaria, eds., Countering Violent Extremism Through Public Health Practice: Proceedings of a Workshop, Washington, D.C.: National Academies Press, 2017.

2. Alcalá, Héctor E., Mienah Zulfacar Sharif, and Goleen Samari, “Social Determinants of Health, Violent Radicalization, and Terrorism: A Public Health Perspective,” Health Equity, Vol. 1, No. 1, December 2017, pp. 87–95; Bhui, Kemaldeep S., Madelyn H. Hicks, Myrna Lashley, and Edgar Jones, “A Public Health Approach to Understanding and Preventing Violent Radicalization,” BMC Medicine, Vol. 10, February 14, 2012; Weine, S., and S. Kansal, “What Should Global Mental Health Do About Violent Extremism?” Global Mental Health, Vol. 6, July 2019, e14.

3. Brown, Ryan Andrew, Todd C. Helmus, Rajeev Ramchand, Alina I. Palimaru, Sarah Weilant, Ashley L. Rhoades, and Liisa Hiatt, Violent Extremism in America: Interviews with Former Extremists and Their Families on Radicalization and Deradicalization, Santa Monica, Calif.: RAND Corporation, RR-A1071-1, 2021. As of November 30, 2021: https://www.rand.org/pubs/research_reports/RRA1071-1.html

4. Simi, Pete, Kathleen Blee, Matthew DeMichele, and Steven Windisch, “Addicted to Hate: Identity Residual Among Former White Supremacists,” American Sociological Review, Vol. 82, No. 6, 2017, pp. 1167–1187.

5. Substance misuse shares much of the neurobiology and psychological and social features of other addictions, such as gambling and sex addiction. We focus on substance misuse in this report because the evidence for this addictive behavior is so well developed.

6. Kellam, Sheppard G., C. Hendricks Brown, Jeanne Poduska, Nicholas Ialongo, Wei Wang, Peter Toyinbo, Hanna Petras, Carla Ford, Amy Windham, and Holly C. Wilcox, “Effects of a Universal Classroom Behavior Management Program in First and Second Grades on Young Adult Behavioral, Psychiatric, and Social Outcomes,” Drug and Alcohol Dependency, Vol. 95, Supp. 1, June 1, 2008, pp. S5–S28.

7. Fergusson, David M., L. John Horwood, and Elizabeth M. Ridder, “Show Me the Child at Seven: The Consequences of Conduct Problems in Childhood for Psychosocial Functioning in Adulthood,” Journal of Child Psychology and Psychiatry, Vol. 46, No. 8, August 2005, pp. 837–849; Goodman, Anna, “Substance Use and Common Child Mental Health Problems: Examining Longitudinal Associations in a British Sample,” Addiction, Vol. 105, No. 8, August 2010, pp. 1484–1496.

8. Siegfried, Nandi, and Charles Parry, “Do Alcohol Control Policies Work? An Umbrella Review and Quality Assessment of Systematic Reviews of Alcohol Control Interventions (2006–2017),” PLoS One, Vol. 14, No. 4, 2019, e0214865.

9. McLellan, A. Thomas, David C. Lewis, Charles P. O’Brien, and Herbert D. Kleber, “Drug Dependence, a Chronic Medical Illness: Implications for Treatment, Insurance, and Outcomes Evaluation,” Journal of the American Medical Association, Vol. 284, No. 13, October 4, 2000, pp. 1689–1695.

10. Henderson, Melinda J., Karen K. Saules, and Luke W. Galen, “The Predictive Validity of the University of Rhode Island Change Assessment Questionnaire in a Heroin-Addicted Polysubstance Abuse Sample,” Psychology of Addictive Behaviors, Vol. 18, No. 2, June 2004, pp. 106–112.

11. Smedslund, Geir, Rigmor C. Berg, Karianne T. Hammerstrøm, Asbjørn Steiro, Kari A. Leiknes, Helene M. Dahl, and Kjetil Karlsen, “Motivational Interviewing for Substance Abuse,” Campbell Systematic Reviews, No. 5, May 11, 2011.

12. National Institute on Drug Abuse, Principles of Drug Addiction Treatment: A Research-Based Guide, 3rd ed., North Bethesda, Md., January 2018. As the National Institute of Drug Abuse notes in its Principles for Drug Addiction Treatment, ”The Adolescents are also especially sensitive to social cues, with peer groups and families being highly influential during this time. Therefore, treatments that facilitate positive parental involvement, integrate other systems in which the adolescent participates (such as school and athletics), and recognize the importance of prosocial peer relationships are among the most effective” (2018, pp. 18–19).

13. Brown et al., 2021

Ryan Andrew Brown is Senior Behavioral/Social Scientist at RAND, and Professor at the Pardee RAND Graduate School. Rajeev Ramchand is Codirector, RAND Epstein Family Veterans Policy Research Institute, and Senior Behavioral Scientist at RAND. Todd C. Helmus is Senior Behavioral Scientist and RAND, and Affiliate Faculty at the Pardee RAND Graduate School. This article is published courtesy of RAND.