The etiology of ATOD abuse is complex, involving multiple determinants and numerous developmental pathways. To be effective, prevention approaches should target these determinants as comprehensively as possible. Approaches that focus on ATOD-related knowledge or attitudes have not been found to be effective. Similarly, the use of prevention approaches relying on scare tactics or approaches promoting affective development have failed to influence ATOD use. The most effective prevention approaches have focused on teaching social resistance skills either alone or in combination with general life skills.