Sunday, August 28, 2011

Guide to Drug Prevention - Mentor Foundation

What is drug prevention?

The term “drug prevention” is a short hand reference to the issue of helping people (often with a focus on young people) avoid the abuse of drugs. This includes preventing “problematic use” and avoiding the harm that drugs can cause.

One definition which reflects this is:

The prevention of drug misuse aims to change personal, social or environmental factors in order to assist delaying or avoiding the onset of drug use and its progression to harmful or problematic misuse. Prevention strategies aim to increase the capacity of individuals and communities to have the resources they need to be protected from the harms that drugs can cause. (Eric Carlin et al, 2011, paper in preparation)
“Drugs” include not only illegal substances such as heroin, cocaine or cannabis but also legal substances such as pharmaceuticals as well as tobacco and alcohol which cause more preventable premature fatalities than illegal substances.

Prevention and Promotion: Supply Control and Demand Reduction

“Prevention” is usually understood as “stopping” people doing something. With respect to drug prevention it usually reflects a concept of ensuring children and young people do not use drugs and for adults (ie over the legal age) how to encourage responsible and appropriate use of legal substances and drugs used or prescribed for medical purposes. Furthermore the prevention of drug abuse usually includes the concept and context for the promotion of health and well-being as a major outcome of drug prevention.

Preventing drugs is tackled in three main ways.

  • There are those who focus on reducing the supply of drugs by tackling those who cultivate and provide the drugs. This is where a great deal of money is spent in respect of policing and customs. The aim is to try to reduce the availability and legal trade through different policy, policing and other measures aimed at restricting the supply to consumers.
  • A second way is to focus on the demand side to try and reduce the demand for drugs through various education and prevention strategies aimed at making the potential user less likely to use or become involved with problematic, harmful or illegal drug use.
  • The third approach for prevention involves the effort to intervene with ex-drug users who need help to prevent them from becoming involved again after the treatment they have received.

Approaches to Prevention

Drug prevention was often seen in three categories: primary prevention (preventing “use”); secondary prevention (helping those involved in drug use); and tertiary prevention (treatment and services for drug users). In 1994, the Institute of Medicine proposed a new framework for classifying prevention into universal, selective and indicated prevention interventions, which replace the previous concepts of primary, secondary, and tertiary prevention. More commonly it is now usually referred to as either universal prevention; indicated prevention; or selective prevention and more recently “environmental prevention” has been added as a strategy.
Universal prevention
Universal prevention strategies address the entire population (local community, pupils, neighbourhood). The aim of universal prevention is to deter or to delay the onset of substance abuse by providing all individuals the information and skills necessary to prevent the problem. Universal prevention programs are delivered to large groups without any prior screening for substance abuse risk. All members of the population share the same general risk for substance abuse, although the risk may vary greatly among individuals.
Selective prevention
Selective prevention serves specific sub-populations whose risk of a disorder is significantly higher than average, either imminently or over a lifetime. This responds to the growing importance of identifiable risk factors for understanding the initiation and progression of substance abuse, particularly among young people. A primary advantage of focusing on vulnerable populations is that they already exist and are clearly identifiable. In European prevention practice, more attention has been paid to those complementary prevention interventions that focus more selectively on special groups or also settings, for instance deprived neighbourhoods or recreational settings.
Indicated prevention
Indicated prevention aims to identify individuals who are exhibiting indicators that are highly correlated with an individual risk of developing substance abuse later in their life (such as psychiatric disorder, school failure, dissocial behaviour etc.) or additionally early signs of problematic substance use (but not clinical criteria for dependence) and to target them with special interventions. Identifiers for increased individual risk can be falling grades, conduct disorders, and alienation from parents, school, and positive peer groups. The aim of indicated prevention efforts is not necessarily to prevent the initiation of use nor the use of substances but to prevent the (fast) development of a dependence, to diminish the frequency and to prevent “dangerous” substance use (e.g. moderate instead of binge-drinking. 
In practice, universal prevention activities in all member states do address licit and illicit drugs together, whereas prevention interventions that focus exclusively on illegal drugs are very rare. The main objective in prevention is usually preventing or delaying the initiation with legal drugs, because their early or intense use is the most important risk factor for initiation and problems with illicit drugs later. Tobacco and alcohol use depend strongly on culture and norms, acceptance of use and availability of these substance.

In this line, environmental approaches are prevention measures that operate on the level of these social, formal and cultural norms about alcohol, tobacco and also cannabis. While universal prevention intervenes on population level, selective prevention at (vulnerable) group level, and indicated prevention on individual level, environmental approaches work on societal level, mostly by shaping attitudes, normality perception and values regarding legal drug consumption. (EMCDDA, 2011)

Different Needs means Different Responses

Increasingly drug prevention is seen within a context of addressing the factors that can contribute to a person abusing drugs. These can vary from person to person and range from issues such as availability and price to an individual’s personal and social environment and condition or environment factors that can lead to someone abusing drugs.

Different ways of preventing drug use/abuse are proposed according to the target group and it is generally agreed that different approaches are required to meet different needs and circumstances. There is no one prevention approach or solution or strategy that meets all needs.

Drug use is a global problem due to the harms that are associated with using drugs, irresponsible and inappropriate use, and what is generally included in the concept of drug abuse. Globally the UNODC estimates that between 149 and 272 million people used illicit substances in 2010, added to which are the significant users of alcohol, tobacco, and prescription and over the counter drugs who develop problems and the range of new substances which are being manufactured without any legal classification but which can be dangerous. Drugs are abused by all sectors of society irrespective of class, culture, religion, social or economic standing. Illegal drug dealing is a major industry earning major amounts of money for those involved in the trade as well as providing an economic means of earning a living for many of those who cultivate drugs.

Mentor, Prevention, Evaluation

The major focus of Mentor and the drug prevention effort generally is to address demand reduction through education and other specific prevention efforts to address different groups and different levels of need and with the intention of achieving successful and effective outcomes. This is reflected in the effort to identify different evidence based approaches to prevention that have proved to be effective in prevention through rigorous evaluation, both quantitative and qualitative.

Evaluation in order to obtain evidence about promising or effective approaches, and to be in a position to offer an evidence based approach is a very necessary component of prevention. However this can be quite challenging given that behaviour change is very difficult to monitor and isolate. It can also be subject to a range of influences and factors other than the prevention input itself; it can be as much about how a prevention approach is implemented as by the content of the input; the ethos or conditions in which an intervention is conducted can have an effect; and it can take time to observe or achieve the impact of an intervention as well as to identify for how long the intervention has an effect. Quantifiable data is often hard to obtain and finding good control groups to measure achievement against is difficult and poses ethical questions by not allowing those involved in the programme intervention and evaluation receive the intervention. However this should not inhibit the need or the effort to undertake evaluation and it is important to take into account other means of evaluation that can include qualitative studies with feedback. This feedback often relies on case studies, observations and informal and formal feedback from different groups and individuals who are recipients, providers or observers of any intervention.

The definition of a successful outcome will differ according to the stated objective and can vary through the following:

  • being able to show an intervention prevents drug use
  • delaying the onset of drug use
  • reducing the harm from using drugs
  • making the use or abuse of drugs less likely; to promoting appropriate and responsible use of legal drugs
Drug (prevention) education also includes many elements such as:
  • providing relevant knowledge and information
  • addressing issues such as peer influence; normative beliefs; brain development
  • developing life skills and/or protective factors and risk factors;
  • considering influences such as the media
  • building the personal and social confidence and competence of young people to weigh up and make appropriate and healthy choices and decisions.
It often addresses issues such as providing and encouraging healthy alternatives and opportunities.

Much of the prevention education work is targeted at helping teachers, parents and other carers address the issue in a meaningful and relevant way and working on the methodologies for active learning and sound communication.

It is also accepted that prevention has to include more than just media campaigns which are often focussed on knowledge and information or even “scare” approaches to the topic. Media can be a very good means of raising awareness but without more long term input is unlikely to be effective whereas scare tactics, as with other “Just Say NO” approaches have been shown to be possibly counter productive for many in achieving an effective prevention outcome.

Drug Prevention is an essential component of any policy or practice with respect to tackling drug abuse. It is too often the element least catered for and which receives very limited profile and investment. However as with any issue that can offer certain benefits but which has significant risks and dangers attached prevention is vital. It is something that requires a holistic approach that encourages, health, education and the legal systems working together to find a solution to managing a global concern.

Extract from Mentor Foundation