The organisation, implementation and monitoring of prevention activities is the responsibility of Belgium’s Communities and regional governments and, for this reason, strategies for drug prevention differ significantly across the three Communities. A Flemish position paper focuses on health objectives for 2017-25, addressing, among other issues, tobacco, alcohol, drugs, psychoactive medicines, gambling and gaming. New health promotion plans have been developed in the French Community.
The Flemish Centre of Expertise for Alcohol and other Drugs (VAD — Vlaams expertisecentrum voor Alcohol en andere Drugs) is responsible for alcohol and drug prevention in the Flemish Community. In the French Community, the Common Community Commission (COCOM) and the Commission of the French Community (COCOF) are responsible for prevention and health promotion actions. There are common themes in the implementation of drug prevention policies, such as a focus on innovative programmes for children and families, and the implementation of environmental strategies in recreational settings.
Prevention interventions encompass a wide range of approaches, which are complementary. Environmental and universal strategies target entire populations, selective prevention targets vulnerable groups that may be at greater risk of developing substance use problems and indicated prevention focuses on at-risk individuals.
Reducing the availability of, and access to, tobacco and alcohol remains the main focus of environmental prevention in Belgium. In the last decade, there has been a new focus on delaying the onset of drinking in various groups and in society as a whole.
Universal prevention activities are mainly implemented through school-based programmes. Prevention activities in primary schools focus on licit substances, while in secondary schools the main focus of programmes differs by region. In the Flemish Community, programme-based comprehensive interventions have been adopted within the framework of the health-promoting school environment. The French Community follows a model in which specialised associations or internal services provide awareness raising, training or counselling in schools, mostly targeting educators and teachers. Addiction Support Points are interfaces between schools and other structures involved in prevention activities, such as the police and municipal organisations and associations. A range of manual-based programmes is used, including Unplugged. The ASL (Arbeitsgemeinschaft für Suchtvorbeugung und Lebensbewältigung) drug prevention activities in the German-speaking Community’s schools are implemented in the wider context of lectures on rights, duties and risks in society. In addition, the communities also develop and implement activities focusing on parenting skills. The French and Flemish Communities provide telephone and email helplines and are increasingly interested in online early intervention services.
In Belgium, selective prevention activities are mainly oriented towards people in recreational settings; drug-using parents and their children; young people with special needs and a mild mental disability; ethnic minorities; and marginalised people.
In recreational settings, selective prevention is limited mostly to the dissemination of information through information stands, peer prevention and websites targeted at partygoers or through mobile teams whose aim is to intervene at locations (generally at large festivals) where there is significant drug use. The Quality Nights Charter is a health promotion label in recreational settings, used in both the Flemish and the French Communities, and is part of a European network of ‘safer party’ labels. It aims to improve the health and safety of people attending festivals, parties, etc., by certifying that the organisers and operators of events have complied with specific health and welfare standards. A simpler version of Quality Nights has been developed for implementation in smaller settings and events.
Indicated prevention activities are increasingly available in Belgium. In the Flemish Community, these include promoting screening and early interventions at the primary healthcare level using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) instrument. Another project in general hospitals integrates SBIRT (Screening, Brief Intervention and Referral to Treatment) into a care pathway and targets patients with hazardous or problematic alcohol use. A number of online self-care and self-help tools are also available in both Communities. Some early intervention and motivational interviewing programmes are available in the German-speaking Community.