The prevention of addiction is one of the four pillars of the National Strategy on Drug and Addiction Policy. Measures for addiction prevention are the responsibility of the federal and Länder ministries, the municipalities, the Federal Centre for Health and Education (BZgA) and the self-governed bodies for social insurance. They all share responsibility for and fund the implementation of drug prevention activities in a multifaceted way. Any federal framework recommendations are within the scope of the German Prevention Health Care Act, which has been in force since 2015. This act provides for cooperation between insurance providers, the government and any other relevant bodies, under the umbrella of the National Prevention Conference. A number of framework agreements and recommendations exist to ensure the provision of prevention measures, including the federal framework recommendations (Bundesrahmenempfehlungen) for lifetime coverage and the Land framework agreements, which address the coordination of services.
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.
Between 2006 and 2016, an average of 33 000 addiction prevention measures, projects and programmes were documented each year in the online documentation system Dot.sys. Nearly two thirds of the measures took a universal preventive approach, followed by approaches using indicated, selective and environmental prevention.
In Germany, environmental prevention measures focus on restricting smoking in public places, banning sales of tobacco products and alcohol to minors, enforcing punishment for driving under the influence of psychoactive substances and implementing police measures to reduce the availability of illicit drugs in general.
School-based prevention activities address mainly alcohol, tobacco and cannabis. In addition to information provision, the school-based prevention programmes promote life skills and encourage students to think critically about drug use and to develop their own values. Klasse2000 is widely implemented in German primary and special needs schools and a positive influence has been found on the health behaviour of children up to three years after finishing the programme. Another programme, KlasseKinderSpiel, (developed in the USA as the Good Behavior Game), employs behavioural change techniques in a game setting, and this has been demonstrated to have a long-lasting protective effect in several evaluation studies. The peer education method is applied in school settings and outside school and usually targets children who are in seventh grade or above. A universal prevention programme, Prev@WORK, has been developed to promote responsible substance use behaviours among young people in vocational training settings.
Other programmes, such as Unplugged, which targets secondary school pupils aged 11-14 years, and REBOUND — My Decision, which targets 14- to 25-year-olds, are also implemented in Germany.
Prevention programmes oriented towards families aim to increase parenting skills, build the protective role played by the family and strengthen the basic life skills of the children. In 2013, the Strengthening Families Programme was adapted for use in Germany, and has been evaluated with convincing results in a group comparison over 18 months.
For selective prevention, FReD goes net, a German project targeting young offenders, has been implemented in at least 10 other European Union Member States.
Indicated prevention programmes in Germany target children and adolescents with behavioural disorders and children in families affected by drug dependency. Trampolin is an indicated prevention strategy developed to assist children from families affected by substance use. The federal pilot programme Family Outreach Therapy for Risky Drug Using Adolescents and their Families assists the parents of drug-using children and adolescents, facilitating intra-family communication and referring young people to services to enable early detection and intervention. Following an evaluation, it has been recommended for wider implementation. These prevention programmes are delivered within a therapeutic or counselling context, while an online counselling programme for cannabis users has also been evaluated.