Drug use prevention policy in France is coordinated at the central level by the Interministerial Mission for Combating Drugs and Addictive Behaviours (MILDECA). A partnership between MILDECA and the Interministerial Committee on Crime and Radicalisation Prevention co-finances a number of programmes supporting those in the criminal justice system and drug trafficking prevention. The first national prevention plan, Priority Prevention: a lifetime of good health, was adopted in 2018; it aims to reduce licit and illicit substance use, with a focus on preventing use during pregnancy and strengthening the partnership between middle and high schools and Youth Addiction Outpatient Clinics (CJCs).
MILDECA provides funding to implement the national prevention priorities at the local level, at which activities are coordinated by MILDECA territorial representatives. Decentralised credits for prevention activities are allocated by MILDECA territorial representatives or by regional health authorities, while the French national health insurance system also provides funding for prevention. At the local level, prevention activities are implemented by a large number of professionals, such as those working in school communities or non-governmental organisations as well as police/gendarmerie officers. Since 2016, prevention has also officially fallen under the remit of specialised drug treatment and prevention centres (CSAPAs).
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.
In France, environmental strategies mostly focus on alcohol and tobacco. In 2017, guidelines for alcohol consumption were revised, with new benchmarks for its consumption.
Universal prevention is the predominant type of drug use prevention in France, mostly carried out in secondary schools, with the school community involved in the coordination and implementation of prevention activities and external stakeholders contributing as required. Under the new strategy, the framework for interventions in schools should be a part of the planning for students’ health and defined annually by each school. Best practice guidelines for addressing health and risky behaviours in school settings exist. Their use is encouraged, but is not compulsory. The new National Action Plan on Addictions 2018-22 aims to roll out programmes for developing psychosocial skills, contributing to a healthy school environment and the prevention of at-risk behaviour, including addictive behaviours.
The prevention of licit and illicit substance use in the workplace, incorporating, although uncommonly, the use of screening for substance use, has been the remit of occupational physicians since 2012. The new National Action Plan on Addictions 2018-22 seeks to ensure that managers and staff representatives are better informed and trained in the management of addictive behaviours in the workplace, notably by introducing a module relating to the prevention of addictive behaviours in management courses.
Selective prevention mainly takes place in at-risk neighbourhoods for illicit drugs or in urban recreational settings for alcohol. These actions are mostly carried out by specialist associations. The new National Action Plan on Addictions 2018-22 aims to focus on children within the child welfare service and the judicial youth protection service. It also charges MILDECA with organising guidance in the party scene. An early parenting support programme aiming to build early attachment and reinforce behaviours promoting health among young parents, called PANJO, is being introduced and evaluated in three departments.
The CJCs, supported by public authorities, are the main indicated prevention system in France.