Drug prevention can be divided into different levels or strategies, which range from targeting society as a whole (environmental prevention) to focusing on at-risk individuals (indicated prevention). Ideally, the different strategies do not compete but complement each other. The main challenges for prevention policies are to match these different levels of prevention to the degree of vulnerability of the target groups (Derzon, 2007) and to ensure that interventions are evidence-based and sufficient in coverage.
Environmental prevention strategies aim at altering the immediate cultural, social, physical and economic environments in which people make their choices about drug use. These strategies typically include measures such as smoking bans, alcohol pricing or health promoting schools. Evidence shows that environmental prevention measures at societal level and targeting the social climate in schools and communities are effective in altering normative beliefs and, consequently, substance use (Fletcher et al., 2008).
Partial or full smoking bans are now implemented in almost all European countries, and tobacco advertisement is banned by an EU directive of 2003 (2003/33/EC). Proposals of minimum pricing for alcohol and clampdowns on alcohol promotion are also being debated in several European countries. Efforts to develop positive and protected school climates, including strict rules regarding substance possession and use, were reported in 2009 by ten EU Member States. Countries in the north of Europe have also developed the concept of positive protected environments at community level, for example through municipal alcohol action plans.
Universal prevention addresses entire populations, predominantly at school and community level. It aims to deter or delay the onset of drug use and drug-related problems by providing young people with the necessary competences to avoid initiation into substance use. Evidence shows that well-designed and structured universal prevention interventions can be effective. A recent example of this is a Dutch combined school–parents programme that reduced alcohol use (Koning et al., 2009). For other interventions, notably mass media campaigns, there is little evidence for effectiveness, and some studies have observed detrimental effects. Despite this, a majority of European countries still report allocating resources to warning campaigns.
School-based universal prevention is reported in all European countries, although with varying content and levels of coverage. Information provision followed by life skills training are the two main intervention types provided. Structured intervention protocols (‘programmes’) are still relatively scarce. The need to improve school-based universal prevention is increasingly recognised in Europe. Eleven EU Member States report, for example, on efforts to define prevention standards.
Selective prevention intervenes with specific groups, families or communities who, due to their scarce social ties and resources, may be more likely to develop drug use or progress into dependency. Because of the difficulty of implementing experimental evaluation designs, evidence of the effectiveness of selective prevention is still limited. This does not apply, however, to interventions for vulnerable families, which have been shown to be effective in different studies (Petrie et al., 2007). Recent examples in this area include and adaptation of the ‘strengthening families programme’ evaluated in Spain, which was found to be effective in reducing predictors for drug use, such as disruptive behaviour at school and depression symptoms. Positive results were also reported in the United Kingdom, with reductions in: risks to children, reported cases of anti-social behaviour, educational issues, youth crime, domestic violence, mental and physical health problems and substance misuse among the first 699 families to have completed ‘Family Intervention Projects’.
European countries report, on average, limited provision of selective prevention, with most interventions targeting young offenders, vulnerable families and ethnic groups. Overall, the data indicate that the coverage of selective prevention has not increased in recent years. There may be some exceptions to this observation, such as interventions for vulnerable families in some countries and FreD, a systematic intervention protocol for young offenders, which is now implemented in over a third of EU Member States.
Indicated prevention aims to identify individuals with behavioural or psychological problems that may be predictive for developing substance use problems later in life, and to target them individually with special interventions. Indicated prevention programmes are usually evaluated, and often show high levels of effectiveness (EMCDDA, 2009). Overall, interventions in this field remain limited, with six countries reporting interventions for children with attention-deficit/hyperactivity disorder or disruptive behaviour, and ten countries reporting early intervention and counselling to individuals who have started using drugs. One recent development is the Dutch ‘Cannabis show’, which is based on an existing cannabis prevention programme (entertaining peer education), and is carried out in a school for young people with behavioural and other psychiatric problems.
Derzon, J. H. (2007), 'Using correlational evidence to select youth for prevention programming', Journal of Primary Prevention 28, pp. 421–47.
EMCDDA (2009), Preventing later substance use disorders in at-risk children and adolescents, EMCDDA Thematic paper, Publications Office of the European Union, Luxembourg (available online).
Fletcher, A., Bonell, C. and Hargreaves, J. (2008), 'School effects on young people’s drug use: a systematic review of intervention and observational studies', Journal of Adolescent Health 42, pp. 209–20.
Koning, I.M., Vollebergh, W.A.M., Smit, F., Verdurmen, J.E.E., Van den Eijnden, R.J.J.M. et al. (2009), ‘Preventing heavy alcohol use in adolescents (PAS): cluster randomized trial of a parent and student intervention offered separately and simultaneously’, Addiction 104, pp. 1669–78.
Petrie, J., Bunn, F. and Byrne, G. (2007), ‘Parenting programmes for preventing tobacco, alcohol or drugs misuse in children <18: a systematic review’, Health Education Research 22, pp. 177–91.