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). 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. Most prevention activities focus on substance use in general; only a limited number of programmes focus on specific substances, for example, alcohol, tobacco or cannabis.
Environmental prevention strategies aim at altering the 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 and the development of health promoting schools. Evidence shows that environmental prevention measures operating at societal level and targeting the social climate in schools and communities can be effective in altering normative beliefs and, consequently, substance use (Fletcher et al., 2008).
With the recent introduction of a total smoking ban in Spain, almost all European countries now have some form of tobacco ban in place. Environmental strategies targeting alcohol are less common in Europe, though most Nordic countries report an increase in the implementation of responsible serving strategies (1), which have demonstrated effectiveness in local studies (Gripenberg et al., 2007).
In most European countries, there has been an increase in the implementation of school drug policies (2), and over a third of countries report that drug prevention is integrated into school curricula, for example, via 'health' or 'civic education' programmes. Four countries (Luxembourg, Netherlands, Austria, United Kingdom) report the implementation of 'whole school' prevention programmes (3), an approach that has been positively evaluated in terms of reducing substance use (Fletcher et al., 2008), and has additional benefits such as improving school atmosphere and enhancing social inclusion.
Universal prevention addresses entire populations, predominantly at school and community levels. 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. When implementing universal prevention approaches, evidence shows that paying attention to cultural, normative and social context improves the chances that programmes will be accepted and successful (Allen et al., 2007).
Europe-wide expert ratings indicate a small shift in school-based prevention, from approaches that have not been shown to be effective, such as information provision alone, information days and drug testing in schools, towards more promising approaches, such as manual-based life-skills programmes and interventions specifically for boys. Countries also report that several of the more effective universal prevention interventions are being transferred from one country to another (4). However, despite the availability of positively evaluated prevention methods, a number of interventions that are not supported by scientific evidence, such as expert and police visits to schools, are being increasingly reported by some countries.
Universal family-based prevention largely takes the form of simple and low-cost interventions, such as parents' evenings and dissemination of leaflets or brochures. More complex interventions such as parents' peer-to-peer groups (Germany, Ireland), personal and social competence training (Greece, Portugal) or manualised parenting programmes (Spain, United Kingdom) are rarely reported.
Selective prevention intervenes with specific groups, families or communities who, due to their reduced social ties and resources, may be more likely to develop drug use or progress into dependency. Several Member States report a shift in focus in their strategies towards targeting vulnerability, while expert ratings suggest an overall increase in the provision of interventions for vulnerable groups from 2007 to 2010, with the exception of interventions for youth in care institutions. The largest increases are reported for pupils with academic and social problems (full or extensive provision in 16 countries) and for young drug law offenders (full or extensive provision in 12 countries) (Figure 3: Provision of selective prevention interventions as estimated by national experts). The former might be due to increasing attention from some Member States and the European Union to academic failure and early school leaving, which share the same risk factors as those for problem drug use (King et al., 2006). The increase in provision for young offenders might be partially explained by the implementation of FRED, a multi-session psychosocial programme (EMCDDA, 2010), in more countries, as well as by new interventions for first-time offenders in Greece, Ireland and Luxembourg.
An increase in the provision of interventions targeting vulnerable families was also reported, most notably for those with substance use problems (full or extensive provision in 14 countries) and socially disadvantaged families (full or extensive provision in seven countries) (Figure 3). In this context, the increasing popularity of the 'Strengthening families' programme (Kumpfer et al., 2008) in Europe may be noted: this programme has recently been implemented in three new countries (Germany, Poland, Portugal) and in additional locations in the United Kingdom.
Selective prevention can be carried out through outreach work or by office-based services. Prevention work with ethnic groups and party/festival goers are the only areas where more outreach work is reported, while there are reports of a reduction in outreach work services for homeless youth. Overall, most service contact with socially excluded groups such as early school leavers, immigrants and homeless youth continues to be office-based.
In addition, relatively little is known about the content of many selective prevention programmes (5). Overall, the available data indicate that the most common interventions in Europe are those that place an emphasis on information, awareness-raising and counselling, despite growing evidence of the effectiveness of approaches such as norm setting, motivation, skills and decision-making.
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. A number of indicated prevention programmes have been positively evaluated (EMCDDA, 2009).
Only half of the EU Member States and Norway report the existence of indicated prevention activities, and very few report the use of structured and manual-based interventions. An increasing number of countries report that the school setting is being used to identify vulnerable pupils, in particular those with behavioural problems, often associated with later drug use. Belgium, the Czech Republic, Portugal and Norway report the use of new tools for screening and early detection in both school and community settings.
Early intervention and counselling for drug use are the most frequently reported indicated prevention strategies; there are few reports of interventions targeting early onset behavioural problems. This suggests that the potential for indicated prevention to help reduce the impact of neuro-behavioural problems during childhood, such as aggression and impulsiveness, on later substance use behaviour (EMCDDA, 2009) is not being fully exploited in Europe. Indicated prevention can act as a bridge between prevention in community environments and the specialist treatment offered in clinical settings, particularly when providing early interventions for particular groups, such as vulnerable cannabis or alcohol users.
(1) Responsible serving strategies aim to prevent alcohol sales to intoxicated and underage individuals, through a combination of server training and policy interventions.
(2) A school drug policy establishes the norms and regulations about substance use in the school setting and provides guidance on how to proceed when rules are broken.
(3) Whole school approaches aim at providing protective school environments and positive school climates.
(4) See SFP, FRED, Preventure, EU-DAP and GBG on the Best practice portal (EDDRA).
(5) Some examples, though, are available in the Best practice portal (EDDRA) website.
Allen, D., Coombes, L. and Foxcroft, D.R. (2007), 'Cultural accommodation of the Strengthening Families Programme 10-14: UK Phase I study', Health Education Research 22, pp. 547-60.
Derzon, J.H. (2007), 'Using correlational evidence to select youth for prevention programming', Journal of Primary Prevention 28 (5), pp. 421-47.
EMCDDA (2010), Annual report 2010: the state of the drug problem in Europe, Publications Office of the European Union, Luxembourg.
EMCDDA (2008), Preventing later substance use disorders in at-risk children and adolescents, Thematic paper, Publications Office of the European Union, Luxembourg.
Kumpfer, K.L., Pinyuchon, M., de Melo, A.T. and Whiteside, H.O. (2008), 'Cultural adaptation process for international dissemination of the strengthening families program', Evaluation and the Health Professions 31, pp. 226-39.
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 (3), pp. 209-20.
Gripenberg, J., Wallin, E. and Andréasson, S. (2007), 'Effects of a community-based drug use prevention program targeting licensed premises', Substance Use and Misuse 42 (12-13), pp. 1 883-98.
King, K., Meehan, B., Trim, R. and Chassin, L. (2006), 'Marker or mediator? The effects of adolescent substance use on young adult educational attainment', Addiction 101, pp. 1 730-40.