Prevention responses to drug use in the EU
The overall framework of prevention strategies
The table below offers examples and direct links to sub-sections for a quick navegation in the prevention section:
| Environmental strategies | Universal prevention | Selective prevention | Indicated prevention | |
|---|---|---|---|---|
| School | Examples: school policies, health promotion frameworks and school climate >> | Examples: interventions for first and early second grader >> | Examples: interventions for pupils with academic or social problems, truants >> | Examples: interventions for pupils with ADHD, Conduct Disorder >> |
| Community | Examples: tobacco and alcohol policies and regulations (taxes, bans, advertising restrictions), community norms on legal drugs, cannabis and antisocial behaviour >> | Examples: interventions for youth in alternative leisure time programmes, in universal youth programmes outside school, in sports clubs, youth clubs >> | Examples: interventions for young offenders, clubbers, ethnic groups, problem neighbourhoods, experimenting youth >> | Examples: follow-up interventions for paediatric patients with ADHD, depression, or CD >> |
| Community setting: family | Examples: education styles (laissez-faire, authoritative, authoritarian) >> | Examples: interventions for families at large >> | Examples: interventions for families at risk >> | Examples: help for families with children at risk >> |
Filter criteria
The distinction between universal-selective-indicated prevention is the level of 'filter'applied for risk-attribution. For universal prevention, there is no filter (all are considered at equal - low - risk). For selective prevention, the filters are social and demographic indicators relating mostly to groups: marginalised ethnic minorities, youth in deprived neighbourhoods, young (drug law) offenders, vulnerable families; hence a rather raw filter by institutional or technocratic indicators. For indicated prevention however, the individual at risk itself needs to have a 'diagnosis', a risk condition attributed by a professional, e.g. Attention Deficit Disorder, Conduct Disorder, etc.
Definitions
In 1994, the Institute of Medicine proposed a new framework for classifying prevention into universal, selective and indicated prevention interventions, which replace the previous concepts of primary, secondary, and tertiary prevention. The guiding principle of the IOM classification is the target population by assumptions concerning its risk for substance abuse, but not the overall objective or content of a prevention intervention.
Environmental prevention strategies
In practice, universal prevention activities in all member states do address licit and illicit drugs together, whereas prevention interventions that focus exclusively on illegal drugs are very rare. The main objective in prevention is usually preventing or delaying the initiation with legal drugs, because their early or intense use is the most important risk factor for initiation and problems with illicit drugs later. Tobacco and alcohol use depend strongly on culture and norms, acceptance of use and availability of these substance.
In this line, environmental approaches are prevention measures that operate on the level of these social, formal and cultural norms about alcohol, tobacco and also cannabis. While universal prevention intervenes on population level, selective prevention at (vulnerable) group level, and indicated prevention on individual level, environmental approaches work on societal level, mostly by shaping attitudes, normality perception and values regarding legal drug consumption. More...
Universal prevention
Universal prevention strategies address the entire population (local community, pupils, neighbourhood). The aim of universal prevention is to deter or to delay the onset of substance abuse by providing all individuals the information and skills necessary to prevent the problem. Universal prevention programs are delivered to large groups without any prior screening for substance abuse risk. All members of the population share the same general risk for substance abuse, although the risk may vary greatly among individuals. More...
Selective prevention
Selective prevention serves specific sub-populations whose risk of a disorder is significantly higher than average, either imminently or over a lifetime. This responds to the growing importance of identifiable risk factors for understanding the initiation and progression of substance abuse, particularly among young people. A primary advantage of focusing on vulnerable populations is that they already exist and are clearly identifiable. In European prevention practice, more attention has been paid to those complementary prevention interventions that focus more selectively on special groups or also settings, for instance deprived neighbourhoods or recreational settings. More...
Indicated prevention
Indicated prevention aims to identify individuals who are exhibiting indicators that are highly correlated with an individual risk of developing substance abuse later in their life (such as psychiatric disorder, school failure, dissocial behaviour etc.) or additionally early signs of problematic substance use (but not clinical criteria for dependence) and to target them with special interventions. Identifiers for increased individual risk can be falling grades, conduct disorders, and alienation from parents, school, and positive peer groups. The aim of indicated prevention efforts is not necessarily to prevent the initiation of use nor the use of substances but to prevent the (fast) development of a dependence, to diminish the frequency and to prevent “dangerous” substance use (e.g. moderate instead of binge-drinking. More...
