What is drug prevention?
'Prevention has more to do with child and adolescent development rather than with talking adolescents out of drugs'
Prevention is evidence-based socialisation where the primary focus is individual decision making with respect to socially appropriate behaviours. Its aim is not solely to prevent substance use, but also to delay initiation, reduce its intensification or prevent escalation into problem use. Socialisation is a process of transferring culturally acceptable attitudes, norms, beliefs and behaviours and of responding to such cues in an appropriate manner with adequate impulse control.
The common view of drug prevention, particularly among lay audiences, is that it consists of informing (generally warning) young people about the effects (most commonly the dangers) of drug use. Prevention is then often equated with (mass media) campaigns. However, there is currently no evidence to suggest that the sole provision of information on drug effects has an impact on drug use behaviour, or that mass media campaigns are beneficial for all.
In reality, the challenge of drug prevention lies in helping young people to adjust their behaviour, capacities, and well-being in fields of multiple influences such as social norms, interaction with peers, living conditions, and their own personality traits. This view is also reflected in modern prevention approaches which aim to reduce risk behaviours related to substances.
How are prevention strategies classified?
The classification officially used by the EMCDDA is comprised of the following types of prevention, which are complementary to one another. What is important for distinguishing them is the known level of vulnerability for developing substance use problems, not how much or whether people are actually using substances.
Here is a simplified overview of the classification:
- universal prevention addresses a population at large and targets the development of skills and values, norm perception and interaction with peers and social life;
- selective prevention addresses vulnerable groups where substance use is often concentrated and focuses on improving their opportunities in difficult living and social conditions;
- indicated prevention addresses vulnerable individuals and helps them in dealing and coping with their individual personality traits that make them more vulnerable for escalating drug use.
This classification of prevention strategies (Mrazek and Haggerty, 1994), which is based on the overall vulnerability of the people addressed, has superseded the previously used medical paradigm of primary, secondary, and tertiary prevention. While this earlier classification is useful to describe interventions for different stages of diseases as they progress, the medical paradigm is regarded as less suitable for describing complex human behaviour, particularly that which is not dysfunctional. Only a relatively small proportion of individuals that experiment with drugs such as cannabis and cocaine progress to more frequent use patterns.
These three prevention types predominantly use persuasion to change the behaviour or at least attidudes of individuals. Complementing these approaches but without persuading each individual, prevention can effectively change human behaviour by modifying its social, physical and economic context:
- environmental prevention addresses societies or social environments and targets social norms including market regulations.
You can learn more about each of these types of prevention in the respective section.
What are typical prevention interventions?
The most frequent, but not necessarily most effective, interventions are:
- School-based prevention programmes. Many of these programmes focus on social skills (empathy, communication), personal skills (decision making, coping) and information about drugs.
- Programmes for parents. Most of these programmes consist of some information sessions. A few programmes are intensive training sessions with parent and child that clarify expectations, appropriate discipline, managing strong emotions and effective communication.
- Peer-to-peer interventions where young people are trained to convey interventions to their peers.
- Alternative leisure time interventions, sometimes for vulnerable young people.
- Mass media campaigns that inform about the risks and dangers of drugs.
- Counselling and information approaches in nightlife setttings.
- Motivational interviewing and brief interventions for young people with heavy alcohol or drug use.
- Counselling interventions for young offenders.
- Regulating the tobacco or alcohol industries with advertisement bans, taxation and sales restrictions.
- Providing a safe and positive learning environment in schools.
Do we know what works and what doesn't?
There is a growing evidence base for what works and what doesn't in the field of drug prevention. A summary of the available evidence can be found in the Prevention section of the Best practice portal.
In general, more effective interventions seem to be those that target the social and emotional determinants of substance use and risk behaviour, such as impulsiveness or disinhibition, conformity to perceived norms or problems with adapting to school and family life. Up until now, appealing to young people's rationality by informing them about the risks and effects of drug use has not proved to be successful.
In the Best practice portal, evidence is presented by target group: families, school students, community members and the general population. You can also access our publication on Prevention guidelines and standards in Europe.
The publication Prevention of substance abuse (2008) provides information on evidence of drug prevention at European, national, regional and municipal level. It is a translation of a German study commissioned by the Federal Centre for Health Education, Cologne.
What's the situation in Europe for prevention?
Each year, the EMCDDA's Annual report provides a European overview of what countries are doing in the area of prevention. On a less regular basis (currently once every three years), a more detailed, interactive overview by country can be found in the Prevention profiles which are mostly based on expert opinion.
Does the EMCDDA have any prevention resources for practitioners?
Yes, the EMCDDA has a variety of prevention-related resources aimed at practitioners, health-care professionals, or anyone involved in planning or implementing prevention interventions. Some of these key resources are:
- Prevention of addictive behaviours (2015): This review is broad in its considerations, covering not only the main topic of drug abuse but also alcohol and tobacco, as well as behavioural addictions, such as gambling.
- European drug prevention quality standards (2011): This Manual is a joint production by the EMCDDA and the Prevention Standards Partnership, and presents and describes basic and expert level quality standards for drug prevention.
- Prevention and Evaluation Resources Kit (PERK) (2010): This manual compiles basic but evidence-based prevention principles, planning rules and evaluation tips. Additionally, it provides related documentation and references for download.
- Evaluation Instruments Bank (EIB): The Evaluation Instruments Bank (EIB) is an online archive of freely available instruments for evaluating drug-related interventions. Details regarding copyright and/or possible use restrictions are specified for each instrument.
- Expert meeting on environmental strategies – June 2006
- Normative education (Prevention Evaluation Resources Kit, Theory)
Useful external links
Environmental prevention aims at altering the immediate cultural, social, physical and economic environments in which people make their choices about drug use. This perspective takes into account that individuals do not become involved with substances solely on the basis of personal characteristics. Rather, they are influenced by a complex set of factors in the environment, such as what is considered normal, expected or accepted in the communities in which they live, the rules or regulations and taxes of their states, the climate and learning atmosphere of their schools, the publicity messages to which they are exposed, and the availability of alcohol, tobacco, and illicit drugs.
In concrete terms, environmental strategies often include unfashionable components, like the control of markets or regulatory measures (age controls, tobacco smoking bans). They have therefore an important potential for social debate as they challenge culture-bound understanding of society and public health. For example, in the eyes of many people behavioural epidemics (obesity, tobacco and alcohol use) are only a matter of private concern and of personal choices, where the state must not intervene. For public health advocates they are 'industrial epidemics' (i.e. where strong industry interests are entangled in the background), and public health policies are called upon to act in the protection of the vulnerable, especially young people.
Useful external links
Universal prevention addresses the population at large regardless of differing vulnerabilities, predominantly at school and community levels. It aims to reduce substance-related risk behaviour by providing young people with the necessary competences to avoid or delay initiation into substance use, like a 'behavioural vaccine'. Among the four drug prevention strategies in Europe, universal prevention prevails and is the most commonly known. In universal prevention it is assumed that all members of the population share the same general risk for substance abuse, although the risk may vary greatly among individuals.
Useful external links
Selective prevention intervenes with specific groups, families or communities which, due to their scarce social ties and resources, may be more likely to develop drug use or progress into dependency. Often this higher vulnerability to problem drug use stems from social exclusion, e.g. for young offenders, school drop-outs, or students, who are failing academically. Vulnerable groups may be identified on the basis of social, demographic or environmental risk factors known to be associated with substance abuse, and targeted subgroups may be defined by family status or place of residence such as deprived neighbourhoods or those with high drug use or trafficking. Because of the difficulty of implementing experimental evaluation designs, the evidence of the effectiveness of selective prevention is still limited.
Indicated prevention aims to identify individuals with behavioural or psychological problems that may be predictive for developing problem substance use later in life, and to target them individually with special interventions. Its subcategory 'Early Intervention' however focuses only and specifically on identifying substance-using individuals to prevent them from progressing into problem drug use. Identifiers for increased individual risk can be dissocial behaviour and early aggression, and alienation from parents, school and peer groups. The aim of indicated prevention is not necessarily to prevent 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).
Information websites about prevention in Europe
- Czech Republic
- United Kingdom