Prevention

Prevention is often divided into ‘universal’ prevention (targeting children and young people in general and implying a no-use objective) and ‘targeted’ or ‘indicated’ prevention (aimed at particular high-risk groups). The latter is discussed in Chapter 3. School is the preferred setting for universal prevention interventions as this environment guarantees long-term and continuous access to large populations of young people. A recent research project on good practices in school-based prevention, funded by the European Commission, drafted recommendations for school-based prevention programmes as well as for necessary frameworks: school policy and school environment. There is a broad evidence base from the international literature identifying approaches that are potentially promising or confirmed to be effective (69).

In all Member States, prevention is included in school curricula, in the sense that the topic ‘drugs’ has to be dealt with in one way or other, but this might simply mean that teachers or police officers provide information about drugs and risks. Purely informative and unstructured approaches have been found to be ineffective (Hansen, 1992; Tobler, 2001). Only a few Member States have national plans for school-based prevention that detail the scope of actions to be carried out (and to be avoided) and by whom (Figure 38 OL). Other countries, however, prefer to develop municipal or departmental plans into which school-based prevention is integrated (Figure 39 OL). Even fewer Member States have clear standards for the content of school-based prevention (mandatory only in Ireland and the United Kingdom) (Table 3 OL). However, EU countries are beginning to recognise the need to provide high-quality prevention measures rather than just reiterating the importance of prevention in their national strategies. Sweden is one of the few countries to admit that its school-based prevention ‘was very often arranged with methods that research has shown have little or no result, while effective methods were seldom in use’ (Skolverket, 2000) and that lack of quality control led to a situation ‘where any school principal was able to decide how drug education should be accomplished’. Now, the whole strategy is being refocused towards ‘regular programmes based on evaluated, effective methods’. Similarly, in France ‘the relative silence […] in the legislative and statutory texts and the early implication of associations […] has resulted in a multiplicity of active participants in prevention, […] without any model or action theory being imposed or particularly encouraged’ (French national report). In reality, this description could be applied to many more Member States. In contrast, Spain, Ireland and the United Kingdom have developed a clear quality control and evidence-based orientation in their prevention policies and intend to further strengthen this focus (70). In addition, stricter quality requirements are now being introduced in Portugal.



Systematic mapping and documentation of programmes as the cornerstones of quality improvement (71) are gaining in importance: recently, Denmark, Germany and Portugal have set up pilot projects to develop monitoring systems similar to those already existing in Belgium, Greece, Spain, France, the Netherlands and the United Kingdom.

Curricular interventions (i.e. formal prevention programmes with detailed contents and outline for sessions) are, according to existing knowledge (Tobler, 2001), the most useful way to deliver effective prevention in a controlled manner that also allows evaluation of both process (good delivery) and outcome (positive results). The proportion of schools covered by such curricular programmes is relatively low in some Member States, either because the necessary information systems are missing (Germany, Italy) or because a non-programme-based treatment of prevention in daily school life is preferred (Austria and Finland (72) (Table 4 OL)).



Because it is a relatively well-defined concept, school-based prevention is the most accessible area for the mapping and quantification of prevention coverage; in this respect, the information systems within the EU are beginning to yield results, whereas information on other important fields still needs to be structured and improved (Table 5 OL).



Community-based prevention, on the other hand, is a very heterogeneous concept partly because it is, by definition, decentralised. The only common feature across Europe is the setting itself: ‘community’. Interventions include general activities (such as staff training and training of trainers), structural measures (development of local policies and networks as well as involvement of decision-makers) and specific actions such as the provision of local centres for the prevention of addiction and marginalisation (France) or parent patrols/’night ravens’ (Denmark, Sweden and Norway) (73). Interventions are not necessarily organised by community groups, but – as, for example, in Luxembourg – may be managed top-down by a national agency responsible for initiating projects, including drug awareness programmes. Often, there is a lack of a solid foundation and of any clear goal; only in Greece are the aims and structure of community projects subject to any monitoring process. Except in Luxembourg and Ireland, no significant evaluations have been reported.

Family-based prevention, despite being frequently mentioned as a key element in national strategies, seems to be developed on a disparate, intuitive and impromptu basis, without any notable experience or evidence base. A frequent feature is the training of parents in parenting skills and/or dissemination of information (Belgium, Denmark, Germany, France, Italy, Portugal and Norway). Only Ireland, the Netherlands and the United Kingdom have focused projects in place, which target families at risk and concentrate on socially deprived neighbourhoods. Spain, however, has issued a systematic and exhaustive overview on family-based prevention practices, while Greece has also developed well-organised and well-documented family projects nationwide.

Until now it has been impossible to compare the amounts spent on prevention in the different Member States, even if focusing only on resources for school-based prevention plans.

Mass media campaigns, despite the weak evidence base for their impact on consumption behaviour when used alone (Paglia and Room, 1999), as well as their considerable cost, often remain important pillars of prevention strategies.


(69) See Drugs in focus No 5.

(70) See Drugs in focus No 5.

(71) See Drugs in focus No 5.

(72) See Drugs in focus No 5.

(73) More information on the ‘night ravens’ is provided on page 72.