A broad continuum of needs and responses

A major EU objective for addressing drugs and alcohol misuse is to make appropriate interventions in order to have the most effective impact. The main focus is on five broad, sometimes overlapping, target groups for intervention strategies: (1) school-age young people; (2) young experimental and recreational drug users; (3) young people in socially deprived areas; (4) young offenders; and (5) young people with a need for drug treatment (Figure 53 OL).

School-age young people

Prevention in schools is a widely used response for this target. See ‘Prevention’ for further details.

At a school policy level, several Member States have issued recommendations on how to react to drug incidents and drug-using students. In France, there is a strong focus on ‘Reference points for the prevention of at-risk behaviour in schools’ and the resolution of problems through targeted counselling. There is a major focus on professional training for school staff in order to handle deviant youth behaviour. In Austria and Germany, the STEP-by-STEP programmes (97) help schoolteachers to identify and intervene with drug-using pupils. In Norway, a handbook for this purpose has been launched.

The United Kingdom Drug Prevention Advisory Service evaluated a drugs-prevention programme aimed at young people excluded from school and concluded that drugs programmes are clearly needed, but that brief periods of drugs education are inadequate. Many young people targeted by the programme were already taking drugs, implying that programmes should be implemented at a younger age, and should clearly identify and deal with problems. The new Portuguese national framework for prevention anticipates allocating EUR 400 000 for alternative school curricula and early professional training for school drop-outs. Almost all Spanish autonomous communities have such programmes in place. In Greece, early interventions are aimed at adolescent drug users and their families (family therapy), as well as at adolescents who have problems with the law.

Young experimental and recreational drug users in the community

The potential harm caused by alcohol and illicit drug use in the lives of a small but significant proportion of the young population is increasingly recognised. A major target for more effective action are vulnerable groups of young people who consume alcohol and experiment with drugs for recreational purposes while being unaware of, or unable to control, the risks associated with their patterns of substance use (overdosing, accidents, criminal behaviours, violence, loss of capacity to study or work, sexually transmitted infections and longer-term health damage to liver/brain, etc.) (Boys et al., 1999; Parker and Egginton, 2002). Concern about changing patterns of use of alcohol and drugs for recreational purposes is growing in the EU, and particularly about the health risks for women. Recreational facilities such as bars, discos, sport clubs and youth clubs would seem to be suitable settings for drug prevention as they guarantee contact with a large number of young people, many of whom use drugs or are at risk of doing so (Figure 54 OL). There is an urgent need for methodological documentation and thorough evaluation of interventions in this setting.

In France, by 2001, at least 30 % of départements were taking preventative actions or providing first aid at dance events. In one regional health board area in Ireland, nightclub staff and clubbers are targeted by ‘The sound decisions’ project. However, in Luxembourg no legal framework exists for drug agencies’ interventions in nightclubs.

Train-the-trainer courses in first aid for drugs incidents in recreational settings are organised in the Netherlands.

The Dutch ‘Going out and drugs’ initiative includes interventions for different settings outside school where youngsters use drugs, such as coffee shops, discos, parties and clubs, and places where major musical events are organised.

Several projects approach drug users within the music scene to minimise the risks of consuming legal and illegal drugs. Sometimes project staff drive to different events in a mobile home, providing a quiet atmosphere for informal counselling. Special hotlines or web sites can be additional features.

An overview and analysis of examples of prevention in party settings has been carried out on the projects in EDDRA. An overview of current projects and policies is provided in a series of online tables (Table 16 OL, Table 17 OL and Table 18 OL).

Specific on-the-spot counselling services and on-site pill testing at rave events are – according to a recent Commission-funded study – effective in reaching those young people who, although they take drugs regularly, do not think of themselves as drug users and would not contact established drug help services. The study also found that pill testing does not counteract abstinence-oriented prevention interventions. In Austria and Spain, these services have now expanded, while in the Netherlands they are restricted to services with high standards of methodological accuracy.

Another set of interventions involves peers, self-help groups and alternatives to drugs use such as information and psychosocial support as well as involvement in cultural or sports activities (e.g. in summer camps in Greece). In Spain, alternative leisure programmes have for some years been available throughout the country.

In Norway, Sweden and Denmark, ‘The night ravens’ are volunteer adults who patrol the city centre streets during weekend evenings and nights. Their mission is to be visible and available to young people. The idea is that their presence will reduce the likelihood of violence and harm.

Young people in socially deprived neighbourhoods

In Sweden, the Drugs Commission conducted a review of the research literature on preventative responses (Narkotikakommissionen, 2000), and concluded that three types of initiative are needed: specific initiatives targeting the poorest people; general initiatives to improve public health; and initiatives aimed at helping vulnerable families.

Ireland, Portugal and the United Kingdom are the only Member States that identify particular areas with a view to providing special programmes in these areas. Ireland’s Young People’s Facilities and Services Fund (YPFSF) aims to attract ‘at-risk’ young people in disadvantaged areas into facilities and activities that divert them from the dangers of substance abuse. In the United Kingdom, Positive Futures is operating in 57 deprived areas to divert vulnerable young people from drugs and crime through involvement in sport. The initial results are encouraging, showing reductions in criminal activity and truancy and improved community awareness. Health action zones (HAZs) are multiagency partnerships located in some of the most deprived areas in England, and their aim is to tackle health inequalities through health and social care modernisation programmes to cover a wide spectrum of vulnerable young people thought to be a risk of misusing drugs (130 projects and initiatives in the 26 HAZs). Connexions is a United Kingdom support and advice service for young people aged 13–19 that incorporates the identification of young people at risk and makes referrals to specialist drug services. Twenty-seven partnerships were operational in 2002, with another 20 expected to be introduced by 2003.

In the United Kingdom, all Drug Action Teams (DATs) conducted a young people’s needs assessment in 2001 and are required, through young people substance misuse plans (YPSMPs), to plan services for young people from universal prevention services through to substance misuse treatment services, which are based on local need.

In Austria, mobile centres targeting young people in the streets are working in close cooperation with other relevant help organisations to provide assistance to drug-using adolescents and young adults at an early stage. It is anticipated that the geographical coverage of these centres will increase in future (98).

In Finland, Walkers youth cafés provide early intervention and currently operate in 24 localities. An important role is played by trained adult volunteers supported by youth work professionals. An effort has been made to develop the youth cafés into safe meeting places. Similarly, in one regional health board area in Ireland a Health Advice Café, which aims to provide a combined prevention and direct access health service for young people, is in place.

In Norway, most large municipalities have outreach services. Their objectives include various preventative interventions aimed at older children and young people as well as counselling and referral to the support and treatment services.

Young offenders

Some Member States provide targeted support, training and outreach programmes for at-risk young people such as young offenders. A major impact of some of these initiatives has been to reduce the number of young people receiving criminal sentences.

Interventions provide alternatives to law-enforcement and punishment strategies, with the aim of reducing or preventing young people falling into a life of crime, with irreversible consequences. In the United Kingdom, youth offending teams (YOTs) include drug workers who assess young offenders for drug abuse and, where appropriate, offer interventions to prevent further abuse. The Luxembourg MSF Youth Solidarity project operates on a similar basis in direct collaboration with youth magistrates and competent law-enforcement actors.

The FRED project in Germany aims at early interventions with first notified drug users. Finnish law-enforcement projects operate under the same principles.

Young people with a need for treatment services

Demand for drug treatment is a significant indicator of drug dependency and severe need. In 2001 in the EU, young people up to the age of 19 accounted for just under 10 % of the total reported specialist drug-treatment demand. Over half of these young people were receiving treatment for cannabis as their main drug of use. Nearly a quarter were being treated for opiate problems, and the remainder were evenly divided between treatment for use of cocaine and other stimulant drugs. However, there are national variations; for example, Ireland treats a larger proportion of young people than any other country in the EU. Treatment for under-18s is complicated by issues of parental consent and concerns about prescribing substitution drugs in the absence of adequate research into the effects of such drugs in this age group. Most young people in treatment with severe drug problems attend ordinary treatment settings.

Specialised treatment services have been developed in some countries. For example, in the Netherlands, there is a small-scale clinic targeting 13- to 18-year-olds. In Finland, special emphasis is on a sustained and intensive psychosocial treatment continuum, with necessary institutional treatment. Based on 1999 information, there were six treatment units for young substance abusers, with a total of 40 beds. In addition, reform schools had three units specialising in drug treatment, with a total of 23 beds. In Luxembourg, there is one specialist centre, 43 % of whose clients are under the age of 16 years. In Greece, early interventions are aimed at adolescent drug users and their families (family therapy) as well as at adolescents who have problems with the law.

In Sweden, young people aged between 12 and 21 who have serious psychosocial problems, often in association with elements of criminal behaviour and psychoactive substance use, can be placed in institutional care without their consent. Methods of treatment include environmental therapy, functional family therapy, cognitive behavioural therapy and, for substance abuse, the 12-step method. Young offenders will, as an alternative to prison, be taken care of according to the Care of Young Persons (Special Provisions) Act in closed institutional youth care treatment. See ‘Treatment responses’ for further information.

(97)  See EDDRA.

(98) See Auftrieb.