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1.
Drug Prevention
Drug prevention is not a simple task. In defining 'prevention'
we must distinguish what we are trying to prevent.
Three main areas of Prevention
have emerged:
i)
Prevention of the supply of drugs: "the push
factor" including:
- prevention of production/ manufacturing
- prevention of distribution/ trafficking
- prevention of smuggling
(ii) Prevention of the demand for drugs: "the
pull factor" including
- promotion of abstinence or prevention of use
- promotion of delay in initiation of use
- promotion of reduction in use
(iii) Prevention of drug problems: "the
problem factor" including
- prevention of problem drug use
- promotion of harm reduction/ minimisation
The type of drug prevention work which is undertaken
depends on the target group, the level of drug use,
the context, and on the role and expertise of the drug
prevention practitioner. NYHP (2002) note that:
-
Well-meaning but ill-informed prevention programmes
can have adverse effects on the target group;
Prevention programmes should be delivered by individuals
who are appropriately trained commensurate to the
type of intervention being employed;
-
The design and implementation of all prevention programmes
should be governed by evidence based techniques;
-
A culture of evaluation commensurate with the level
of intervention should be actively encouraged
2.
Universal & Targeted Programme
The multifaceted nature of drug use has led to the development
of several broad prevention strategies.
These include:
(1).
Universal
programmes which aim to reach general population
or smaller defined settings.
(2).
Targeted programmes which have been termed
selective and indicated. While selective programmes
target those who are members of at risk groups, indicated
programmes are designed for those young people who
have already tried drugs or show risk related problem
behaviours.
| Universal
Programmes: Selected
advantages and disadvantages |
Advantages
|
Disadvantages
|
No
labelling or stigmatisation of individuals
Provides a setting or prepares the way for targeted
programmes
Provides the possibility for focusing on community-wide
contextual factors
Behaviourally appropriate e.g. high risk children
are not expected to change their behaviour when
they are living amongst children who have high levels
of the same behaviour |
May
be unappealing to the public or decision makers
Little benefit to the individual
May have the greatest effect in those at lower risk
Community initiatives may be undermined
Maybe perceived by low-risk population as being
of little benefit to them
Difficult to detect an overall effect
|
| |
|
| Targeted
Programmes: Selected
advantages and disadvantages |
| Advantages |
Disadvantages
|
Potential
of addressing problems early on
Potentially efficient in directing resources appropriately
Early mobilisation of inter-disciplinary resources
|
Possibilities
of labelling and stigmatisation
Difficulties with screening : Cost and commitment,
Boundary problems, Risk status unstable, Difficulty
of
targeting accurately
Power to predict future disorder usually very weak
High risk group contributes many fewer cases than
low
risk group
Tends to ignore the social context as a focus of
the intervention
Behaviourally inappropriate e.g. - the whole population
has the high levels of the behaviour that is the
focus of the intervention |
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(DOH,
2001:19:20) |
3.
Drug Prevention Programmes Guidelines
Target
Group
- Be
firmly based on the needs, motives and values of the
target group, which should be identified prior to
programme delivery
-
Be age, developmentally and culturally sensitive and
appropriate
-
Aim to target those most at risk and introduce timely
programmes
-
Encourage agencies and groups to select trainees who
would get the most from training
-
Take into account all the needs of trainees: personal
and professional needs, their needs as trainees and
as part of wider networks
-
Take into account the diversity of the target group
when planning course content and method
Content
- Allow
participants to negotiate course content and method
to ensure training meets their needs
-
Target all forms of drugs both legal and illegal
-
Ensure information is up-to-date, authentic, accurate
and relevant
-
Messages should be perceived as familiar, attractive
and credible by the target audience
-
Consider varying attitudinal and experiential levels
of drug use
-
Involve more explicit educational content than "just
say no"
-
Do not involve zero tolerance policies
-
Do not exaggerate negative effects of drugs
-
If trying to promote a behaviour change, then this
behaviour should be specific
-
Emphasise the positive benefits of changing behaviour
rather than the negative effects of current behaviour
-
Reinforce existing attitudes and beliefs of non-regular
users
-
Explore a few substantive issues rather than trying
to cram too much in
Methods
- Use
a variety of training methods; embrace interactive
methods rather than didactic techniques alone
-
Design to enhance protective factors and reduce risk
factors
-
Include skills to resist drugs, strengthen personal
commitments against drug use and increase social competencies
-
Value multidisciplinary work as an integrated approach
-
Be sustainable – with booster sessions to reinforce
original goals
-
Be consistent, and repeatable
-
Allow trusting relationships with participants to
develop
-
Encourage trainees to articulate their needs during
courses and adapt the training to meet their needs
-
Build in networking opportunities to the training
sessions
-
Deliberately facilitate post-course networking among
participants
Context
- Be
firmly positioned in a health promoting framework
-
Be adapted to address specific local issues
-
Ensure the programme is supported through policy at
an organisational level
-
Involve multi-point educational approaches: including
parental, family, school, community and social influences
-
Locate the programme within a context such as the
family, community, school, etc
Implementation
- Have
a clear highly defined purpose, including clear aims
and objectives which are measurable and realistic
-
Show awareness of the cost effectiveness of prevention
programmes
-
Have continuous built in evaluation mechanisms
-
Monitor and evaluate the success of training against
planned outcomes. Use principles involving quantitative
and qualitative outcome measures to rate a programme's
effectiveness
-
Plan the structure and content of the course carefully
-
Think of practical considerations e.g. - the suitability
of the venue, noise and privacy
-
Concentrate on smaller groups if possible
-
Use only high-quality worksheets and resource material
-
Exchange good ideas and practice with other trainers/training
providers
Adapted from Williams, 1995:3; NIDA, 1997; Lindesmith,
1999; Baker and Caraher, 2001
4. Educational Approaches
to Drug Prevention
A
range of educational approaches have emerged, with varying
degrees of effectiveness, as indicated in the chart
below. It is of critical importance that the approach
to be adopted by an organisation/ worker has been thoroughly
analysed prior to its endorsement and implementation.
| Approach |
Content |
Effectiveness |
| 1.
Didactic Approach |
| Shock-Horror |
Based
on ‘deterrence by horrible example' theory, e.g.
dead addicts on mortuary slabs. |
Not
effective, may have reverse effect. |
| |
Uses
fear-based propaganda. |
Message
may not be entirely rejected. |
| |
|
May
focus concerns on dangers to others rather than
to oneself. |
| Scientific
Information |
Gives
scientific information or facts about drugs. |
Can
increase knowledge. |
| |
Based
on the belief that all behaviour is rational |
Virtually
no impact alone on drug use or intentions to use
drugs. |
| |
Assumes
that increased knowledge will change behaviour |
|
| 2.
Affective Approach |
| |
Considers
individual and community attitudes and values to
drugs.
|
Can
succeed in clarifying and/or modifying attitudes |
| |
Assumes
that clarification of feelings will produce healthier
behaviour. |
Marginal
effect on knowledge or behaviour |
| |
Assumes
that increased knowledge and clarified attitudes
lead to behaviour change. |
|
| 3.
Behaviorial Approach |
| |
Based
on increased life skills and social competence. |
Varying
effectiveness according to the drug.
|
| |
Assumes
that drug use is a learned functional behaviour |
Can
lead to reduction in e.g. smoking alcohol use.
|
| |
Assumes
that increased self-esteem and social skills lead
to reduced drug use |
May
be criticised for being manipulative.
|
| |
Recognised
as the ‘just say no' approach |
Can
increase knowledge and modify attitudes |
| 4.
Situational Approach |
| |
Focuses
on giving information and increasing decision-making
skills when first offered drugs |
Can
improve decision-making skills.
|
| |
Assumes
the situation or context for drug use is important |
Can
increase knowledge |
| |
Assumes
specific skills are needed to make health choices |
Does
not reduce experimentation with drugs.
|
| |
|
Can
promote less harmful methods and / or circumstances
of drug use. |
| 5.
Cultural Approach |
| |
Focuses
on the social situation of the drug user. |
This
is a new, holistic approach and is more pertinent
in some areas than others (low socio-economic areas). |
| |
Considers
how culture, race, class and income influence behaviour
norms. |
Recognises
the realities of drug use. |
| |
Assumes
that socio-economic factors and behaviour norms
influence drug use. |
Provides
a focus for social change in which young people
in a community setting are empowered to influence
change and bring about change. |
| |
Mirrors
a political education model. |
|
| 6.
Harm Reduction Approach |
| |
Focuses
on reducing or minimising harm related to drug use. |
Aimed
at those already involved in using drugs. |
| |
Examines
the risks involved in the different drug |
Not
immediately effective in reducing the numbers using
drugs. |
| |
Does
not aim to prevent or reduce those using drugs. |
Has
been effective in minimising harm among injecting
drug users, but has not been assessed to great extent
among non-injecting drug users. |
| |
This
approach may be combined with any of the other approaches
mentioned above, depending upon the education setting.
|
|
| 7.
Peer Approach |
| |
Uses
peers to educate others of similar age and / status. |
Very
much en vogue at present. Needs to be genuinely
critiqued by all involved. |
| |
Can
range from general mentoring to skills building. |
There
is some evidence that it may delay onset of use. |
| |
Uses
elements of information, life skills, resistance
training approaches. |
Peer
leaders need person-based credibility, experience-based
credibility and message based credibility. |
| Source:
Dealing With Drugs Issues in Youth work, NYHP,
2002 (p. 52) |
5. The
National Drugs Strategy
On
a national level, responses to drugs and related problems
have developed around 4 pillars, namely: supply reduction,
prevention, treatment and research. With regard to prevention,
the National Drugs Strategy 2001-2008 (NDS) highlights
the need for comprehensive demand reduction strategies
which:
- Seek
to strengthen resilience among young people by fostering
positive, stable relationships with family or key
community figures, thereby increasing their sense
of belonging to family / social group / locality and
improving their educational, training and employment
prospects.
-
Seek to increase the communities understanding of
the antecedents of drug misuse and effective harm
reduction interventions.
-
Are cognisant of the complexity of youth culture and
which can effectively influence young people's choices
in relation to drug misuse.
-
Link drug-specific interventions with interventions
in related areas such as youth crime prevention and
mental health promotion strategies, employment, education
and training initiatives.
-
Maximise the effectiveness of school-based programmes
through efforts to keep young people engaged in education
and the identification of supports for ‘at-risk' children,
management of drug-related incidents and a broad-based
curriculum which supports all aspects of the child's
development.
The
NDS recommends that as our knowledge of how individuals
become involved in drug misuse increases, this should
elicit a corresponding level of efficacy with regard
to the specific drug prevention strategies employed.
The NDS, in addition to emphasising the importance of
prevention, stresses the need for a wide range of services
and structures to be augmented.
‘as
well as effective drug specific prevention strategies,
tackling poverty, providing better housing, access to
educational opportunities, supportive environments for
parents and employment prospects, all have a role to
play in prevention and management of drug misuse and
drug-related harm….. there is a need to develop an inclusive
approach which aims to ensure that young people are
afforded opportunities for well-structured leisure activities'
(NDST,2001:98)
6. Why do drugs education
programmes fail?
Dr.
Mark Morgan has identified five factors which contribute
to rendering certain drug prevention programmes ineffective;
-
Unrealistic Expectations:
Differing expectations about what a prevention programme
can achieve, and to what extent the school curriculum
can play a part in drug prevention.
-
Programme Implementation:
Many prevention programmes fail as a result of non-implementation
or partial implementation.
- Problems
of Implementation:
Practical problems involved in implementation, including
the failure to evaluate the process and outcomes as
well as other chronological and administrative difficulties.
- The
Future of Implementation:
The congested curriculum in the formal education sector
creates difficulties in providing space for prevention
programmes.
- Environmental
and Cultural factors:
Firstly, there is often a major gap between the content
of programmes and the experience of the young people
at whom they are targeted. Secondly, for many young
people, experimentation with drugs is the norm while
use of recreational drugs has a specific function.
Finally, the effectiveness of interventions is sometimes
lessened by a failure to take into account that young
people may be at different stages of use.
-
Morgan, 2001:46-56
7. Drugs Education and Prevention
Resources:
The
following resources are available from source, or can
be consulted in the DAP offices in Clonliffe College,
Dublin 3.
Building
on Experience - National Drugs Strategy 2001-2008; Department
of Tourism, Sport & Recreational, 2001.
Choosers or Losers? Influences on Young People's Choices
About Drugs in Inner-City Dublin; Paula Mayock, the
Children's Resource Centre, Trinity College, 2000.
Copping On, National Crime Awareness Initiative; Marian
Quinn, Copping On, 2000.
Drug Use Prevention, Overview of Research; Dr. Mark
Morgan, National Advisory Committee on Drugs, 2001.
Health Promotion in Youth Work Settings, A Practice
Manual; The National Youth Health Programme, 1999/2000.
Illicit Drug Use in Northern Ireland, A Handbook for
Professionals; The Health Promotion Agency for Northern
Ireland, 1996.
It's Your Choice! Creative Ways of Working With Young
People on Alcohol Awareness, Resource Pack for Adults
Working With Young People; The National Youth Health
Programme.
The Youth Work Support Pack For Dealing With the Drugs
Issue, The National Youth Health Programme, 1996.
Young People and Drugs, Critical Issues for Policy;
Barry Cullen, The Children's Resource Centre, Trinity
College, 1998.
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