Prevention work can plan its attack at different moments in time. If one works on the chain of
production - distributive trade - retail sale - consumption, then it is quite clear that each link in the chain offers scope for prevention work.
In planning prevention activities which are, in the first place, directed at users and potential users, a series of questions emerge - questions whose answers are not foregone conclusions.
Prevention is a field or market in which a diversity of programmes, with just as diverse aims, are competing for attention. A few decades ago the prevailing view that the use of psycho-active substances was highly condemnable has increasingly been swept away by the view held by certain groups of users that it is ‘normal’ to have a drug on hand for every desirable emotion. Faced with this confusion on standards, policymakers and prevention workers have to decide upon their own position. In making their choice, they are confronted with innumerable, quasi age-old dilemmas, like:
Voluntary control - as opposed to - external coercion to ensure control.
Concentrating on protective factors - as opposed to - encouraging factors.
Concentrating on risk groups - as opposed to - the general population.
Concentrating on primary - as opposed to - secondary prevention.
Concentrating on First Order Change (increasing the price, forbidding sales and the like) - as opposed to - Second Order Change (behavioral change and the like).
Concentrating on civil liberties, protecting the privacy of the individual – as opposed to - state intervention (‘the ends justify the means’).
Concentrating on the declaration of measures - as opposed to – the maintainability of measures.
Concentrating on what works in the dominant culture - as opposed to – what works in a counter-productive way for the subculture.
Concentrating on pure use - as opposed to - use as a part of problem behaviour.
If viewed from a historic point of view the prevention sector has always been inclined to opt for the more radical approaches to achieve abstinence - based on the assumption that it is easier to begin than to stop.
Providing guidance for use, as an exercise in itself, remained outside the field of prevention work for a long time. Nowadays it is becoming more common to focus on the extent to which use can be considered safe and consciously under control. For alcohol this approach is more or less accepted.
Viewed from the tradition of addiction care, discouragement of use is one of the main tasks of prevention. From the political arena, and society at large, there are regular reminders that absolute abstention from drugs is highly desirable. The advantages of abstinence from drugs, as a moral view, speak for themselves, so prevention workers should make it their job to see that these advantages are pointed out to the public.
However, if protecting public health, and in particular protecting young people, is the aim, it is sometimes necessary to set up users’groups.
A current problem for prevention (comparable to that experienced in the ‘marketing’ of services and products) is that at present cultures and youth cultures are subject to fragmentation - as a result of the individualized nature of society - whereby it isdifficult to appeal to people collectively. Yet another reason to spare the prevention sector from overburdening by providing them with a good support system.
a. striving to reduce the chance of serious social and personal problems arising by: weakening the influence of risk factors (like circumstances, inadequate social skills); strengthening the influence of protective factors (like social support, adequate social skills);
b. encouraging people to seek and find help as quickly as possible once problems arise and intensify.
This last aim, in principle, runs up against the fixed capacity of care-providing institutions and professional groups. In view of the fact that early help shows a higher therapeutic yield and is relatively cheaper, it is advisable to encourage early interventions.
One of the main questions facing preventive health care is whether it is useful, and subsequently questions like where, for whom, when, under what circumstances and with what results. But, where the effects and efficiency of prevention have been proven and it can, as it were, be weighed against curative care, there is sufficient reason to offer both elements as a mix in an extensive programme.
Educational aims for parents are:
they must be aware of the drugs, their names, and how they work;
they must know where drugs can be obtained and what kind of situations they are used in;
they must set a good example themselves;
they must be capable of listening to their children carefully and must lay down clear rules on smoking and drinking at home. If a strong, clear-cut value system is transmitted to children it gives them something to go by when taking decisions;
as the mass media (advertising, films, etc.) are the main sources of information for children on the use of alcohol, cigarettes and drugs, parents must be encouraged to evaluate media messages with their children;
parents can be taught how to detect alcohol or drug use at an early stage, and what to do next;
drug users and addicts generally have a negative self-image. People with a positive self-image are more resistant to social pressure. Parents can help children to develop a positive self-image by encouraging them to achieve and not comparing them with others;
parents can be advised to encourage their children to engage in healthy and/or creative activities for the sake of their personal development and to combat
Features of these programmes are:
1. A broad base of support
This could be achieved, for example, by setting up a broad-based advisory council on which schools and outside organizations work together to formulate a clear message on alcohol and drug use.
2. Parent involvement
Information leaflets can be sent out to try to involve parents. This would of course be the absolute minimum. It would be far better to organize meetings for parents and to try and involve them in the process actively, both at school and at home.
3. Teaching material on alcohol, tobacco and other drugs
To be suitable, teaching material should meet the following criteria:
It should transmit a clear message (‘don’t take drugs’);
It should make it clear that drugs are illegal and harmful;
It should make it clear that young people have to accept responsibility for the choices they make;
It should not contain illustrations of how to use drugs;
It should tie in with the world and culture of the target group in terms of language and design.
4. Rules and regulations on alcohol and drug use
These are a very strong deterrent. Clear, specific, well-defined rules on use and enforcement could be drawn up, based on research into the nature and extent of use.
This is a prevention programme targeted at schools, where children are assigned a mentor to assist them in improving their performance at school and to help with other problems.
Teachers need to be well informed about alcohol and drug use. It is important for them to be able to recognize signals of problem behaviour in general, and drug use in particular, at an early stage. Teachers can be trained in skills of this kind and in how to implement prevention programmes properly. It is also important for them to be encouraged to review their own convictions and conduct as regards smoking, drug and alcohol use.
It is well-known that programmes of this kind require a low level of fear and an information-provider with good communication skills.
There are different types of schemes:
knowledge-based; based on affective and interpersonal communication; based on ‘kicks’ that are an alternative to alcohol and drug use; and based on behavioral aspects such as dealing with social pressure.
The research findings in these different domains are generally not clear-cut:
knowledge is often enhanced, but this does not always result in a change in behaviour for the better. As regards the programmes concerned with affective and interpersonal communication, the objectives are laudable, but these are far removed from the immediate goal of reduced use or abstention.
The current programmes include some of the following components:
technical information on drugs and their effects;
training in decision-making techniques regarding drugs;
clarifying values;
stress management techniques;
working on self-esteem;
training in setting and achieving goals;
training in social skills for resisting social pressure;
pledging not to use drugs;
guiding group norms and individual norms;
learning how to help a fellow-student;
finding and encouraging alternative activities.
The benefits category will include not only effectiveness but also factors such as the support of the parties involved (e.g. teachers, parents’ council) and of the financial backers for the chosen method.
Before asking someone from outside to give a lecture on drugs, it is important, as far as schools are concerned, to ask the following questions:
Does the prevention worker agree with the school’s philosophy and the approach it takes to health education?
Will his or her contribution fit in with the school’s philosophy, theory and practice?
Does the project fit in with the existing teaching material?
Why is the school asking for input from an external person, and is the person in question (the prevention worker) the most suitable person to give the talk?
Is the prevention worker acquainted with the emotional and intellectual level of the target group, and does he or she speak ‘their language’?
Is the school aware of the possible legal implications of calling in someone from outside?
Experience has shown that it is important for the follow-up for the class teacher to be present when the prevention worker speaks. Before the prevention worker decides to give a lecture, he or she must be aware of:
The school’s reasons for calling in someone from outside.
What the course is expected to accomplish.
What previous education on drugs the students have already had, and what they will be receiving later.
The characteristics of the target group such as number, age, family background, etc.
One prerequisite for the implementation of a prevention programme in a school - if the initiative is taken elsewhere - is support from above. The school administration must acknowledge that there is a need for it and be positive and enthusiastic about the new prevention project. It must be able to stimulate and encourage the teaching staff during the execution of the programme.
The following principles are important for the management of the process:
Personal contact with all levels is a fundamental requirement.
The staff must be convinced of the importance of the programme and prepared to invest in it.
Flexibility and openness to suggestions on the part of the staff are important.
Teamwork must be emphasised, especially when it seems difficult.
The staff must have a strong feeling of being involved in the running of the course and form an essential part of the project.
Those carrying out the project do so on a voluntary basis; preferably, they should be rewarded (not necessarily in a material sense) for their efforts.
Research into the effectiveness of health promotion in schools has revealed that in general:
The effects of interventions based on providing information depend on the type of behaviour one is trying to influence.
Intervention based on providing information only seems to be effective in primary schools.
Anti-smoking campaigns that involve recognizing and learning to deal with peer group pressure appear to be more effective than ones aimed at supplying factual information, working on the target group’s self-respect or acquiring competence in, for example, decision making.
Changes in behaviour stop when the intervention ends - the cognitive effects are more permanent.
Programmes that lead to long-term changes in behaviour form part of a broad social approach.
Do not just consider the effectiveness of a programme, but also the extent of its usefulness within the education system in question.
Request feedback from the teaching staff.
Look for relevant behaviour determinants by carrying out a survey of needs and use its results in theoretical considerations of intervention alternatives.
Long-term evaluations indicate that the positive effects on behaviour decrease after a relatively short time. Thus, prevention programmes in schools must be combined with broader activities aimed at the general public.
Spread the interventions through the school year. This leads to a longer-lasting change in behaviour rather than a one-off prevention action.
Excerpts from the Handbook prevention : Pompidou Group – Council of Europe & Jelllinek Consultancy, 1998. http://www.pompidou.coe.int/English/prevenir/act-prev.html