‘School and family-based programmes for preventing substance misuse’ was the theme of the fifth annual Addiction Research Centre conference, held in Trinity College Dublin in September. A panel of international and national speakers addressed aspects of the topic in three sessions.

1.      Being realistic about school programmes

Primary prevention (stopping young people from ever using drugs or getting them to stop using) has been the main approach to school-based drug education, and to date it has proved to be ineffective in preventing drug use among young people. This was the view of keynote speaker Julian Cohen, an independent researcher and consultant in drug education in the UK, who argued that drug prevention programmes based on the primary prevention approach rely on false assumptions about young people’s drug use and are more in the realm of propaganda, than being based on research evidence and what happens in the real world. Cohen advocated a harm-reduction approach, which would take full account of research evaluations and the reality of young people’s drug use and would be based on sound educational principles. Such an approach would focus on young people’s health, safety and well-being, rather than on whether or not they use drugs. Cohen outlined the possible content of such programmes, together with good-practice guidelines for implementing them.

In response, Bernie McConnell of Community Awareness of Drugs argued that it is unhelpful to polarise the debate about drug prevention, as Cohen had done, and that it is more useful to recognise the complexity of good prevention and remain open to new ways and ideas about overcoming the complexity, drawing on both primary prevention and harm-reduction approaches as appropriate. Dr Mark Morgan of St Patrick’s College, Drumcondra, emphasised the need to consider what expectations we have of any school intervention; to consider the evidence regarding implementation, and the extent to which failures are due to non-implementation; and to distinguish between programmes that are relatively ‘better’ than others.

2.      Prevention with high-risk families

Dr Karol Kumpfer, Professor of Health Promotion and Education at the University of Utah, USA, gave a paper on the Strengthening Families Program (SFP), designed to prevent substance abuse. The programme was based on research on over 10,000 young people, which suggested that the most important protective mechanism against drug abuse is the family, and that the most important protective factors are parent/child attachment, parental supervision and effective family communication and expectations about the use of drugs and alcohol. Dr Kumpfer described other research which revealed that children of substance abusers can learn to be resilient and have happy productive lives. In outlining the design, content, implementation and outcomes of the SFP, Dr Kumpfer demonstrated how it was based on this research and focused on reducing family risk factors by increasing family protective and resilience factors.

The SFP has been replicated in randomised control trials by a number of independent researchers other than the programme developer, Dr Kumpfer, with large positive changes being demonstrated in parent and child behaviour even in 10-year longitudinal studies. Dr Kumpfer reported that the SFP is listed as an evidence-based substance abuse prevention programme by US government research agencies and also by the WHO International Cochrane Collaboration Reviews. It has age adaptations for 3–17-year-olds and is being implemented in six countries, with about 1,000 group leaders being trained each year.

In response, Mary Cullen of Mounttown Neighbourhood Youth Project in Dun Laoghaire considered the practical application of family support programmes in the context of social and economic disadvantage. Barry Cullen, former director of the Addiction Research Centre, welcomed the development of programmes such as the SFP and argued that, in developing this policy further, policy makers and health service managers would do well to test, evaluate and assess the application of family intervention programmes.

3. Drugs, alcohol and the ‘whole school’ approach

Ruby Morrow of the Church of Ireland College of Education suggested that schools should be just one of the groups and agencies involved in seeking to prevent drug use among young people. Attitudes to and use of drugs among young people reflect the influence not only of the formal education system but also of the family, local community, and the wider culture and media. Morrow outlined a ’whole school’ approach that sees schools, together with family, peers and community, helping children and young people develop the personal strengths and skills to make informed decisions and deal with challenges as they arise. The approach includes the following key elements:

·       a health-promoting school

·       delivery of the Social, Personal and Health Education (SPHE) programme

·       early identification of the vulnerable and of those experiencing difficulties

·       referral to appropriate outside agencies (as necessary) and in-house school support.

Sinéad O’Mahoney Carey, Drug Education Officer with the HSE South Eastern Area, gave a regional, as opposed to a national, perspective on the ‘whole school’ approach. She described the holistic implementation process involved in developing secondary school substance-use policies within the South Eastern Area. The speaker identified the key issues that arose in the process whereby drug education officers worked in partnership with schools and health promotion personnel in implementing the policies.