The National Institute for Health and Care Excellence (NICE) in the UK published updated guidance on Drug misuse prevention: targeted interventions.1 The focus was on preventing or delaying ‘harmful use of drugs in children, young people and adults who are most likely to start using drugs or who are already experimenting or using drugs occasionally’ (p. 5). It was concerned with the use of illegal drugs, ‘legal highs’ and prescription-only medicines.

The guideline was aimed at a range of stakeholders: health and social care professionals; commissioners and providers; practitioners working in drug misuse prevention and specialist drug treatment services; owners and staff at venues where people using or at risk of using drugs attend; educational governance workers; people who use drugs; their carers and families; and the public. The recommendations were based on the findings of an expert committee’s review of the evidence and submissions from experts working in the area. They considered both the effectiveness of the interventions in reducing drug use and their cost-effectiveness. If an intervention delivered on the former but was not cost-effective, it was not recommended. Overall, the committee found limited evidence for the cost-effectiveness and effectiveness more broadly of drug misuse prevention interventions across the groups at risk.2

Assessment

Carrying out an assessment of the individual’s drug use was consistently found to be a part of effective interventions – this helped ensure that an appropriate intervention was offered. The committee recommended that people in these groups should be routinely and opportunistically assessed for vulnerability to drug use. This should be done as part of any appointments they might have with services such as health and social care services, and the criminal justice system.

Children/young people assessed as vulnerable to drug misuse

Where children and young people were assessed as vulnerable to drug use, the committee recommended skills training for them and their carers or families. They did not recommend skills-based training for the young people alone or just their carers/families. This was found to be a more cost-effective way to reduce the risk of drug misuse than other interventions explored: family-based interventions, manualised/licensed programmes, or motivational interventions. They noted that skills training was likely to improve a range of drug-related and non-drug-related outcomes.

Components of effective skills training for children and young people included developing skills in listening, conflict resolution, refusal, managing stress, making decisions, coping with criticism, dealing with feelings of exclusion, and making healthy behaviour choices. For carers or families the skills to develop were: communication, developing and maintaining healthy relationships, conflict resolution, and problem solving. They recommended that age, developmental stage, vulnerabilities, cultural context, religion, and ethnicity should all be considered when deciding on the details of the skills training sessions.

Adults assessed as vulnerable to drug misuse

There was not enough evidence of effectiveness and cost-effectiveness to be able to recommend skills training or motivational interventions for adults who had been assessed as vulnerable to drug misuse. Instead, the committee recommended that practitioners continued to deliver ‘current practice’. This was found to include brief information and education on drugs and their effects (including the health and social effects), with the opportunity for feedback. The committee also recommended that adults be given information on sources of advice and support if their risk of drug misuse increased. The information and other resources should be delivered at the time of assessment in both a written and verbal format. A plan for follow-up should also be made at the time of assessment.

People at risk of using drugs

The report also makes recommendations for working with people who are not in touch with services. In the absence of an evidence base of effective interventions, they recommend providing information about drugs and an online assessment and feedback tool. This could be web-based and use social media. However, written information should be provided to those who do not access online services.

Research recommendations

Given the weak evidence base for targeted prevention interventions, the committee recommended support for research on a number of topics, including: the long-term consequences of drug use, interventions for image and performance-enhancing drugs and new psychoactive substances; effectiveness of digital technologies in delivering prevention interventions; and acceptability of drug misuse prevention interventions among vulnerable groups.

1    National Institute for Health and Care Excellence (2017) Drug misuse prevention: targeted interventions. NICE guideline [NG64]. London: National Institute for Health and Care Excellence. https://www.drugsandalcohol.ie/26887/

2    For the purpose of the guideline, ‘groups at risk’ were defined as including: people who have mental health problems; people who are being sexually exploited or sexually assaulted; people involved in commercial sex work; people who are lesbian, gay, bisexual or transgender; people not in employment, education or training (including children and young people who are excluded from school or who truant regularly); children and young people whose carers or families use drugs; children and young people who are looked after or care leavers; children and young people who are in contact with young offender teams but not in secure environments (prisons and young offender institutions); people who are considered homeless; people who attend nightclubs and festivals; and, people who are known to use drugs occasionally or recreationally.