Home > ‘What works’ in drug education and prevention? A review.

Dillon, Lucy (2017) ‘What works’ in drug education and prevention? A review. Drugnet Ireland , Issue 61, Spring 2017 , pp. 17-18.

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In December 2016, the Scottish Government published the report by Warren on ‘What works’ in drug education and prevention?’.1 While the previous decade and a half had seen an overall reduction in substance use among young people in Scotland, there was a poor understanding of why this had happened and whether prevention activities had played any role in the decline or not. The review was the first step toward filling this knowledge gap – it aimed ‘to explore the evidence of effectiveness of different types of drug prevention and education for children and young people, principally that which is delivered in schools’ (p. 7). This was not a systematic review and no critical appraisal of the literature was carried out. However, the report provides a useful overview of the main issues faced by those trying to evidence the impact of drug prevention activities; the findings from key systematic reviews on drug prevention activity; and the findings of other core documents in the field.

 

Prevention science

Prevention science is a relatively new field, with its main aim being ‘to improve public health by identifying malleable risk and protective factors, assessing the efficacy and effectiveness of prevention interventions and identifying optimal means for dissemination and diffusion’.2 The author highlights that while the terms ‘drug prevention’ and ‘drug education’ are often used interchangeably they are in fact distinct activities. Drug prevention’s primary aim is to change people’s behaviour around drug use, whereas drug education is more about delivering factual information about drugs to people. There was no evidence that information provision alone changed behaviour and reduced drug use. The point was made that much of what is delivered in schools may be more drug education than prevention as such.

 

The report highlighted the complexities and challenges involved in carrying out research in this field, in particular in evidencing the impact of drug prevention activities: ‘Evaluating prevention is difficult, in particular, measuring something that has not yet happened, and unpicking which intervention made the difference in the long term’ (p. 11). These challenges included a lack of clarity around definitions of prevention; the high cost involved in measuring long-term changes in behaviour; the use of unsuitable shorter-term outcome measures concerning changes in knowledge and attitudes rather than behaviour; publication bias in favour of studies that showed positive outcomes; and, that changes presented as statistically significant could in fact be so small as to be meaningless.

 

Key messages

Despite these challenges, some key messages were identified from the evidence base:

  • A Cochrane review3 found that the effects of universal school-based programmes were small. It examined the effectiveness of universal school-based interventions in reducing drug use when compared to usual curricula activities or no intervention. Where an effect was found, it occurred in some programmes that were based on a combination of the social competence approach and the social influence theoretical approach. The former aimed to improve the young person’s personal and interpersonal skills; the latter focused on reducing the influence of society in general on use, for example, through normative education. Knowledge-focused approaches alone did not have a positive effect on preventing drug use.
  • As the effect of universal school-based programmes tended to be small, the authors of the Cochrane review concluded that to achieve population-level impact, school-based programmes should only be a part of a more comprehensive range of drug prevention strategies.
  • The findings of other reviews explored by Warren (2016) suggested other components that might have contributed to an increase in programme effectiveness. These included taking an interactive approach to delivery where students had a high level of participation; having more components to the programme over and above that in the school curriculum; ensuring that the content was age appropriate; and, peers being involved, but not leading, in the delivery of the programme.
  • While looking at the components of effective programmes was useful, a recurring finding was that what really mattered was the programme itself. Therefore, there was better evidence of effectiveness for specific manualised programmes as they had been rigorously evaluated. Indeed, manualised programmes tend to be highly structured and include training and implementation guidance. Fidelity to the programme design and delivery was highlighted as critical if they were to deliver similar outcomes when transferred to a new setting. Success was also dependent in part on the existence of an established national and local prevention system. Effective programmes discussed included the Good Behaviour Game and the Strengthening Families Programme.
  • There was a growing body of evidence of what did not work in preventing drug use among young people. The United Nations Office on Drugs and Crime (UNODC) found that programmes that had the following characteristics had no or negative prevention outcomes: using ‘ex-drug users’ as testimonials; using police officers to deliver classroom sessions; providing just information about drugs, especially if used for ‘fear arousal’; using non-interactive methods such as lecturing; and, focusing only on the building of self-esteem and emotional education.
  • Programmes do not need to target drug use specifically to have a positive impact on drug-using behaviour.
  • While the evidence base suggested that drug prevention should be embedded in strategies that take a broader approach to healthy development and well-being, there was a case for delivering more drug-specific prevention interventions for young people who are most at risk of drug-related harm or who are already using drugs. These young people were found to benefit in particular from universal programmes in which they had participated. The School Health and Alcohol Harm Reduction Project (SHAHRP) was identified as a universal programme for which there was evidence of positive outcomes for this higher risk group. 

Considerations for policy-makers

In conclusion, the report’s considerations for policy-makers when commissioning prevention programmes included that they should: adhere to recognised quality standards; incorporate a high-quality evaluation; ensure that ineffective or iatrogenic programmes were not funded; consider carrying out economic analysis to establish cost-effectiveness; take a wider view of the prevention system and the programme’s fit; and, consider programmes that target multiple risk behaviours.

 

1    Warren F (2016) ‘What works’ in drug prevention and education? Edinburgh: Scottish Government. https://www.drugsandalcohol.ie/26557/

2    Society for Prevention Research (2011) Standards of knowledge for the science of prevention. Fairfax, VA: Society for Prevention Research. Cited in Warren (2016, p. 12).

3    Faggiano F, Minozzi S, Versino E, Buscemi D (2014). Universal school-based prevention for illicit drug use. Cochrane Database of Systematic Reviews. https://www.drugsandalcohol.ie/23203/

Item Type:Article
Issue Title:Issue 61, Spring 2017
Date:April 2017
Page Range:pp. 17-18
Publisher:Health Research Board
Volume:Issue 61, Spring 2017
EndNote:View
Subjects:J Health care, prevention and rehabilitation > Prevention outcome
J Health care, prevention and rehabilitation > Prevention approach > Prevention through information and education
N Communication, information and education > Education and training
N Communication, information and education > Education by subject > AOD education

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