Home > Communities That Care: a review.

Dillon, Lucy (2017) Communities That Care: a review. Drugnet Ireland, Issue 62, Summer 2017, p. 21.

PDF (Drugnet issue 62)

The National Substance Misuse Strategy1 found that community mobilisation can be successful in bringing stakeholders together to develop alcohol and drug policies. Communities That Care (CTC): a comprehensive prevention approach for communities is a review of one such approach and was published as part of the EMCDDA Papers series.2


Community mobilisation/coalitions

‘Community mobilisation’ and ‘community coalitions’ are strategic approaches used to reduce substance use and other harmful behaviours. Broadly speaking, they refer to a process through which communities work together to take action and bring about change, working with a range of stakeholders from the public, statutory and private sectors to identify the changes they want to bring about in their area. Based on the best evidence available, the different stakeholders plan together how to bring about the desired changes. They then implement the plan and monitor its progress in reducing the target behaviours.3


Communities That Care (CTC)

CTC is a US-developed system for mobilising communities to address young people’s health and behaviour problems, including substance use. According to the EMCDDA paper, it is essentially ‘a prevention operating system’ (p. 2) that provides a method for communities to assess the particular needs of their young people, coordinate the stakeholders, and select and implement suitable evidence-based programmes. The approach is based on the belief that by understanding the risk and protective factors experienced by the young people within the community, appropriate tested and effective prevention and early intervention programmes can be implemented to build on the protective factors and thus reduce problematic behaviours.


The review

The EMCDDA paper reviews the evidence on the effectiveness of CTC programmes in preventing substance misuse in young people. The review was facilitated by the availability of ‘some good-quality studies with diverse results’, although most of the research comes from North America. Of the 18 studies included in the review, 12 related to the same randomised controlled trial (RCT) of a CTC project in the US. The paper provides an overview of the findings from two RCTs, a before-and-after study, two quasi-experimental longitudinal studies with a comparison group, and an EMCDDA report on international organisations. The primary outcomes considered were a reduction in incidence and prevalence of alcohol and other drug use among young people; and the enhanced ability of communities in adopting, implementing with fidelity, and sustaining tested and effective prevention and early intervention programmes. Secondary outcomes sought were reductions in delinquency and other problem behaviours among young people.



The review’s analysis is described by the author as ‘limited’ by the lack of a meta-analysis (p. 4). Such a pooled analysis was not possible given the variation between studies in the outcomes measured, the statistical analysis methods used, and the quality of reporting. Instead, an overview of the findings from each study can be found in the paper. Overall, the findings were mixed. The authors concluded that the two RCTs, which were conducted in very different contexts (US and Australia), ‘do not provide conclusive evidence regarding the effectiveness of CTC, although they do strongly suggest a positive effect’ (p. 9). The strongest evidence of effectiveness by reducing the incidence and prevalence of delinquency and substance use for some cohorts came from the US-based RCT.



The other studies reviewed were of Europe-based CTC projects. They were used to assess the transferability of CTC to Europe. A number of issues were identified, such as:

  • The very concept of ‘community’ differs between countries. While the community members of the coalition tended to be volunteers in the US, they were more likely to be paid professionals in some European projects.
  • The CTC sites in Europe were less rural and more heterogeneous than those in the US, and disadvantaged neighbourhoods were not as poor and their residents not as socially excluded.
  • There is only a limited number of evidenced-based prevention programmes to draw upon in Europe compared to the US.
  • More lead-in time was required for projects, as participants were not always familiar with the concept of prevention programmes and their implementation. 


In conclusion, the review described CTC as a ‘useful preventative intervention in North America, but its effectiveness still needs to be clearly assessed in Europe’ (p. 9). To do so would require a sufficiently robust randomised study to be supported, as well as the appropriate adaptation of the programme to fit the European context.


1    Department of Health (2012) Steering group report on a national substance misuse strategy. Dublin: Department of Health. https://www.drugsandalcohol.ie/16908/

2    European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) (2017) Communities That Care (CTC): a comprehensive prevention approach for communities. EMCDDA Papers. Luxembourg: Publications Office of the European Union. https://www.drugsandalcohol.ie/26931/

3    The findings of the evaluation of an Irish community mobilisation programme were reported in issue 58 of Drugnet Ireland. https://www.drugsandalcohol.ie/25954/. See also Galligan C (2016) National community action on alcohol pilot project 2015: external evaluation project. Dublin: Department of Health. https://www.drugsandalcohol.ie/25098/

Item Type
Publication Type
Irish-related, Open Access, Article
Drug Type
All substances
Intervention Type
Harm reduction
Issue Title
Issue 62, Summer 2017
August 2017
Page Range
p. 21
Health Research Board
Issue 62, Summer 2017

Repository Staff Only: item control page