In March 2019, the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) published Drug prevention: exploring a systems perspective, as part of its Technical Report series.1 Drawing on systems theory, the report considers substance use prevention in Europe through the lens of a system. A system is described as being made up of ‘a set of elements organised for a common purpose that are connected and interact with each other to form an integrated whole’ (p. 6). By taking this approach, the report highlights the wide range of factors that need to be considered when implementing substance use prevention programmes and policies.

Prevention system model

Data gathered from the Reitox National Focal Points, as part of the EMCDDA’s annual reporting cycle, were used to develop a model of an overall prevention system (see Figure 1). It is proposed as a starting point for comparing and analysing national or regional approaches to prevention, and reflects how prevention is conceived, organised, and delivered across the member states, as well as how the components interact. 

The five commonly accepted components of a prevention system featured in the model are each explored in the report using analysis of the Reitox data. For the purpose of this article, each component is described alongside a selection of the related findings.

1. Organisation

The authors focus on three aspects of how prevention delivery is organised:

• Decision-making – where decision-making happens, how evidence is used in the process, and how local needs are assessed. In relation to the second, of these a need was identified for a better understanding of how research and policy interact, and for researchers to become more attuned to the needs of policymakers and practitioners. Having an assessment of local needs was described as a feature often lacking in the area of prevention, in particular when compared with the fields of treatment and harm reduction.
• Intersectorial cooperation – how/if it occurs and the conflicting views and priorities that exist. While there may formally be a drug coordinating role or body in a country, this did not necessarily result in coordination in practice. Barriers included the conflicting priorities within a country’s governing bodies; for example, between the revenue produced by the sale of addictive goods such as alcohol and the health costs associated with its use.
• Funding – how prevention is funded and why certain activities may be funded and not others. While the sources of funding for prevention across Europe varied, data on funding and how decisions are based on it was described as ‘scarce’ (p. 15).

1. Research and quality assurance

Having the capacity to translate scientific findings, effective interventions, and principles of effectiveness into practice and existing services is described as ‘one of the most vital features of a prevention system’ (p. 17). The authors identify a number of challenges in doing so, which include:

• A lack of knowledge among stakeholders about the evidence of what works in prevention.
• The focus of the (largely North American) evidence base on manualised activities presents challenges in the European context. A need is identified for more focus on how to translate evidence into practice and evidence on non-manualised activities.

1. Interventions

The authors note that in order to be of use in the prevention field, the systems approach needs to take account of interventions of all forms (universal, selective, and indicated) and functions (developmental, environmental, and informational) that currently feature in the debate. They identify one of the main debates among prevention professionals in Europe to be ‘whether manual-based programmes should be scaled up or emphasis should instead be given to local solutions that fit the particular circumstances of the culture, problem and infrastructure’ (p. 21).

The prevention field in Europe and the range of interventions delivered is complex. Manual-based programmes, selective and indicated services, and environmental policies are discussed in this section of the report ‘to showcase the different perspectives and priorities that a systems approach to prevention is able to incorporate’ (p. 19). It was found that a distinctive feature of European prevention systems is that manual-based interventions often do not play a significant role. The authors explored the focus of each member state’s prevention activities, asking whether they focused more on environmental policies or manualised programmes; Ireland was found to put more emphasis on the former.

Another key issue identified under interventions was that while there is often overlap between the determinants of different problem behaviours (e.g. substance use and violence/delinquency) and therefore the possible prevention interventions that could affect change, because they fit under different political portfolios, these commonalities are not understood and opportunities to have an impact are missed.

1. Workforce

This component covers the numbers in the workforce, the types of individuals, and the skills they have. Overall, the prevention workforce is diverse and finding information on its composition and training was described as ‘difficult’ (p. 23). It was noted that there is no agreed means to monitor the quality of prevention work and there was no common professional profile of a prevention worker. The need for standards and training for those working in the area was highlighted.

1. Target populations

The recipients of prevention are a critical component of any system, not only as recipients but also in the development of interventions. As mentioned above, assessing local needs is often lacking from prevention systems. Other issues identified that need to be considered when selecting suitable and relevant interventions included the level of social exclusion experienced by the target population and the acceptability of programmes by the target population.

Alongside the five components laid out above was a set of moderators that influence the interaction between the components. These included: social inequality; social capital; social norms; alcohol and tobacco policies; and drugs legislation.

Concluding comment

This report is not a ‘how to’ guide on prevention, rather through the experiences of member states it provides a useful starting point for looking at core components of prevention systems and how they interact. It raises a number of interesting themes for prevention in the Irish context. For example: promoting and advancing a comprehensive definition of prevention; making links between substance use prevention and other behaviours; the relationship between funding and quality assurance; skills development and training for prevention professionals; and decision-making about interventions at national, regional and local level. 

1    European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) (2019) Drug prevention: exploring a systems perspective. Technical Report. Luxembourg: Publications Office of the European Union. https://www.drugsandalcohol.ie/30362/