Five projects are to receive funding over the next 3 years under the Department of Health’s National Drug Prevention and Education Funding Programme. The fund aims to increase the delivery in Ireland of prevention programmes that are supported by evidence and adhere to international prevention standards.1,2 The five funded organisations and their projects are outlined in Box 1.

They will be delivered in school, third-level, youth work, and community-based settings. To mark the start of the funding programme, representatives of the five projects met with statutory and non-statutory stakeholders working in the field of prevention at an event hosted by the Department of Health on 6 June 2023.

European prevention expertise
The keynote speaker at the event was Gregor Burkhart, president of the European Society for Prevention Research (EUSPR) as well as principal scientific analyst for prevention at the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). He gave a comprehensive presentation outlining the science behind prevention, common fallacies that exist in Europe about this field, and some of the interventions for which there is evidence of effectiveness.

Aetiology of drug use
To understand how to prevent drug use, it is critical that the aetiology of drug use is understood. Burkhart led the development of the EMCDDA’s 2019 European Prevention Curriculum: a handbook for decision-makers, opinion-makers and policy-makers in science-based prevention of substance use, which is a valuable and accessible resource containing details of the science of prevention and the evidence base that underpins the field.3 It is grounded in the aetiology model (see Figure 1), which is based on studies of risk behaviours such as substance use.

It shows that initiating substance use involves an interaction between individual personal characteristics, such as genetic predisposition, temperament and personality type, differences in how one actually sees, hears and ‘feels’ the surrounding environment or persons, and experiences outside the individual. The aetiology model shows these interactions, which are bi-directional at both the micro and macro levels. (p. 32)3

A clear understanding of this model is a prerequisite for successful prevention.

Source: EMCDDA, 2019, p. 32.3

Figure 1: The aetiology model

In the context of explaining why information-based interventions do not work in preventing initiation of substance use, Burkhart presented the graphic in Figure 2 on the pathways of substance use. He emphasised that at initiation environmental factors, such as the perception of normality about substance use, are more important than factors associated with the individual’s personality.

However, personality aspects, such as a tendency towards sensation-seeking, become more important in influencing whether someone continues their use, once initiated. Pharmacological aspects of the different drugs, such as how addictive a substance is, only really come into play at the later stage in the pathway to problematic use. Interventions need to be cognisant of these influential factors to have an impact.

Source: EMCDDA, 2019, p. 37.3

Figure 2: Pathways of substance use

Key messages
While the findings of research in this field are complex and wide-ranging, some of the key messages conveyed by Burkhart in relation to ‘what works’ included the following.

• Prevention interventions that focus on providing information on specific drugs to young people have been found to be either ineffective or to increase levels of drug use among young people.
• Parents/carers introducing young people to substances creates problems – for example, parents introducing young people to alcohol through early sipping or tasting has been found to increase their frequency and quantity of alcohol consumption and related problems in late adolescence.
• Talking to young people about alcohol or cannabis at an early age is a message often promoted by industry bodies. This approach has been found to be a risk factor for use as, in its simplest terms, it creates an environment in which use is normalised.
• Higher levels of pocket money have been found to be associated with higher levels of use and the use of different substances. For example, young people with the highest rate of pocket money are the most likely to use cocaine.

Extended opening hours of licensed premises result in increased alcohol-related harms.

Concluding comment
Prevention science is a fast-evolving field and there is an increasing evidence base for what works and what does not. The selection of prevention interventions can sometimes be more influenced by stakeholders’ beliefs about what works rather than the scientific evidence of what has been found to work.

Developments at national and international levels offer support and training for those working in the prevention field. There are also an increasing number of resources available to Irish stakeholders to draw upon. For example:

• The European Prevention Curriculum (EUPC) aims to implement a standardised prevention training curriculum in Europe and improve the overall effectiveness of prevention.3,4
• The EMCDDA’s Xchange is an online registry of evidence-based prevention interventions that aims to provide stakeholders with access to the evidence needed to make better decisions about which interventions to fund and implement.5
• While addressing a broader range of outcomes than drug use, the What Works Ireland Evidence Hub of the Department of Children, Equality, Disability, Integration and Youth will support a culture of evidence-based practice in Ireland in the field of prevention. See the article on page 55 in this issue of Drugnet Ireland for more details on the launch of the Evidence Hub.

The Prevention and Education Funding Programme and its focus on international quality standards provide a further indication of a more evidence-based approach to prevention in Ireland. In announcing the selection of projects, the Minister for Public Health, Wellbeing and the National Drugs Strategy Hildegarde Naughton TD noted that ‘a monitoring and evaluation framework will be developed for the successful projects, and those exhibiting a positive impact will be expanded to reach additional groups’.6

1    United Nations Office on Drugs and Crime (UNODC) and World Health Organization (WHO) (2018) International standards on drug use prevention. 2nd edn. Vienna: UNODC. Available from:  https://www.drugsandalcohol.ie/30048/

2    European Prevention Standards Partnership (2015) European Drug Prevention Quality Standards (EDPQS) Toolkits. Lisbon: EMCDDA. Available from: https://www.drugsandalcohol.ie/24582/

3    European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) (2019) European Prevention Curriculum: a handbook for decision-makers, opinion-makers and policy-makers in science-based prevention of substance use. Luxembourg: Publications Office of the European Union. Available from: https://www.drugsandalcohol.ie/31119/

4    For further information on the EUPC, visit:
https://www.emcdda.europa.eu/best-practice/european-prevention-curriculum-eupc_en

5    For further information on the Xchange Registry, visit: https://www.emcdda.europa.eu/best-practice/xchange_en

6    Department of Health (2023) Minister Naughton announces successful projects for €1.5 million drug prevention and education funding scheme [Press release]. 18 May 2023. Dublin: Department of Health. Available from:  https://www.gov.ie/en/press-release/92172-minister-naughton-announces-successful-projects-for-15-million-drug-prevention-and-education-funding-scheme/