Illicit drugs: effective prevention requires a health promotion approach

Abstract

All countries now face a major crisis in illicit drug use, both directly and indirectly. Emotions run wild when the issue is debated publicly and, understandably, all would wish the problem to go away. But good policy cannot be based on feelings and hearsay—evidence drawn from practice and theory should be the basis for both intervention and prevention strategies. For too long, illicit drug prevention programmes have been short term, uncoordinated, and have concentrated too much on simple information provision. They have usually operated in isolation from broader health promotion initiatives, and have not been linked to other drug control responses. They have also lacked sustained community-based approaches, which are required to achieve real and long-term benefits. A broader-based health promotion approach is urgently needed. People have lived in drug-using societies for centuries. Drugs perform many functions—they can treat disease and control pain, and they can relax, remove inhibitions and alter sensations. But they can also do great harm at both the individual and community levels; in many developed countries, for example, deaths due to drug overdoses now exceed those due to road accidents. One of the most significant developments in the last decade has been the massive increase in availability, purity, potency and cheapness of illicit drugs such as cannabis, amphetamines and heroin. From trends monitored by the United Nations Office for Drug Control and Crime Prevention (UNODCCP, 1999), it appears that overall, strategies to reduce cultivation of opium and cocoa, and to seize products before they reach markets are having only a limited effect. At the same time, production of synthetic drugs such as ecstasy is booming. In Australia, for example, the amount of heroin that can be purchased for the same amount of money increased four-fold between 1997 and 1999, and is now as available and simple as ordering a pizza. If supply-side strategies are inadequate and failing, then demand-side strategies to reduce and modify uptake are even more important. There is no simple answer to the question of why young people become involved in drugs; the reasons are many and varied. Fortunately, over the last decade our knowledge base has become stronger, and is moving us towards a more socio-ecological framework for intervention than a medical and legal one. Researchers such as Resnick, Brooks, Jessor, Hawkins, Catalano and Patton have investigated the factors that put young people at risk of developing problem behaviour, and they appear to be protective (Jessor, 1991; Hawkins et al., 1992; Brooks, 1994; Resnick et al., 1997; Bond et al., 2000). Two key themes emerge for improving and maintaining well-being: connectedness and resilience. Connectedness refers to a sense of belonging, and having strong and meaningful connections to family, school, peers and the community. Resilience refers to the quality that helps people deal with the problems and demands that may confront them, and to respond well to a range of life events. In both these areas, parental support and assistance are very important. In Victoria, Australia, the State Government's Drug Policy Expert Committee (VDPEC, 2000) has recently released a major report on drug control strategies. Drawing on a range of international research, a useful framework, covering of a range of risk and protective factors for community, school, family and individual/peer levels of intervention, has been presented (Table 1). There is an emerging evidence base for interventions that tackle particular risk and protective factors. In the USA, for example, the Midwestern Prevention Project, conducted by Pentz and co-workers, examined the effectiveness and replicability of a multi-component, community-based drug misuse prevention programme (Anderson et al., 1990). The study looked at the effectiveness of school interventions in the context of broader community mobilization strategies. Significant reductions in tobacco and cannabis use occurred amongst students followed up at Years 9 and 10. However, training for community leaders and the use of mass media was less effective when not teamed with school-based and parenting programmes. Another US study, Project Northland, led by Perry and colleagues, used similar school- and community-based approaches to reduce alcohol and other drug use in North West Minnesota (Perry, 1996). The research found statistically significant reductions in drug use, changed peer norms and improved parent–child communication. The case can be made from both of these studies for whole-community approaches that complement individual-focused interventions. The Gatehouse project in Australia aims to reduce the rates of depression and self-harm amongst young people (Centre for Adolescent Health, 2000). This school-based programme emphasizes the importance of positive connectedness between the individual and both teachers and peers. It has identified three priority are