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Three Decades of Drug Prevention Research
PIM CUIJPERS*
Trimbos Institute (Netherlands Institute of Mental Health and Addiction), 3500 ASUtrecht, The Netherlands
ABSTRACT Dozens of drug prevention programmes have been developed and examined inthe past few decades. These interventions are aimed at tobacco, alcohol or all substances.Prevention programmes have different goals, including the following: increasing knowl-edge about drugs; reducing the use; delaying the onset of first use; reducing abuse;minimizing the harm caused by the use. Most research has been conducted on school-baseddrug prevention programmes. School-based drug prevention programmes that usedinteractive methods were found in research to reduce the use of drugs. All school-baseddrug prevention programmes (interactive and non-interactive) that have examinedincrease the knowledge about drugs. Although effective school-based prevention pro-grammes are available, the dissemination at schools has not been successful for mostprogrammes. Family-based drug prevention programmes are a promising new area of drugprevention. Most research examining the effects of mass media campaigns about drugs isflawed by major methodological problems. Results suggest that these campaigns cannotreduce the use of substances, but they may increase the effects of community-basedinterventions. Community interventions (a combined set of activities organized in aspecific region or town, with the participation of the residents) are possibly more effectivethan each of the interventions alone.
Introduction
In the last three decades, dozens of interventions have been developed inWestern countries to prevent the use and the abuse of tobacco, alcohol, mar-ihuana and other illegal drugs. Most of these interventions are conducted inschools, but there are also interventions aimed at the parents of adolescents,interventions aimed at professionals working with drug users, and interventionsthat consist of activities aimed at school, as well as parents, and the largercommunity. Furthermore, in many Western countries, mass media campaignsaimed at the use and abuse of drugs are conducted regularly.
In this paper we present an overview of the goals, target groups and generalcontents of these interventions, as well as an overview of the scientific researchexamining the effects of the interventions. In the last few years we conductedseveral systematic reviews and meta-analyses, on the effectiveness of drug
Drugs: education, prevention and policy ISSN 0968–7637 print/ISSN 1465–3370 online # 2003 Taylor & Francis Ltdhttp://www.tandf.co.uk/journals
DOI: 10.1080/0968763021000018900
Drugs: education, prevention and policy, Vol. 10, No. 1, 2003
* Correspondence to: Pim Cuijpers, Trimbos Institute (Netherlands Institute of Mental Health andAddiction), P.O. Box 725, 3500 AS Utrecht, The Netherlands. e-mail: [email protected]
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prevention in general (a systematic review of earlier reviews and meta-analyseshas been given by Van Gageldonk & Cuijpers (1998)), on innovative preventiveschool programmes, family programmes, and community programmes (for asystematic review of primary studies, see Bolier & Cuijpers (2000)), on the relativeeffectiveness of peer-led and adult-led school-based drug prevention (a meta-analysis was made by Cuijpers (2002a)) and on the effective ingredients of school-based drug prevention programmes (systematically reviewed by Cuijpers(2002b)). In this paper we shall present a general overview of the field basedon these reviews. Because the field is so large and up to several hundreds ofstudies and meta-analyses have been conducted, it is not possible to conduct asystematic review or meta-analysis covering the entire field. Therefore, weconduct a traditional review of the field, with all the disadvantages of thesereviews (a non systematic selection of the included studies, non systematicanalyses of included studies, etc.), but with the advantage that we cover themost important sections of the complete field.
In this paper, we use the word ‘drugs’ in this paper for all substancesmentioned earlier (tobacco, alcohol, marihuana and other illegal drugs). Mostresearch examining the effects of drug prevention programmes has been con-ducted in the USA. In our reviews of the international scientific literature, wefound many studies on this topic but scarcely any about European interventions.
Classification of Preventive Intervention
Traditionally, prevention interventions have been classified into the categories ofprimary, secondary and tertiary prevention. Primary prevention is aimed atpreventing the use of drugs altogether, or at preventing abuse and dependencedisorders according to diagnostic criteria. Secondary prevention is defined as theearly identification and treatment of people who use or abuse drugs. Tertiaryprevention is defined as treatment of identified cases, in order to reduce thedamage caused by the drug use or abuse. Tertiary prevention is now generallyconsidered to be in fact treatment and not prevention. Tertiary prevention willnot be discussed in this section.
In recent years, a new more specified framework for defining preventiveinterventions has been spreading rapidly among scientists working in the areaof prevention of addiction and mental disorders (Mrazek & Haggerty, 1994;National Advisory Mental Health Council Workgroup on Mental DisordersPrevention Research, 1998). Three categories of preventive interventions aredistinguished.
(i) Universal preventive interventions are aimed at the general population or apart of it that is not identified on the basis of individual risk factors (e.g. massmedia campaigns, and school-based programmes aimed at all students).
(ii) Selective interventions are aimed at individuals or groups of people who havean increased risk of drug use problems (e.g. programmes aimed at children ofalcoholics, or at high-risk inner-city youth).
(iii) Indicated prevention is aimed at subjects who do not have addiction problemsaccording to diagnostic criteria, but who have some early characteristics ofproblematic use (e.g. interventions aimed at youths experimenting withdrugs). Early intervention is aimed at subjects who do have addictionproblems according to diagnostic criteria, but who have not yet considered
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seeking help. In practice, it is often not possible to differentiate betweenindicated prevention and early intervention. In this paper, we shall considerthem as one category of interventions.
Goals and Settings of Preventive Interventions
Preventive interventions in the three categories described above may havedifferent goals, including the following:
(a) increasing the knowledge about drugs in adolescents;(b) reducing the use of drugs;(c) delaying the onset of first use;(d) reducing abuse of drugs;(e) minimising the harm caused by the use of drugs.
The interventions that have been developed are conducted in several settings.Most interventions are developed for schools, but there are also several inter-ventions aimed at the families of (potential) drug users. Other interventions areaimed at the broader community and may include mass media interventions,community mobilizing committees, educational activities in bars, cafes, discos andhouse parties, and training of general practitioners, teachers and other profes-sionals who work with adolescents. Most interventions are aimed at children andadolescents between 10 and 16 years of age. It is during this age span that mostpeople start to use drugs, and preventive interventions try to intervene justbefore the adolescents start using drugs. In Table 1, an overview is presented ofuniversal, selective and indicated preventive interventions in school, family andcommunity settings.
Prevention interventions are, in ideal cases, based on scientific knowledgeabout the prevalence of drug use in the target population, the age of first use,determinants of drug use, patterns of drug use, mental health problems in thespecific population, and a theoretical view of the intervention components thatmay change behaviour. However, in daily drug prevention practice, the devel-opment of prevention interventions is often not conducted systematically. Inrecent years, manuals, guidelines and overviews have been published to supportthe systematic development of complex interventions, such as drug abuseprevention programmes (e.g. the framework for development and evaluationof randomised controlled trials (RCTs) for complex interventions to improvehealth, from the British Medical Research Council (2000)).
In the next few paragraphs, we shall focus on the main categories of preventiveinterventions; namely school-based interventions, family-based interventions,mass media campaigns, and interventions in the community, and describe theresearch that has been conducted in these areas. In Table 2 this research and theresults are briefly summarized.
School-based Interventions
Over the past 30 years, three phases can be distinguished in the development ofschool-based drug prevention programmes (Gorman, 1995; Moskowitz, 1989;Perry & Kelder, 1992). In the first phase (early 1960s to early 1970s), programmeslargely focused on the provision of knowledge about drugs and the risks of druguse. During the second phase (early 1970s to early 1980s), so-called affective
Drug Prevention Research 9
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programmes predominated. Most of these programmes were not drug specificbut concentrated on broader issues of personal development such as decisionmaking, values clarification and stress management (Gorman, 1995). In the thirdphase (early 1980s to date), the social influence model has dominated school-based drug prevention programmes (Hansen, 1992). In this model, resistanceskills are developed, sometimes in combination with broader personal and socialskills (including components of stress reduction and decision making (Botvin et al.,1990)).
During the three phases of programme development, several hundred studiesinvestigated the effects of drug prevention programmes and several dozens havebeen found to be methodologically well designed (Tobler et al., 2000). In the lasttwo decades, several meta-analyses have been conducted, to integrate the resultsof individual studies statistically in order to obtain a better estimate of the realeffects of prevention programmes than individual studies can do. In the mostcomprehensive and most recent meta-analysis it was found that drug preventionprogrammes have large and significant effects on the knowledge of studentsabout drug abuse (Tobler et al., 2000).
Interactive drug prevention programmes included in this meta-analysis werefound to result in significant reductions in drug use (including tobacco, alcoholand illegal drugs), while non-interactive programmes do not. As these effectsdecrease over time, it is usually assumed that this indicates a delay of onset ofdrug use. In interactive programmes, the lessons are less structured; the focus is
10 P. Cuijpers
Table 1. Examples of universal, selective and indicated preventiveinterventions in school, family, and community settings
School Parents/family In the community
Universal Lessons about drugs for allstudents in high schools
Parent training aboutparenting and drug use, forall interested parentsHomework assignments forparents and child, takenhome from school
Mass media campaigns (allresidents)‘Community’ interventionsPrevention at the workplaceCommunity mobilizingcommitteesEducational activities inbars, discos
Selective support groups for childrenof alcoholicsTraining programmes forhigh-risk youths
Parent training for addictedparentsSupport groups for parentsof high-risk youths (innercity, minority, etc.)
Mass media campaigns(high-risk groups)Prevention at the workplace(high-risk groups)
Indicateda Mentor programmes forfirst offendersScreening and earlyintervention programmesCounselling programmes
Parent training for youthswith beginning or earlydrug problems
Training of healthprofessionals (generalpractioners, social workers)and teachers in screeningfor addiction problemsTraining of coffee-shopowners
a Including early intervention.
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not on didactic presentations but on discussions, role playing and interactionbetween students. Non-interactive programmes are structured; they focus on oralpresentations by the teacher and do not stimulate interaction between students.This meta-analysis also shows that effective programmes are all based on thesocial-influence approach to drug prevention. The social-influence approach todrug prevention is based on the idea that ‘inoculation’ in the classroom againstactive or indirect social pressure to use drugs will help to prevent drug use(Donaldson et al., 1996). Although the effects on drug use are significant (in
Drug Prevention Research 11
Table 2. Overview of major examples of studies examining the effects of drugprevention programmes
Research Results
School-based interventionsUniversal Several meta-analyses (major examples
are by Bruvold (1990, 1993), Rooney &Murray (1996), Tobler et al. (2000), Tobler& Stratton (1997) and White & Pitts(1998)) (the largest includes 144controlled studies of 207 school-baseddrug prevention programmes (Tobler &Nicholson (2000))
Universal interactive school programmeshave small effects on substance use; non-interactive programmes have no effecton use. All programmes increaseknowledge
Targeted Several primary studies (major examplesare by Eggert et al. (1990, 1994, 1995),Hostetler & Fisher (1997), Rentschler(1996), Valentine et al. (1998) and Weisset al. (1998)); no meta-analyses
Some interventions have significanteffects; for others, no effects on use arefound
Family based interventionsUniversal Several primary studies (major examples
are by Spoth et al. (1998a, b, 1999) andWerch et al. (1991)); no meta-analyses
Recent approaches (e.g. Preparing forthe Drug-Free Years) have promisingeffects
Targeted Some primary studies (major examplesare by DeMarsh & Kumpfer (1986),Kumpfer et al. (1996) and Werch et al.(1998, 1999)); no meta-analyses
The few studies find promising effects(Strengthening Families)
Mass media interventionsUniversala Some primary studies (suboptimal
quality) (major examples are be Flynnet al. (1997), Harrington & Donohew(1997), Ramirez et al. (1997),Reis et al. (1994) and Secker-Walkeret al. (1997))
Mass media campaigns do not changedrug use, but they increase knowledgeand may strengthen effects ofcommunity interventions
Community interventionsCombinedb One meta-analysis of community
interventions aimed at smokingprevention (Sowden & Arblaster, 2002);several primary studies on alcohol(major examples are by Hingson et al.(1996), Holder et al. (2000), Perry et al.(1996) and Wagenaar et al. (2000)); onestudy on illegal drugs (Pentz et al. (1989)
There is some limited support for theeffectiveness of communityinterventions in helping to prevent theuptake of smoking in young people.Recent community interventions aimedat alcohol are promising
a Mass media campaigns are universal.b Community interventions are often combined interventions including universal and targetedinterventions.
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interactive programmes), they are also small (standardized effect sizes smallerthan 0.20), but interventions with small effects in large populations do have alarge impact.
Most school-based prevention programmes are universal interventions, aimedat all students regardless of their risk status. There are several studies examiningthe effects of selective and indicated prevention programmes on drug use.However, the number of these studies is considerably smaller than the numberof studies of universal programmes. The results of the studies examining selectiveand indicated prevention programmes are not conclusive. Some studies find noeffects on drug use (Hostetler & Fisher, 1997; Rentschler, 1996); others do indicatesome positive effects (Eggert et al., 1990, 1994, 1995; Valentine et al., 1998; Weiss &Nicholson, 1998). Therefore the conclusion must be that there is no convincingevidence that selective and indicated school-based prevention programmes canreduce drug use or abuse.
Family-based Interventions
There is no doubt that parents have an important influence on the use of drugs bytheir children, by both genetic factors (Merinkangas, 1990) and social factors suchas parental neglect or abuse (Block et al., 1988). Protective characteristics ofparents reduce the chance of drug use in adolescents, such as a close relationshipbetween parents and children and involvement of the parents in adolescentactivities outside the family (Bry et al., 1997). It is assumed that the influence ofparents decreases when children become adolescents and that the influence ofpeers increases strongly in this age (Engels et al., 1999). However, there are alsoindications that the parents continue to have a strong influence, for example inthe selection of peers (Dusenbury et al., 1994) or by a lifestyle that has beeninternalized earlier. The parents can also function as role models for their child,and his or her peers and drug use by parents may make drugs easier to obtain fortheir children.
Several interventions have been developed for parents and families in order toprevent or reduce drug use and abuse in their children. In a recent systematicliterature review, seven family based drug prevention programmes were foundwhose effects were examined in eight controlled studies (Bolier & Cuijpers, 2000).The goals, target populations and contents of the interventions were diverse, andthe studies were of varying quality.
There is some evidence that universal family based prevention programmesmay reduce drug abuse. An example of a universal family-based programme isthe Preparing for the Drug-free Years programme, a five-session training pro-gramme in which any parent who is interested can learn to identify risk factorsfor drugs use, parenting skills and conflict management skills. In a well-designedrandomized study of 667 families, it was found that adolescents whose parentsparticipated in the programme used fewer drugs than adolescents whose parentsreceived a minimal intervention only (Spoth et al., 1998a, b, 1999). In anotheruniversal intervention, children take home from school some homework assign-ments. They should work on these assignments together with their parents (the‘Keep a clear mind’ project). In a randomized trial in which 511 studentsparticipated, no difference in drug use was found between adolescents partici-pating in the project and students on a waiting list (Werch et al., 1991).
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There is also some evidence that selective and indicated family-based inter-ventions may reduce drug abuse and risk factors for drug use. For example, theStrengthening Families programme is a training programme for addicted parents,aimed at reducing drug use and other problem behaviour in their children. In thisprogramme, a parallel 14-session training is delivered to parents (parenting skills,and communication skills) and to their adolescent children. In a randomized trialin which 118 families participated, positive and significant effects on drug usewere found in adolescents and their parents who participated in the programme,compared with families who did not participate (DeMarsh & Kumpfer, 1986;Kumpfer et al., 1996). In another study, it was found that the Stars for familiesprogramme had positive and significant effects on drug use (Werch et al., 1998,1999). In this programme, high-risk families receive individual health advice andskills training for parents. Another programme (DARE to Be You) is aimed at veryyoung high-risk children (2–5 years), and effect research did indicate positiveeffects on the children and the education style, but the children were too youngfor effects on drug use to be found (Miller-Heyl et al., 1998).
Overall, we have to conclude that family-based interventions are an interestingnew way of preventing drug use in children, but there is not sufficient evidencefor their effectiveness to warrant dissemination of these programmes on a largescale. It is important, however, to stimulate further pilot projects and research inthis promising area.
Mass Media Interventions
Mass media campaigns on drug use are conducted regularly in most Westerncountries. There are, however, only a few studies that have examined the effectsof mass media campaigns on drug use, and the studies that have been conductedare hampered by several methodological shortcomings.
In a recent systematic literature review, only five studies (published after 1990)examining the effects of mass media campaigns aimed at drug use were found inthe international literature (Spruijt-Metz & Van Gageldonk, 2000). Three of thesedid not include a control group (Harrington & Donohew, 1997; Ramirez et al.,1997; Reis et al., 1994). Because it is often not feasible to use proper control groupsin studies examining the effects of mass media campaigns (as the total populationis exposed to the intervention), it may be acceptable not to use a traditional pre-post randomized intervention-control group design, but a time series design inwhich several measurements are conducted before and after the intervention(see, for example, Bland et al. (2002)). The three uncontrolled studies did not usesuch a design either. In one of the remaining two studies that did use a controlgroup, the effects on drug use were not measured (Freimuth et al., 1997). Theother remaining study examined the effects of the Midwest Prevention Projectand was relatively well designed, but this project was in fact a large communityintervention consisting of several diverse components, such as school interven-tions, community mobilization and mass media campaigns (Chou et al., 1998;Johnson et al., 1990; Pentz et al., 1989). The effect study of this project did notpermit examination of which component of the set of interventions was respon-sible for the effects. So, we have to conclude that there are no recent well-designed studies giving information about the effectiveness of mass mediacampaigns on drug use. In a much-cited review of older studies (Flay & Sobel,
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1983) it is also concluded that the quality of most studies in the area of mass mediacampaigns on drugs use is inadequate.
In the field of health education, there is a broad consensus that mass mediacampaigns are not capable of changing risky behaviour in general (Spruijt-Metz &Van Gageldonk, 2000). This is supposed to be also true for mass media campaignson drug use. However, there are indications that mass media campaigns canincrease knowledge and they may strengthen the effects of local or communityinterventions (Pentz et al., 1989). This was confirmed in a recent study, whichshowed that a mass media campaign in combination with a school programmewas more effective than the school programme alone in the prevention of tobaccouse (Flynn et al., 1997; Secker-Walker et al., 1997).
Community Interventions
In recent years, researchers, practitioners and policy makers have becomeincreasingly interested in ‘community interventions’. In these interventions, acombined set of activities is organized in a specific region or town, aimed atadolescents, as well as parents and other people and organizations. An importantcharacteristic of such community interventions is that people living in thecommunity play an important role in deciding which interventions are developedfor whom (Bracht & Gleason, 1990). The increasing popularity of communityinterventions is the result of the growing consensus among scientists andpractitioners that the combination of several interventions at different levels ismore effective than individual interventions.
In the area of community interventions aimed at drug use, several well-designed studies have been conducted in the area of prevention of alcoholproblems. For example, Holder et al. (2000) examined the effects of a five-com-ponent community intervention (including media campaigns, training and sup-port of sellers of alcohol, and increasing traffic controls) and found that thisresulted in a 49% reduction in drunk driving, a 10% reduction in nightly trafficaccidents and a 43% reduction in first aid accidents. In several other communitystudies comparable results were found (Hingson et al., 1996; Wagenaar et al.,2000). In another community project aimed at reducing alcohol use, a 3 yearschool-based programme was combined with an extensive parent programmeand a community task force to organize other activities to support the reductionof alcohol use by adolescents (Perry et al., 1996). In a well-designed effect study itwas shown that the percentage of students that used alcohol was 29% in controlstudents, compared with 24% in experimental students, and alcohol use in thepast week was 11% in experimental students compared with 15% in controlstudents.
In the area of community projects aimed at drug use, few studies have beenconducted, the most important exception being the studies examining the effectsof the Midwestern Prevention Project. In this project, the interventions includeschool programmes aimed at skills for resisting peer pressure to use drugs andknowledge about drugs (18 lessons), as well as mass media campaigns, severalactivities to stimulate the involvement of parents in drug prevention, and acoordinating committee in the local community. Two studies have examined theeffects of the Midwestern Prevention Project. In the first quasi-experimentalstudy, 42 schools were assigned to an experimental (community intervention)or control condition (only mass media campaign). Significant effects of the
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community intervention were found on drug use, 1 year after the intervention. Ina second randomized trial, 57 schools were included (Chou et al., 1998). Theresults of study were comparable but, because more follow-up measurementswere taken, it could be shown that the effects of the intervention decreased overtime and, 31
2 years after the intervention, no effects were found any longer.In the area of smoking prevention, several studies examining the effects of
community interventions have been conducted. In a recent meta-analysis fourrandomized controlled trials could be included (Sowden & Arblaster, 2002). Inthis meta-analysis some support was found for the effectiveness of these inter-ventions. One of the most important studies in this area was conducted by Biglanet al. (2000). They conducted a randomized trial in eight small communitiescomparing the effects of a school programme with the effects of a schoolprogramme plus community intervention. This community intervention con-sisted of media advocacy, family communication, and reduction in youth accessto tobacco. They found that the effects of the school plus community programmewas more effective than the school programme alone.
In summary, the evidence is increasing that community prevention interven-tions can reduce drug use in the community. There is also increasing evidencethat combined sets of interventions in a specified community may be moreeffective than each of the interventions alone.
Dissemination
Dissemination of effective interventions is an important issue in drug prevention.There is sufficient evidence that drug prevention. There is sufficient evidence thatdrug prevention at school is potentially effective in reducing drug use. However,many of the more effective prevention programmes have been developed inresearch settings and do not fit easily within the school system, because of thelarge number of sessions and the requirements of scientific research. Otherprogrammes are disseminated widely in schools but are not effective in reducingdrug abuse. The most well-known example in the international literature is theDARE programme. This is the most widely used drug prevention programme inthe USA, but many well-designed studies have shown that it has no significanteffects on drug abuse (Clayton et al., 1996; Ennet et al., 1994; Lynam, 1999).Although the DARE programme has proven to be ineffective, the programme isnow being implemented on a large scale in several other Western countries,including the UK and The Netherlands. This is clear example that successfuldissemination is possible even though the programme has no effect on drug use.
One of the next major steps in drug abuse prevention has to be the dissemina-tion of effective prevention programmes and the results of the scientific knowl-edge base that has been built up in recent decades. That it is possible todisseminate widely drug prevention programmes that have been proven to beeffective is shown by the Dutch Healthy School and Drugs project. This is nowused in 64–73% of the Dutch secondary schools (Cuijpers et al., 2002).
A major concern in the dissemination of effective programmes is implementa-tion fidelity. Many teachers and other professionals working in daily practice arenot easily convinced to work with a standard protocol developed in research.They need to be able to use the protocols and manuals in their own way. Here is achallenge for both researchers and professionals working: to develop methods
Drug Prevention Research 15
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that meet scientific criteria and at the same time to meet the requirements of dailypractice.
What Determines the Effectiveness of Drug Prevention Programmes?
It is not clear which characteristics make prevention programmes effective. Amajor problem is that the preventive interventions that have been examined inresearch differ strongly in goals, target population, theoretical framework, con-tent and research methods. Therefore, it is very difficult to determine what makesprevention programmes work.
In the area of universal school-based drug prevention, we recently conducted asystematic literature review examining the current scientific knowledge thecharacteristics of effective drug prevention programmes (Cuijpers, 2002b). Wereviewed three types of study: meta-analyses (three studies were included);studies examining mediating variables of interventions (six studies); studiesdirectly comparing prevention programmes with or without specific character-istics (four studies on boosters; 12 on peer-led versus adult-led programmes andfive on adding community interventions to school programmes).
Seven evidence-based quality criteria could be formulated on the basis of thisresearch.
(i) The effects of a programme should have been proven.(ii) Interactive delivery methods are superior.
(iii) The ‘social influence model’ is the best that we have.(iv) Focus should be on norms, commitment not to use and intentions not to use.(v) Adding community interventions increases effects.
(vi) The use of peer leaders is better.(vii) Adding life skills to programmes may strengthen effects.
These quality criteria match well with other overviews and studies examining theopinions of experts (Dusenbury, 2000; Dusenbury & Falco, 1995; NationalInstitute of Drug Abuse, 1997).
Discussion
In this study we found that many universal, selective and indicated interventionshave been developed for use in schools, in the family and in the community forpreventing the use and abuse of drugs. Most effect research has been conductedin the area of school-based drug prevention and this research indicates thatschool programmes are effective in the reduction of drug use, if they useinteractive methods. However, the effects of school programmes are small, andit should be a major challenge for researchers in the next decades to increase theeffect sizes of school programmes. This could be realized by better examining thecausal factors of drug use and abuse, and by examining the effective ingredientsof school-based interventions. Other drug prevention programmes in the familyor in the community have not been subjected to sufficient research in order toconclude whether they do reduce the use or abuse of drugs. However, several ofthese interventions, such as parent training programmes and community inter-ventions, are promising and may reduce drug use and abuse.
The majority of drug prevention programmes are aimed at children andadolescents aged 10–20 years. Very few preventive interventions have been
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developed for other age groups. It is known that, in most cases, drug problemsdisappear spontaneously when young people grow up. There is only a very smallproportion of people with continuing drug problems after the age of about 24. Itis very useful to examine the characteristics of those with continuing problemsand to develop more intense prevention programmes for subjects with a high riskof ongoing problems.
At the beginning of this paper, several goals of drug prevention programmeswere presented, such as increasing the knowledge about drugs in adolescents,delaying the onset of first use, reducing use and abuse of drugs, and minimizingthe harm caused by the use of drugs. Most research has concentrated on theeffects of prevention programmes on knowledge, and the use of drugs. Somestudies have examined the effects of prevention programmes on the delay of thefirst use, but few studies have examined whether it is possible to reduce thenumber of new cases of problematic drug use. Accordingly, it is not knownwhether the number of subjects with serious drug problems (according to thediagnostic criteria of the DSM-IV) is significantly reduced by drug preventionprogrammes while this is in fact one of the most important issues from a publichealth perspective.
In the last few decades, major advances have been made in the field ofprevention of use and abuse of drugs. This includes the development ofschool-based programmes that are capable of reducing the use of drugs. It alsoincludes the development of many new interventions, such as parent training,mass media campaigns, and community interventions that have promisingeffects. However, many questions remain unanswered as yet. Can we reducemajor drug problems with prevention programmes? Can we prevent drugproblems with a chronic nature? How should the dissemination of effectiveprogrammes be conducted? It is these and other questions that should beaddressed in the decades ahead.
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