Health promotion in young people for the prevention of

substance misuse

Health promotion effectiveness reviews Summary bulletin 5 - 1997
ISBN 0 7521 0827 1

Summary of findings | Recommendations for action |
Recommendations for further research | Conclusion

Introduction

Surveys of young people in Britain suggest many are experimenting with illicit drugs. The misuse of drugs and solvents appears to be widespread in secondary
schools. In the UK, drug use often starts at around the age of 13, (1) yet drugs education may not start until theage of 14- 16. (2)Young people have different
motives for using drugs. Many rate curiosity and the fact that drug use is exciting and fun as the most important reasons for their first experiments. Peer pressure,
the perceived high prevalence of drug use, the need to conform and the belief that drugs can help them deal with problems are all important factors. Interventions
aimed at discouraging drug use among young people must take account of these beliefs and attitudes. The Health Education Authority has commissioned a review
of health promotion literature describing evaluations of interventions intended to tackle the problem of substance misuse among young people. The aim is to
identify interventions that have been effective in preventing or reducing use of illicit substances. The research was carried out by David White and Marian Pitts of
the Department of Psychology, University of Staffordshire. This bulletin summarises the main findings and should be referred to alongside the full report.

The review makes the following key points:
Inadequate evaluation makes it difficult to assess the effectiveness of many interventions, and so only cautious recommendations can be made.
Too few interventions target the specific needs of individuals or particular groups of young people.
Interventions tend not to consider the varying contexts in which drug misuse occurs.
Promising approaches include teaching relapse prevention skills to dependent users and targeting pregnant women.
School -based interventions should be tailored to take account of the stage of drug use reached by individuals and other circumstances affecting drug
use.
Additional interventions need to be developed targeting a range of settings, audiences and substances outside the school environment.
There needs to be better understanding of what young people believe about drugs and their consequences if plausible and relevant interventions are
to be developed.
Background
The review looked at studies that included evaluations of interventions targeting illicit drug use, use of solvents or use of hallucinatory mushrooms. The different
types of intervention examined included: school -based interventions; interventions combining school - and community-based elements; family-based interventions;
community-based interventions; relapse prevention interventions; mass media programmes; and harm minimisation interventions.
Commentaries and discussion on some of the issues raised about the research evidence
Executive summary
Background details including why young people use drugs, the age at which they start, and research methodology
Review of programmes followed by a discussion of the different approaches
Appendices including the estimated prevalence of drug use among young people, and detail about the methodology and search results.

Summary of findings
Most studies were evaluations of interventions introduced in schools targeting gateway drugs. These tended to be better designed than
interventions outside schools targeting other drugs.
The only interventions to be adequately evaluated are projects in the US and Australia target ing marijuana use among schoolchildren. However,
even here there was not enough data to draw clear conclusions.
Few studies examine longer-term effectiveness. Those that do, suggest that programme gains, if any, do not last long.
There is not enough evidence to assess the effectiveness of different approaches to drugs education. Better evaluation is needed.
More focused interventions should be developed. In particular, too little attention has been paid to the contexts within which drug use occurs and th e
need to match interventions to the specific needs and experiences of individuals and groups.
Interventions aimed at minimising drug -related harm have not been evaluated adequately. Again, more effort needs to be put into better evaluation.
Promising approaches include teaching relapse prevention skills to dependent users and interventions directed at pregnant women. However, not
many evaluations of these approaches have been carried out and more studies are needed to confirm their effectiveness.


Recommendations for action
The inadequacies of the studies reviewed allow only cautious recommendations to be made for effective programme planning. As more evidence becomes
available, the following points may need to be modified.
School-based interventions
All new interventions should be evaluated thoroughly. Appropriate outcome indicators should be identified at the outset and monitored throughout the
programme.
Interventions should incorporate a needs assessment allowing them to be tailored to match the stage of drug use reached by individuals, and taking
account of social and cultural factors.
Students aged 11-13 years should be included as targets of interventions.
Substances should be addressed and measured independently of each other.
Programmes should be intensive, lasting 15 hours or more.
Regular programmes of booster sessions should be incorporated into programmes to reinforce any gains.
Programmes should point out that drug use is neither as prevalent nor as acceptable as young people may believe.
Programmes should have a mix of elements which could include soci al influence and skills training.
All approaches should be consistent and carried out in a social context that encourages a drug-free lifestyle. School -based interventions can be
supported by other elements, including parental training, use of local mediaand involvement of community groups.
Messages must be credible to young people and should not be delivered by uniformed police officers.
More interventions are needed targeted at a wider range of groups, settings and substances than existing programmes.
In particular, interventions need to focus on young people currently experimenting with drugs who may progress to regular use, or use of other
substances. In addition, more research is needed in the following areas:
Long term follow-ups of intervention programmes should be developed, tracking individuals from the age of 11 through to early adulthood. This is to
determine whether a small delay in the age at which a young person starts to use substances postpones the progression to regular use of
substances.
Programmes mixing a number of elements seem to have greater impact. However, existing evaluations tend to assess the whole programme.
Evaluations should assess the effectiveness of each separate component as well as the programme as a whole.
A few interventions incorporating booster sessions have had longer -term success than the same interventions without the boosters. More needs to
be known about the impact of boosters and how they contribute to the overall effectiveness of the programme.
Drug use may have a range of meanings for young people. There is a need to explore the range of beliefs that exist about drugs and their health and
social consequences. This is essential if interventions are to be developed that are plausible to young people and relevant to their perceived needs
and situations.
Non-school based interventions
Existing interventions running in settings such as dance venues and sports clubs need to be evaluated more effectively.
Alternative evaluation strategies are needed to assess the impact of harm minimisation interventions and other programmes targeting hard-to-reach
groups.
There should be more interventions targeting a range of settings, audiences and substances, with appropriate messages.
Long term studies are needed to explore the transition from school life to adulthood, identifying the experiences that help to foster resilience or
susceptibility to drugs.

Recommendations for further research

School-based interventions
There is a clear need for long -term follow- ups of intervention programmes which track individuals from the age of 11 through to, and including, early
adulthood to determine whether a small delay in age of onset of substance use translates into either a further delay in regular use of substances, or
the non-progression to regular substance use.
While a greater mix of programme elements seems to be associated with greater programme impact, existing evaluations of programmes only
assess the whole programme. There is a need for an assessment of which elements or mix of elements are most effective as well as an assessment
of the programme as a whole.
A small number of interventions incorporate booster sessions into their programme. Generally, these interventions have had greater longer -term
success than the same intervention without the booster sessions. However, an intervention with boosters exposes the recipients to more intervention
sessions and to interventions closer to the final evaluation than the intervention without this booster element. There is a need to understand the
impact of these boosters and to determine whether their effectiveness reflects the recency of an intervention, the intensity of an intervention or the
phasing of the elements of the intervention.
Drug use may have a range of meanings for young people. There is a need to explore the range of beliefs that exist about drugs and their health and
social consequences. Without this contextualising knowledge it is impossible to develop interventions that will be plausible to young people and
relevant to their perceived needs and situations.
Non-school based interventions
Longitudinal studies are needed to explore the transition from school life to adulthood and identify what experiences foster resilience or vulnerability
in relation to drug use.

Conclusion
So what should we conclude about drugs prevention? First we should continue to work with the belief that prevention is possible. We should recognise that drug
taking is a category term used to cover a complex set of behaviours. Prevention should be more clearly formulated with regard to its recipients (or better still its
participants) and there is a need for innovative thinking in the development of drugs prevention programmes. However, we should remember that there is only so
much we can learn from the published evaluative literature.

Dr Michael Gossop, Head of Research, Addictions Directorate, National Addiction Centre, Maudsley Hospital, London


References
1. Abdulrahim, D., White, D.G., Phillips, K.C., Nicholson, J. and Elliott, J. (1994) Ethnicity and drug use: towards the design of community interventions North East
Thames Regional Health Authority.
2. Eiser, C., Eiser, J.R. and Bocker, M. (1988) Teachers evaluation of a life-skills approach to drugs education. Education Research 30: 20210.
There is a dearth of good quality research in this area that has either been carried out in the UK, or which is applicable to UK settings.
Research is needed on the development of health promotion interventions aimed at women who are pregnant and those of childbearing age.