'What Works' in Drug Education and Prevention?

Executive Summary

• The Cochrane Review of universal schools-based prevention for illicit drug use shows that a combination of social competence and social influence ^[1] approaches are most likely to be effective in preventing drug use. However, the evidence is not strong, effect sizes are small, and so the authors conclude that schools-based programmes should form part of more comprehensive strategies for drug use prevention to achieve population level impact.
• There are difficulties in disentangling which are the key elements of an effective approach, especially in hybrid programmes, and whether the programme components or the delivery aspects and timing account for the effectiveness.
• Nevertheless, and despite some study quality limitations, there is highly processed and review-level evidence that school-based interventions which focus on psychosocial and developmental skills can be effective in reducing drug use (Dickie, 2014). Prevention programmes for young people are more likely to be effective if they combine social and personal development, resistance skills and normative education techniques.
• There are named 'manualised' ^[2] and licensed interventions for which there is evidence of success in reducing drug use among young people. Faggiano et. al. (2014) state that what may be of greatest relevance is the programme itself. However, accurate implementation, methods of programme delivery, age appropriate programmes etc. are all instrumental in delivering success. In addition, the importance of a country's social context, drug policies and supporting structures required for delivery all influence the effectiveness of a programme.
• While the evidence does not show clear findings about how long or concentrated a programme should be, there is agreement that programmes need to be of sufficient intensity and duration to influence change and no reviews suggest the use of a one off single session.
• Evidence suggests that wider programmes that are delivered in schools, which target multiple risk behaviours, help build self-esteem and life skills are more likely to be effective in preventing drug use. This suggests a departure from drug specific education. Generic programmes, such as the Good Behaviour Game, which do not focus on drug/substance use, can be effective in reducing substance use and other problematic behaviours in the long term.
• There is considerably more, and more robust, evidence that shows what is ineffective in preventing drug use amongst young people. These include knowledge-focussed/information provision (standalone and without reference to the wider context), fear arousal approaches and stand-alone mass media campaigns. Using ex-drug users as testimonials in the classroom - an approach anecdotally considered to be popular in secondary schools in the UK - is also associated with no or negative prevention outcomes.
• Despite the clear evidence of ineffectiveness of these approaches, interventions based on these principles continue to operate and be funded, both in Scotland, the UK and internationally. Given that there is strong evidence that these approaches are ineffective or potentially harmful, the Advisory Council on the Misuse of Drugs ( ACMD) (2015) suggest that for ethical reasons, local commissioners should carefully consider their investment in such approaches, and whether such interventions and approaches should be discontinued. The European Drug Prevention Quality Standards ( EDPQS) (2015) simply state that such programmes should not be funded, even if popular.
• Whilst the evidence suggests that drug prevention is better embedded in more holistic strategies that promote healthy development and wellbeing, drug-specific prevention interventions for those young people most at risk of harm, or already misusing drugs should be maintained. However, the evidence also suggests that young people at greater risk will also benefit from universal approaches.
• Policy makers/commissioners should consider a range of factors before commissioning any new intervention, including; ethical principles, quality standards, avoiding ineffective or potentially harmful programmes/those with unintended consequences, cost effectiveness, the use of a common language when discussing prevention principles and high quality evaluation.
• Evaluation is highlighted in the literature as an important part of any prevention project, especially as the evidence shows that many popular types of prevention activity are ineffective at changing behaviour, and some may even cause harm. The ACMD, amongst others, recommend research funders and charities to support high-quality evaluation research, including economic evaluation.
• On the basis of these findings, it is argued that new work is needed to understand what is currently being delivered in schools and the third sector in Scotland. Such a comprehensive overview of prevention activity in Scotland would allow an assessment of whether approaches have shifted towards social competence and social influence approaches and more generic resilience building approaches in line with the evidence, and whether what is being delivered in Scotland is cost effective.