Models of intervention and care for psychostimulant users, 2nd edition - monograph series no. 51

Prevention and population-based interventions

Page last updated: April 2004

Few studies of prevention and population-based interventions have been reported that focus specifically on younger people and psychostimulants. However, given the popularity of psychostimulants amongst this age group, a large proportion of the sample in broader population studies will have been drawn from psychostimulant users. As such, the findings reported in the previous chapters may be applicable to this younger population.

General prevention that targets risk and protective factors
Generic drug prevention interventions for young people

General prevention that targets risk and protective factors

Addressing multiple risk and protective factors results in a decrease not only in problematic substance use but also in rates of homelessness, mental health issues, suicide and criminality. For a comprehensive review of the risk and protection literature, see Bond et al. (2000), Commonwealth Department of Health and Aged Care (1999), National Crime Prevention (1999a) and National Crime Prevention (1999b).

Prevention programs can focus on the child, the family or the community. They occur within health centres, homes, schools, whole communities or a combination of these. Preventive interventions range from identification (such as hospital or school screening and referral services), to diagnostic and direct intervention programs.

Early intervention may begin at any time as long as it occurs prior to the development of problematic substance use and impaired functioning. Strategies focus on enhancing the child's development via building resiliency skills and providing family support and assistance.

Examples of prevention programs include:
  • intensive nurse home visitation aimed at at-risk mothers;
  • early intervention programs for high-risk infants and pre-schoolers;
  • early childhood education;
  • mental health services for young children;
  • parenting programs;
  • programs that ease the transition from primary to secondary school;
  • child protection casework;
  • foster care;
  • family support agencies; and
  • AOD treatment for the young person's parents.
Many of these programs have been extensively reviewed with findings indicating they are cost effective and have positive effects on a range of child and adult outcomes, including lowered rates of licit and illicit substance use. For a comprehensive review of prevention programs, see Mitchell et al. (2001), National Crime Prevention (1999a) and National Crime Prevention (1999b).Top of page

Generic drug prevention interventions for young people

Mass media campaigns

Mass media campaigns mostly attempt to prevent the onset of substance use and subsequent problems. Well-designed campaigns have been shown to impact on smoking and drug use among young people (Strasburger & Donnerstein, 1999). One study that utilised anti-marijuana public service announcements decreased marijuana use by more than 25% among high-sensation-seeking adolescents (Palmgreen, Donohew, Lorch, Hoyle & Stephenson, 2001). The impact of such campaigns are contingent upon targeting a clearly defined audience, a clear understanding of their prevailing attitudes and beliefs, and the design of credible messages that are frequently presented during programs watched by that audience (Bertram, Barbir, Ball & Carroll, 2003). The pre-testing of these messages for their effectiveness and appropriateness to the target audience is crucial (National Institute on Drug Abuse, 2002). Governments periodically release media campaigns targeted at young people, most often around alcohol.

School-based prevention programs

There have been a number of criticisms levelled at the limited capacity of school-based prevention programs to address the complex range of factors associated with the onset, escalation and maintenance of substance use. An additional concern is that many young people most in need of an effective intervention are not currently enrolled in or have been excluded from the school system for a variety of reasons (e.g. truancy and expulsion).

Both school-based and media campaigns focused on the need for young people to 'Just Say No' to drugs have been criticised for their na´ve and simplistic nature. Such school-based interventions need to be based on an assessment of local need, be comprehensive and culturally sensitive, provide life skills and be delivered over a significant period of time with booster sessions. A number of authors have developed guidelines to effective school-based education programs (Dennis & Ballard, 2002; Hansen, 1997; Lohrmann & Wooley, 1998; Midford, Munro, McBride, Snow & Ladzinsji, 2002; National Institute on Drug Abuse, 1997; UNICEF, WHO, World Bank & UNFPA, in press; World Health Organisation, 1994).

However, a recent meta-analysis indicated there is limited evidence for the effectiveness of school-based programs (White & Pitts, 1998). More intensive and comprehensive programs with both educational and skills training components and booster sessions had the most evidence for their effectiveness. An example of an effective prevention program is the 'Life Skills Training Program' (Botvin, Baker, Dusenbury, Botvin & Diaz, 1995). The program comprises a three-year prevention curriculum intended for late primary and early secondary school students and covers three major content areas: drug resistance skills and information, self-management skills and general social skills. A randomised controlled trial found the Life Skills Training program had a positive impact on both drug and polydrug use outcomes on students compared to controls which were maintained at six-year follow-up (Botvin et al., 1995; White & Pitts, 1998). While initially this program was used largely with middle-class white populations, recently similar results have been reported for other groups of youth (Botkin & Griffin, 2001).

A need for targeted interventions for different groups of young people, particularly for high-risk youth, has also been identified (Gilvarry, 2000). An example of a promising targeted school-based program is the Reconnecting Youth Program (Eggert, Thompson, Herting & Nicholas, 1994). This program targets young people who show signs of poor school achievement and potential for dropping out of high school, as well as young people with multiple problems. Through personal growth classes, social activities and school bonding, the program teaches resiliency skills to moderate the effect of risk factors and the early signs of substance abuse. Participants in this program have shown improved school performance, self-esteem, personal control, school bonding and social support; and reduced drug involvement, deviant peer bonding, depression, anger, aggression, hopelessness, stress and suicidal behaviours, although there was no comparison group (Eggert, Thompson, Herting & Nicholas, 1995).

Other interventions have targeted high-risk, out of school youth and the promotion of drug free activities (Substance Abuse and Mental Health Services Administration (SAMHSA), 2003). The former include formal and informal projects directed toward high-risk, out-of-school youth, delivered as 'outreach' or 'centre-based' by a mix of peer educators and professionals. The latter include various activities such as rock concerts and sporting events sponsored by the health promotion sector. The rationale for such events is two-fold: first, linking pleasurable activities with drug-free experiences and messages reinforces the strength of the drug-free message and, second, to combat boredom that is often associated with substance use. However, these programs have not been extensively evaluated.Top of page

Prevention strategies specifically targeting psychostimulants

In the knowledge that much psychostimulant use by the younger population is experimental or social in nature, the emphasis of many interventions has been aimed at reducing the harm caused by this time-limited or lower-level use (Weir, 2000). This has included the dissemination of information on the effects and risks of taking psychostimulants or placing oneself in a position where psychostimulants are freely available.

The aim of prevention strategies that specifically target individuals who have used psychostimulants is to assist them to minimise the harm associated with use. Prevention strategies include teaching early signs of problematic use, how to assist peers with problems and where help is available for individuals with problems (Dennis & Ballard, 2002). One example is 'Venue Safety', a harm minimisation strategy for raves and clubs which has been adopted by the rave community and municipal and public health authorities (Weir, 2000). Many information booklets, such as 'Rave Safe' (Marinelli, 1996), 'Club Drugs' (Dillon & Degenhardt, 2000) and 'Ecstasy — Facts and Fiction' (Topp, Dillon & Hando, 2002), have been developed to give young people relevant information on the different drugs used, short-term and long-term effects, risks involved with use and hints and tips on safer use, as well as emergency responses to adverse effects. The provision of sterile injection equipment should also be part of any harm reduction strategy.

In prevention and harm reduction strategies, much emphasis has been placed on information conveyed at schools, or raves and dance parties. As noted earlier, these prevention strategies and harm reduction initiatives need to better target possibly more 'at-risk' groups (e.g. homeless youth, juvenile justice youth and non-school attending youth) and other settings like parties and general celebrations where young people are likely to use psychostimulants. One attempt at targeting these areas involved the development of a psychostimulant-specific comic entitled 'On the Edge' (Streetwize Communications, 2002). This was distributed to youth centres, refuges and other locations in which various populations of young people were likely to be present. Integral to the development of this publication was qualitative research carried out via focus groups into the information needs of young psychostimulant users. The result was a language appropriate publication, in the form of a comic, which addresses the issues of side-effects (in particular drug induced psychosis), harm reduction techniques and treatment availability and accessibility. Evaluation reports have consistently shown that comics are more successful than other print media in disseminating information to young people. Additionally, research on previous issues has shown that 80% of young people recalled the main message of a Streetwize comic up to four months after they had read it. Research has also shown that young people are more likely to pass Streetwize resources onto their friends.

In any prevention and population based intervention, attention needs to be given to the following:
  • providing accurate, unbiased information;
  • attending to personal variables that may be associated with increased vulnerability to negative peer influence for some individuals or groups;
  • teaching of coping and decision-making skills and those associated with resistance to negative influences;
  • challenging and changing incorrect normative beliefs about the extent of use in a particular area or among a particular target population;
  • improving communication between young people and their parents, teachers and other adults;
  • providing harm minimisation strategies (e.g. safer using techniques) as appropriate; and
  • exposing participants to satisfying and acceptable alternatives to substance use.