International Standards on Drug Use Prevention (2012)
Documento disponible (en inglés) en:http://www.unodc.org/documents/prevention/prevention_standards.pdf
"There was a time when drug prevention was limited to printing leaflets to warn young people about the danger of drugs, with little or no resulting behaviour change. Now, science allows us to tell a different story. Prevention strategies based on scientific evidence working with families, schools, and communities can ensure that children and youth, especially the most marginalized and poor, grow and stay healthy and safe into adulthood and old age. For every dollar spent on prevention, at least ten can be saved in future health, social and crime costs .
These global International Standards summarize the currently available scientific evidence, describing interventions and policies that have been found to result in positive prevention outcomes and their characteristics.(...)
It is our hope that the International Standards will guide policy makers worldwide to develop programmes, policies and systems that are a truly effective investment in the future of children, youth, families and communities".
1. Prevention is about the healthy and safe development of children
"The primary objective of drug prevention is to help people, particularly but not exclusively young people, to avoid or delay the initiation of the use of drugs, or, if they have started already, to avoid that they develop disorders (e.g. dependence).
The general aim of drug prevention, however, is much broader than this: it is the healthy and safe development of children and youth to realize their talents and potential becoming contributing members of their community and society. Effective drug prevention contributes significantly to the positive engagement of children, youth and adults with their families, schools, workplace and community.
Prevention science in the last 20 years has made enormous advances. As a result, practitioners in the field and policy makers have a more complete understanding about what makes individuals vulnerable to initiating the use of drugs (‘risk factors’) at both the individual and environmental level. More than a lack of knowledge about drugs and their consequences, the evidence points to the following among the most powerful risk factors: biological processes, personality traits, mental health disorders, family neglect and abuse, poor attachment to school and the community, favourable social norms and conducive environments, and, growing up in marginalized and deprived communities. Conversely, psychological and emotional well-being, personal and social competence, a strong attachment to caring and effective parents and to schools and communities that are well resourced and organized are all factors that contribute to individuals being less vulnerable (protective factors, recently also referred to as assets) to drug use and other negative behaviours.
It is important to emphasize that these risk factors referenced above are largely out of the control of the individual (nobody chooses to be neglected by his/her parents!) and are linked to many risky behaviours and related health disorders, such as dropping-out of school, aggressiveness, delinquency, violence, risky sexual behaviour, depression and suicide. It should not, therefore, come as a surprise that prevention science demonstrates that many drug prevention interventions and policies also prevent other risky behaviours.
Research indicates that some of the factors that make people vulnerable (or, conversely, resistant) to starting to use drugs, differ according to age. Science has identified risk and protective factors during infancy, childhood and early adolescence, particularly relating to parenting and attachment to school. At later stages of the age continuum, schools, workplaces, entertainment venues, media are all settings that may contribute to make individuals more or less vulnerable to drug use and other risky behaviours.
Needless to say, marginalized youth in poor communities with little or no family support and limited access to education in school, are especially at risk. So are children, individuals and communities torn by war or natural disasters.
In summary, drug prevention is an integral part of a larger effort to ensure children and youth are less vulnerable and more resilient."
2. Prevention of drug use and substance abuse
"Prevention is one of the main components of a health-centred system to address drugs, as mandated by the existing three international Conventions . This document focuses on prevention of the initiation of drug use and the prevention of transition to drug use disorders. The global International Standards do not address other kinds of prevention (e.g. the prevention of health and social consequences of drug use), drug dependence treatment and care, or law enforcement efforts.
This is not to say that these other efforts are not worthwhile. Indeed, it should be stressed that no effective prevention intervention, policy or system can be developed or implemented on its own, or in isolation. An effective local or national prevention system is embedded and integrated in the context of a larger health-centred and balanced system responding to drugs including law enforcement and supply reduction, treatment of drug dependence, and prevention of health and social consequences (e.g. HIV, overdose, etc.). The overarching and main objective of such health-centred and balanced system would be to ensure the availability of controlled drugs for medical and scientific use whilst preventing diversion and abuse.
Although the main focus of the global International Standards is the prevention of the use of drugs controlled in the three International Conventions (including also the non-medical use of prescription drugs), it draws upon and presents evidence with regard to the prevention of other psychoactive substances, such as tobacco, alcohol and inhalants.
Many useful lessons and parallels can be drawn from these complementary prevention fields, but this is far from the only reason for presenting such a comprehensive picture of the evidence. Inhalants are strongly toxic with devastating consequences, driving the urgent need for prevention efforts to address initiation of use. Moreover, in the case of children and adolescents, prevention of tobacco and alcohol initiation is a powerful tool for preventing drug use as well. The brain of children and adolescents is still developing and prevention science tells us that the earlier they start to use psychoactive substances, the more likely they are to develop substance and drug abuse disorders later in life."
3. Prevention science
"Thanks to prevention science, we also know a lot about what is effective in preventing substance abuse and what is not. It is important to note that science does not happen of its own accord. We owe what we know to the dedication and efforts of researchers and practitioners who rigorously evaluated these prevention programmes, and to the organizations that funded this research. The purpose of this document is to organize the findings from these years of research in a format that enhances the ability of policy makers to base their decisions on evidence and science.
This is not to say that we know it all. Through the review process many gaps in prevention science were noted. The majority of the science originates from a handful of high-income countries in North America, Europe and Oceania. There are few studies from other cultural settings or in low- and middleincome countries. Moreover, most studies are ‘efficacy’ studies that examine the impact of interventions in well-resourced, small, controlled settings. There are very few studies that have investigated the effectiveness of interventions in a ‘real life’ setting. Additionally, there are limited studies that have calculated whether interventions and policy are cost-beneficial or costeffective (rather than just efficacious or effective). Last, but not the least, it has been observed that few studies report data disaggregated by sex.
Another challenge suggests that often studies are too few to be able to conclusively identify ‘active ingredients’, i.e. the component or components that are really necessary for the intervention or policy to be efficacious or effective, including with regard delivery of the strategies (who delivers them best? what qualities and training are necessary? what methods need to be employed? etc).
There is a lack of resources and opportunities to undertake rigorous evaluations in some settings, and particularly in low- and middle income countries. This is not to say that work being undertaken is ineffective. Some of the qualitative evaluations that are undertaken reflect promising indications. However, until these strategies are not given the opportunity to be tested in a rigorous scientific manner, it is just not possible to state whether they are effective or not.
Finally, as in all medical, social and behavioural sciences, publication bias is a real problem. Studies which report new positive findings are more likely to be published than studies that report negative findings. This means that ouranalysis risks overestimating the efficacy and the effectiveness of drug prevention interventions and policies.
There is a strong and urgent need for research to be nurtured and supported in the field of drug prevention globally. It is critical to support prevention research efforts in low- and middle-income countries, but national drug prevention systems in all countries should invest significantly in rigorously evaluating their programmes and policies to contribute to the global knowledge base. It is hoped that future updates and editions of these Standards will be able to present a much richer picture of the available evidence.
What can be done in the meantime? Should policy makers wait for the gaps to be filled before implementing prevention initiatives? What can be done to prevent drug use and substance abuse, and ensure that children and youth grow healthy and safe NOW?
The gaps in the science should make us cautious, but not deter us from action. A prevention approach that has been demonstrated to work in one area of the world is probably a better candidate for success than one that is created locally only on the basis of good will and guesswork. This is particularly the case for interventions and policies that address vulnerabilities that are significant across cultures (e.g. temperament, parental neglect). Moreover, approaches that have failed or even resulted in negative outcomes in some countries are prime candidates for failure and iatrogenic effects elsewhere. Prevention practitioners, policy makers and community members involved in drug prevention and substance abuse prevention have a responsibility to take such lessons into consideration.
What we have is a precious indication of where the right way lies. By using this knowledge and building on it with more evaluation and research, we will be able to provide to policy makers the information they need to develop national prevention systems that are based on scientific evidence and that will support children, youth and adults in different settings to lead positive, healthy and safe lifestyles."
4. The International Standards
This document describes the interventions and policies that have been found to result in positive prevention outcomes by the scientific evidence and could serve as the foundation of an effective health-centred national drug prevention system. The International Standards also provide an indication as to how interventions and policies should be implemented drawing on the common characteristics of interventions and policies that have been found to yield positive outcomes. Finally, the document discusses how interventions and policies should exist in the context of national prevention systems supporting and sustaining their development, implementation, monitoring and evaluation on the basis of data and evidence.
The process of development of the International Standards.
The document has been created and published by UNODC with the assistance of a globally representative group of 85 researchers, policy makers, practitioners, non-governmental and international organizations. Members of this Group of Experts were in part identified by UNODC because of their research and activities in the field of drug prevention. Additionally, members were nominated by Member States, as they had all been invited to join the process. (...)
The document
Following this introduction, the document is comprised of three main sections. The first describes the interventions and policies that have been found to yield positive outcomes in preventing drug use and substance abuse. Interventions and policies are grouped by the age of the target group, representing a major developmental stage in the life of an individual: pregnancy, infancy and early childhood; middle childhood; early adolescence; adolescence and adulthood.
Some interventions and policies can be targeted at (or are relevant for) more than one age group. In this case, the description is not repeated. They are included under the age for which they are most relevant with a reference to the other developmental stages for which there is also available evidence.
The description of each strategy includes, to the extent possible, the following details.
- A brief description;
- The available evidence; and,
- The characteristics that appear to be linked to positive, no or negative outcomes.
(...)
A second section briefly describes prevention issues where further research is particularly required. This includes interventions and policies for which no acceptable quality evidence was found, but also emerging substance abuse problems, as well as particularly vulnerable groups. Wherever possible, a brief discussion of potential strategies is provided.
The third and final section describes the possible components for an effective national prevention system building on evidence-based interventions and policies and aiming at the healthy and safe development of children and youth. This is another area where further research is urgently needed, as investigations have traditionally focused more on the effectiveness of single interventions and policies. Therefore, the drafting of this Section benefited from the expertise and the consensus of the Group of Experts.
Documento disponible en:
http://www.unodc.org/documents/prevention/prevention_standards.pdf
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