1. PREVENTION

The distinction between universal-selective-indicated prevention is the level of "filter" applied for risk attribution. For universal prevention, there is no filter (all are considered at equal - low - risk). For selective prevention, the filters are social and demographic indicators relating mostly to groups: marginalised ethnic minorities, youth in deprived neighbourhoods, young offenders, vulnerable families, therefore, a rather "raw" filter. For indicated prevention, however, the individual at risk itself needs to have a "diagnosis", i.e. a risk condition attributed by a professional, e.g., Attention Deficit Hyperactivity Disorder (ADHD).

Definitions

Environmental prevention strategies

In practice, universal prevention activities are focused on licit (alcohol, tobacco, etc.) and illicit drugs together, whereas prevention interventions that focus exclusively on illegal drugs are very rare. The main objective of such prevention is usually preventing or delaying the initiation of legal drug use, because their early or intense use is the most important risk factor for initiation and problems with illicit drugs later. Tobacco and alcohol use depend strongly on culture and social norms, acceptance of use and availability of these substances.
Therefore, environmental approaches are prevention measures that operate at the level of social, formal and cultural norms related to alcohol, tobacco and also cannabis. While universal prevention intervenes on population level, selective prevention at (vulnerable) group level, and indicated prevention on individual level, environmental approaches work on societal level, mostly by shaping attitudes, normality perception and values regarding legal drug consumption.

Universal prevention

Universal prevention strategies address the entire population (local community, pupils, neighbourhood). The aim of universal prevention is to completely deter or delay the onset of substance abuse by providing all individuals the information and skills necessary to prevent the problem. Universal prevention programs are designed for large groups without any prior screening for substance abuse risk. All members of the population share the same general risk for substance abuse, although the risk may vary greatly among individuals.

Selective prevention

Selective prevention is directed at specific sub-populations whose risk of a disorder is significantly higher than average, either imminently or over a lifetime. This responds to the growing importance of identifiable risk factors for understanding the initiation and progression of substance abuse, particularly among young people. Leading advantage of targeting high-risk groups is that they already exist and are clearly identified, however, these interventions require a special effort to avoid stigmatization and to implement preventive strategies that will lead to desired results.

Indicated prevention

Indicated prevention aims to identify individuals who are exhibiting indicators that are highly correlated with an individual risk of developing drug abuse later in their life (such as psychiatric disorder, school failure, dissocial behaviour, etc.), or additionally, early signs of problematic substance use (but not DSM-IV criteria for dependence) and to target them with special interventions. Identifiers for increased individual risk can be falling grades, conduct disorder, and alienation from parents, school and positive peer groups. The aim of indicated prevention is not necessarily to prevent the initiation of use or the use of substances, but to prevent the (rapid) development of dependence, to diminish the frequency and to prevent “dangerous” substance use (e.g., moderate instead of binge-drinking).

Environmental strategies

Environmental strategies are prevention strategies aimed at altering the immediate cultural, social, physical and economic environments within which people make their choices about drug use.

This perspective takes into account the fact that individuals do not become involved in substance abuse solely on the basis of personal characteristics. Rather, they are influenced by a complex set of factors in the environment, such as what is considered normal, expected or accepted in the communities in which they live, the rules and regulations of their states, public messages they are exposed to, and the availability of alcohol, tobacco, and illicit drugs. Because drug abuse is viewed as a result of the entire system, the rationale of environmental prevention strategies is to target the community at large.

In reality, environmental strategies often include unpopular components, such as market control or coercive measures (age controls, tobacco bans). Therefore, they have an important potential for social debate as they challenge culture-bound understanding of society and public health.

Drug use as a behaviour is independent from the legal status of substances, and almost all prevention policies in Europe take this into consideration while covering legal and illegal substance in prevention interventions. Environmental strategies - despite targeting predominantly legal drugs - are important for the whole prevention field because early, widespread and intense use of alcohol and tobacco is related to illicit drug use in many countries.

Many environmental strategies are implemented at state (macro) or even EU level. Examples are smoking bans, total or only in working places, additional taxes on alcohol and tobacco, marketing and advertisement regulations and age limits for tobacco or alcohol sales to youth.

2. HARM REDUCTION

Harm reduction policy is primarily concerned with reducing harm caused by drug abuse, addiction and risky lifestyles. This principally means preventing the spread of infectious diseases: hepatitis B, hepatitis C, HIV and AIDS through organized activities such as free and anonymous distribution of syringes and needles for intravenous drug users, taking and destroying used syringes and needles, provision of condoms, information materials, counselling focused on change in opinions and habits of the target population. The beginnings of such programs can be found in the UK, the Netherlands, and Switzerland, some thirty years ago, and today they exist in almost all countries of the world and have always been opposed to the classic restrictive drug policy.

The EU Drugs Strategy (2005–2012) addresses the reduction of drug-related harms to health and society as a main objective and encourages national action that gives emphasis to the reduction of infectious diseases and drug-related deaths. The EU Drugs Action Plan (2009–2012) stipulates the prevention and reduction of social harm and health damage as the ultimate aim. Objectives defined in the Action Plan to guide Member States include the prevention of health risks related to drug use, adequate availability and accessibility of effective harm reduction services as highlighted already in the Council Recommendation on the prevention and reduction of health-related harm associated with drug dependence.

Harm reduction programs in Croatia began their work in 1996 when the Croatian Parliament adopted harm reduction activities as an integral part of the National Strategy on Combating Drugs Abuse, and when the first harm reduction program began in a non-governmental organization "Help" in Split. In 1998 Red Cross begins harm reduction programs in Zagreb, Zadar and Pula, and in 1999 the association "Terra" starts the same in Rijeka.  Today there are 4 non-governmental organizations (Help, Terra, Let, Institut) and one institution (Croatian Red Cross) active on a regular basis at different locations countrywide where harm reduction programmes are conducted.  

3. DRUG TREATMENT

Ensuring the availability of drug treatment is the specific objective of the EU Drugs Strategy (2005–2012). Similarly, in all Member States, drug treatment is considered as a key element of their National drug strategies in the field of illicit drug demand reduction. The task of the EMCDDA is to support Member States and the European Commission in the evaluation of the EU Action Plan by monitoring and reporting on drug treatment in terms of organization, characteristics and availability of treatment in the EU.

The latest Drug treatment overviews on the availability of drug-related treatment (including social reintegration) are available for 30 countries - the 27 EU Member States, Norway as EMCDDA member, and Turkey and Croatia as Candidate Countries. The drug treatment overviews consist of five main parts:

•    Description of the national context, i.e., overall drug treatment system and organisation;

•    Description of treatment registries and monitoring systems available in each country;

•    Current treatment demand data including new clients entering treatment for the first time and a breakdown by primary drug;

•    Availability and provision of treatment services in the country, with a specific focus on substitution treatment;

•    References and additional resources.

The overviews are based primarily on data from standard tables on drug treatment and national reports. They have been produced with the assistance of the Reitox National Focal Points.

4. SOCIAL REINTEGRATION

Social reintegration is an intervention that ensures reintegration of former drug addicts into society through education, employment or housing. Traditionally, social reintegration is understood as a series of measures taken after (successfully) completed treatment process, but recently it has been increasingly perceived as an intervention that can be applied at any stage of treatment. Social reintegration has surely made progress in recent decades, but apparently it still remains an intervention in which modest funds are invested, hence the low availability of its services.

The ultimate goal of this field is to monitor social reintegration in order to improve the evaluation of these measures in EU Member States. A number of complementary projects that are part of the evaluation of the EU Drugs Action Plan (2005–2008) have been realized for the purpose of investigating this issue.

5. PREVENTION OF DRUG-RELATED CRIME

The mere concurrence of illicit drug use and crime is not enough to conclude that illicit drugs cause crime. According to qualitative research conducted in the EU (EMCDDA - QED), there is little evidence of crime consequences from the vast recreational drugs scene across Europe. Alternatively, there is an almost universally identified connection between "hard" dependent drug use, poverty, prostitution and crime.
Prison generally does not have a rehabilitative effect. Prisons may exacerbate harm caused by drug use – this harm may then be spread to the community outside prisons. There is also an adverse impact that the arrest and imprisonment of drug addicts has on their future employment, which contributes to the recurrence of criminal behaviour. Owing to these and other pressures, interventions have been suggested and developed as a more effective way of working with problem drug users who commit crimes.

There is some evidence that the implementation of alternative measures instead of imprisonment has a positive effect in reducing crime. The objectives of alternative measures vary, but basically two can be identified:

1.    Reduce criminal justice costs, as well as criminogenic effects in the case of minor offences;

2.    Coerce severe drug addicts involved in crime to undertake appropriate treatment.

Outside the criminal justice system, primary prevention strategies as well as treatment and rehabilitation programmes may reduce drug-related crime. Universal prevention strategies may have beneficial effects on social functioning, including criminal behaviour. There is evidence that treatment programmes, which reduce drug consumption, also generally reduce criminal behaviour.

6. DRUG SUPPLY REDUCTION

Interventions aimed at drug supply reduction can be divided into three main areas:

•    Interventions against drug supply;

•    Interventions against diversion of chemical precursors;

•    Interventions against money laundering.

In accordance with the EU Drugs Action Plan (2009-2012), numerous activities were carried out relating to two specific targets:

•    Reduce availability of illicit drugs;

•    Reduce money-laundering and illicit trafficking of precursors.

7. EVALUATION INSTRUMENTS BANK (EIB)

The Evaluation Instruments Bank (EIB) is an online archive of freely available instruments for evaluating drug-related interventions. Its purpose is to encourage implementation and evaluation of preventive programs and treatment programs, and assist in the use of standardized and reliable methods at the European level. EIB is regularly upgraded and currently contains 170 evaluation instruments in the treatment field and 70 instruments in the prevention field, and has been translated into 19 languages.

8. EDDRA

The Exchange on Drug Demand Reduction Action (EDDRA) is a multilingual online information system for collecting information on best practices in the EU.

Established in 1996, EDDRA provides a detailed overview of evaluated prevention, treatment and harm reduction programs in the EU, and promotes the exchange of "first hand" expertise and experience. EDDRA is primarily designed to assist professionals and policy-makers in the planning and implementation of high-quality interventions in response to the drugs issue. It offers the ability to search by country, language, theme and target group. EDDRA is one of Reitox core tasks and all National Focal Points report projects and programmes to EDDRA.