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National Amphetamine-Type Stimulant Strategy Background Paper: Monograph Series No. 69

4.1 What is prevention?

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Various strategies have been used to prevent drug problems, such as law enforcement approaches to prevent and disrupt production and supply, community based information and awareness raising programs, and strategies that aim to prevent and/or reduce problems in those who are currently engaged in drug use. In their extensive review of the literature on prevention, Loxley and colleagues (2004) defined prevention as:

measures that prevent or delay the onset of drug use as well as measures that protect against risk and reduce harm associated with drug supply and use (p.xiii).

Prevention approaches are typically generic to all drug types and may be adapted to address a specific drug class, such as amphetamine-type stimulants (ATS). The most common classification for these strategies is as follows:

1. Primary prevention – prevent and reduce initiation of drug use (for example, education programs warning of the risks of drug use and supply control strategies);
2. Secondary prevention – reduce the up-take of high-risk drug use, such as injecting and dependence, to prevent problems in those already engaged in drug use (for example, targeting interventions to current users to ensure that they avoid injecting); and
3. Tertiary prevention - prevent behaviours that lead to significant social and/or individual harms among dependent users (for example, reducing the risk of HIV or Hepatitis; reducing the risk of overdose).

An alternative conceptualisation of prevention was suggested in 1994 by the United States Institute of Medicine, and based on the level of risk of disorder in various target groups, as follows:

1. Universal prevention – target whole populations at average risk;
2. Selective prevention – target specific groups at increased average risk;
3. Indicated prevention – target individuals with early emerging problems.

According to both these models and, as indicated in the definition of prevention provided above, the nature of and methods used in any prevention strategy will depend on the specific aims and intended audience or targeted behaviour/contexts. Strategies that aim to inform the broad community about drug use and drug risks are likely to be distinguished from strategies that are aimed at preventing use among school aged children, and strategies that aim to reduce the problems arising from injecting behaviour.

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The range of different ATS prevention strategies therefore includes broad strategies (e.g., targeting the whole community, through mass media campaigns; focusing on all schoolaged children, through school drug education; preventing use and problems among employees, through workplace programs); programs aimed at those who are identified as at risk of engaging in drug use and experiencing related problems (e.g., targeting vulnerable families and/or communities; targeting people affected by mental health problems); and programs that target current users (e.g., peer education to reduce the risk of HIV or drug overdose). The range of potential prevention strategies was summarised by the Australian National Council on Drugs (ANCD) (2007):

The means of implementing prevention strategies varies from strengthening societal infrastructure (e.g., providing opportunities for education, employment and recreation), educating young people about the harmful effects of drugs (e.g., school-based prevention programs), to early interventions and peer-based outreach programs aimed at reducing problematic patterns of drug use (e.g., injecting drug use and HIV risk behaviour). Media campaigns have also been used successfully to reduce a range of unhealthy behaviours, including drug use (p.6).

The nature and impact of various drug prevention strategies, including harm reduction measures, are reviewed elsewhere and will not be considered in detail here (for example, see review by Loxley et al., 2004). However, in the sections that follow, a brief commentary on some common illicit drug prevention and harm reduction strategies is provided, before discussing their application to ATS. For the present purposes, measures that prevent or delay onset of drug use will be referred to as prevention strategies, while measures targeting related harms for those already using drugs will be referred to secondary prevention and/or as harm reduction strategies. Measures that address or alleviate the effects of use (e.g., dependence, psychological problems, overdose, withdrawal) will be considered in the separate section on ‘treatment’.

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