Contents of programmes and activities

An increase in programme-based approaches and improved standardised information collection have enabled the contents of and trends in prevention policies to be reviewed and compared across the EU. The information usually comes from national experts or expert groups who have a reliable overview of their country’s situation that allows them to come up with standardised ratings or from quantitative data on monitored, programme-based interventions that is available in some Member States, e.g. Greece and Hungary.

For instance, most Member States have implemented personal and social skills training in schools as a prevention approach. Topics covered include decision-making, coping, goal-setting and assertiveness, communicating and showing empathy. This evidence-based technique, which is derived from social learning theories (35), seems now to be an important methodology in most Member States, even in countries where programme-based approaches do not exist (France, Luxembourg and Sweden) (Table 2). Estonia reports the widespread use of a book that teaches social skills.

Table 2: School-based prevention in Europe

Information provision continues to play a central role in drug prevention in many Member States (see Table 2). The limited value of information provision in the prevention of drug use is only slowly being acknowledged (see, for example, the Swedish national report). Approaches based solely on health education are also limited to influencing cognitive processes and often lack concrete components of behavioural and social interaction training. However, these approaches are still widespread in some countries despite our present understanding of effective drug prevention.

There are two explanations for the continuance of such approaches to drug prevention. One is the instinctive and traditional presumption that providing information on drugs and the risks associated with drug use will act as a deterrent. The second explanation reflects a very recent trend inspired by harm reduction movements and is based on the belief that cognitive skills are more important than behavioural approaches in teaching young people to make informed decisions and choices in life. Advocates of this technique believe that behavioural approaches to drug prevention, such as improving life skills, are patronising and demonise drug use (Ashton, 2003; Quensel, 2004) and that giving young people the cognitive tools they need, by providing information, is the best method. Despite their different traditions, both approaches view health behaviour, and specifically drug use, as a matter of personal rational choice, whereas the broad consensus in the health sciences is that social factors (neighbourhood, peer group, norms) and personal factors (temperament, academic and emotional skills) are more influential in shaping health and drug use behaviour than is mere cognition.

The erroneous perception of drug use as normal and socially acceptable among the peer population is the most important cognitive element that can be influenced by prevention. In fact, a lifetime prevalence of cannabis use among young adults of 30 % means that more than two-thirds of this population have never used cannabis, and that is the true ‘normality’. However, despite the proven benefit of techniques that address young people’s normative beliefs (Reis et al., 2000; Taylor, 2000; Cunningham, 2001; Cuijpers et al., 2002), they are rarely used in Europe.

(35) Behaviour is seen as result of social learning by role models, norms, attitudes of ‘important others’ (Bandura, 1977). Negative attitudes to drug use and protective self-efficacy can be learned or conditioned. This concept is the basis for peer models and the specific life skill model.