title: Drug prevention programmes for young people: where have we been and where should we be going?
abstract: OBJECTIVE
  Substance use by young people has long been a concern of western society, but opinion is mixed as to which prevention approach offers the greatest benefit, and whether indeed there is any benefit at all. This paper reviews the nature of prevention programmes, the research evidence that underpins these programmes and the prevention objectives against which effectiveness is measured. The aim of this is to create better understanding of the elements that maximize programme effectiveness, what can be achieved by prevention programmes and how programmes can be improved.
  
  
  RESULTS
  There is a range of prevention approaches for which there is evidence of effectiveness. Some are classroom-based; some focus upon parenting; some have substantial whole-of-school and community elements; and some target risk and protective factors in early childhood. All, however, are based substantially on the social influence model. In an attempt to improve practice lists of effective programmes have been developed, but there are concerns about the science behind selection. On balance, there is consistent evidence that social influence prevention programmes do have a small, positive effect on drug use, but this then raises the question as to whether harm, rather than use, would be the more worthwhile target for prevention. Prevention that seeks to reduce harm has been demonstrably effective, but has found little support in some jurisdictions.
  
  
  CONCLUSIONS
  Research has created a progressively better understanding of how to optimize programme effectiveness and what can be achieved realistically by even the most effective programmes. However, further research is required to identify which, if any, particular approach offers greater promise. The effectiveness of harm reduction should be compared with more traditional abstinence and the additional effects of whole of school, parent and community elements need to be measured more accurately. Contemporary social influence prevention programmes are flawed, but the approach is still the best way of influencing drug use behaviour in young people as a whole. Evidence-based refinement is the best option for greater benefit.
authors.affiliation: Edith Cowan University, Perth, WA, Australia. r.midford@ecu.edu.au
authors.forename: Richard
authors.initials: R
authors.lastname: Midford
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology / Q000517:prevention & control; D001315:Australia / Q000453:epidemiology; D002648:Child; D003657:Decision Making; D019049:Developed Countries; D004493:Education; D019317:Evidence-Based Medicine; D005192:Family Health; D040261:Harm Reduction; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D016730:Program Development; D015397:Program Evaluation / Q000379:methods / Q000592:standards*; D012307:Risk Factors; D012572:School Health Services / Q000458:organization & administration / Q000592:standards / Q000639:trends*; D012574:Schools; D012907:Smoking / Q000453:epidemiology; D000074606:Smoking Prevention; D012945:Social Values; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000517:prevention & control*