The theme of this year’s International Day against Drug Abuse and Illicit Trafficking (26 June) is “The evidence is clear: invest in prevention”. The theme is anchored in the importance of investing in prevention but also in the understanding that such an investment must be grounded in evidence. If correctly applied, prevention is a massive cost-saver, and thus, a very efficient tool. Take note: every dollar spent on prevention can save governments up to 10 dollars in later costs.
The United Nations Office on Drugs and Crime (UNODC) has summarized this evidence in the , published jointly with the World Health Organization in 2018. Based on a global review of the scientific literature, the Standards identify a series of interventions and policies that can be applied by governments according to their context and resource availability.
Key to the Standards is that prevention should be person-centred. The science guiding the responses is based on the understanding of the complex interplay between personal and environmental factors that make people, including children and youth, vulnerable to the initiation of drug use. Such an understanding includes four complementary perspectives for effective prevention responses.
The first is a multiple risk and protective factor perspective. There is a range of competing factors of risk and protection that make people more (or less) vulnerable to starting drug use and possibly develop drug use disorders. These factors are to be found at the personal level, in the immediate environment (family, schools, peers) and in the wider environment (the community, the country). Such a perspective also reflects on the complementarity and multiplicative effect of diversifying prevention interventions that address different vulnerability factors.
The second is a developmental perspective. Diverse challenges are faced at every age of development, with stronger and more long-lasting impact in the early ages. Every age of development has different needs. There are diverse prevention programmes that can start as early as during pregnancy or early infancy and support optimal reach of an individual’s developmental milestones. An investment in preventing the initiation of drug use at an early stage is crucial, as the younger a child starts to use psychoactive substances, the more likely he or she is to develop mental health disorders, including drug use disorders. Such a perspective also brings in the importance and value of gender considerations in responses. Boys and girls have different developmental trajectories and are affected differently by environmental factors.
The third perspective for effective prevention responses is a contextual perspective. Certain interventions are generic in nature─or “universal”─supporting any person of a specific age, regardless of the context they are in. Other interventions are “selective” and address populations that are living in more challenging environments, and as such would benefit from more tailored interventions. A third set of interventions is even more pointed─or as we call it, “indicative”─and addresses individuals with symptoms of risks that need to be dealt with before escalation into more problematic behaviours. This perspective adds to the need for tailoring responses to “leave no one behind”.
The fourth is a common vulnerability perspective. The vulnerabilities in question are common not only to the initiation of drug use but also to many other negative outcomes, including risky sexual behaviours, violent behaviour and school delinquency, or other violent and aggressive behaviours. This perspective adds to the importance of the return on investment (reaching 10 times the investment costs in savings to the health, social and criminal justice system) that can be generated from this person-centred perspective.
While effective interventions exist for all ages, children have been chosen as a priority focus due to the importance of the developmental element in prevention.
Applying these four perspectives allows one to appreciate that drug control is not simply an individual choice─a moral lapsus─but a series of complex interacting factors. For instance, nobody chooses to be born in a dysfunctional family or in a violent and marginalized community. These factors do not make one a “problem user” but they do generate vulnerability. This also explains why a multisectoral approach is required, covering interventions for a variety of potential pain points, particularly in the family and in schools, but also in the workplace, in the community and through the health sectors.
UNODC engagement with Member States is particularly focused on interventions addressing early adolescence through schools and families by piloting evidence-based, manualized programmes in more than 50 countries worldwide and documenting their effectiveness.
Family skills-based prevention is of particular importance given its practicality and effectiveness even in very difficult circumstances, including in situations in which populations are displaced by violence, war or natural disasters. Moreover, it benefits both boys and girls and not only in helping them avoid drug use, but equally in preventing child maltreatment and youth violence, as well as in cases of developmental or mental health difficulties of a child.
After applying programmes conceived by universities (Strengthening Families Programme 10-14, Families and Schools Together), UNODC opted to design programmes for use in the public domain and tailored to the needs and infrastructures of low- and middle-income countries (Strong Families, Family UNited).
Family UNited is a family skills package that is universal in nature but designed to be low in cost of implementation to ensure higher chances of scale-up and sustainability. Strong Families is a tool to support caregiving under stressful circumstances. With the growing number of families living in humanitarian settings, the Strong Families programme expanded to become part of a suite of tools ranging from basic messages in the form of tips, leaflets or more detailed booklets, to a three-session programme such as Strong Families, up to a tool for strengthening family skills after addressing trauma in caregivers and their children (TRT+). UNODC has been delivering such programmes among families in distress during COVID; for refugees in Bangladesh, Iran, Jordan, Lebanon, Pakistan, Syria and Ukraine; and in slums in Central America and elsewhere.
Life and social skills, and a package of social and emotional learning tools, are also fundamental for UNODC programming and have been applied in over 1000 schools in Central America, South-Eastern Europe and West Africa.
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A few months ago, UNODC launched a novel framework for prevention named CHAMPS─Children Amplified Prevention Services. The aim of the framework is to demonstrate the usefulness and cost-effectiveness of investing in prevention systems that support the development of children from birth to 18 years of age (according to the definition provided in the ). While effective interventions exist for all ages, children have been chosen as a priority focus due to the importance of the developmental element in prevention.
Our planet is currently home to the largest youth population in the history of its existence. This population is facing unprecedented stresses such as climate change, cyber risks, pandemics, crime, and social and political instability. Notably, the youth population is growing faster in low- and middle-income countries, where vulnerabilities are more prominent and infrastructure is weaker. Youth should be central in the response and should not only be recipients but also agents of the response. The evidence is clear, the time is now. The call for action is an open invitation to the international community to champion and invest in evidence-based prevention interventions, and most importantly, to amplify prevention services and invest in systems of prevention such as CHAMPS.
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References
Aala El-Khani and others, “Bridging the Gap between the Pressing Need for Family Skills Programmes in Humanitarian Settings and Implementation”, International Journal of Environmental Research and Public Health, vol. 19, No. 4, (February 2022), p. 2181.
Aala El-Khani and others, “Caregiving for children through conflict and displacement: a pilot study testing the feasibility of delivering and evaluating a light touch parenting intervention for caregivers in the West Bank”, International Journal of Psychology, vol. 55, Suppl. 1 (January 2019), pp. 26-39.
Aala El-Khani and others, “Enhancing Teaching Recovery Techniques (TRT) with Parenting Skills: RCT of TRT + Parenting with Trauma-Affected Syrian Refugees in Lebanon Utilising Remote Training with Implications for Insecure Contexts and COVID-19”, International Journal of Environmental Research and Public Health, vol. 18, No. 16 (August 2021), pp. 8652.
Karin Haar and others, “Family UNited: piloting of a new universal UNODC family skills programme to improve child mental health, resilience and parenting skills in Indonesia and Bangladesh”, International Journal of Mental Health Systems, vol., No. 1 (December 2023), p. 49.
Hanna Heikkil?, Wadih Maalouf and Giovanna Campello, “The United Nations Office on Drugs and Crime’s Efforts to Strengthen a Culture of Prevention in Low- and Middle-Income Countries”, Prevention Science, vol. 22, No. 1 (January 2021), pp. 18-28.
Wadih Maalouf and Giovanna Campello, “The influence of family skills programmes on violence indicators: Experience from a multi-site project of the United Nations Office on Drugs and Crime in low- and middle-income countries”, Aggression and Violent Behavior, vol. 19, No. 6 (November 2014), pp. 616–624.
Wadih Maalouf and others, “Lions Quest Skills for Adolescence Program as a School Intervention to Prevent Substance Use—a Pilot Study Across Three South East European Countries” Prevention Science, vol. 20, No. 4 (May 2019), pp. 555-565.
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