A range of interventions with different
objectives and operating in different settings are covered
in this section. An overview of the various settings
and approaches in demand reduction are provided in Figure
in schools remains a priority in all Member States.
Many teaching guidelines exist on prevention and it
may be necessary to carry out a market overview in order
to select the most appropriate material (as has been
done in Germany). In most curricula, drug prevention
is included in a context of general health promotion.
Peer-to-peer approaches (that is students educating
one another) are considered advantageous, although they
are difficult to establish and sustain. Parents involvement
is considered crucial.
pupils in prevention activities
At the request of the Ministry
of Education in France, an evaluation was
carried out of the schools that took part
in a pilot programme 'Les eleves acteurs
de prevention'. The pupils received guidance
in organising campaigns and transmitting
knowledge on the issues concerned to their
fellow students. Their involvement in managing
the programme earned them the recognition
of their peers. The experiment proved a
success for half of the schools involved
but even where it was not, it attracted
a great deal of interest from pupils in
all schools. Its impact on the atmosphere
and quality of life in schools was very
positive, both in terms of the pupils' perception
and the schools' external reputation.
Increasingly, the police take an interest
in primary drug prevention in schools (in Belgium, France,
the Netherlands, Austria and Sweden) although there
has been some debate as to whether they are equipped
with the necessary educational skills for this type
Students do take drugs (see Chapter
1, Drug use in the school population) and are in
the risk zone. This was formerly largely denied since
schools feared damage to their image. Increasingly -
in Spain, France, Luxembourg, the Netherlands, Austria
and the United Kingdom - strategies are set up to develop
school policies on the prevention of risk behaviour,
early intervention and the facilitation of referral
to addiction care. Of particular concern are young people
who drop out of school or who are expelled. Spain reports
standardised interventions for this group and in the
United Kingdom 95 % of secondary schools have policies
covering drug-related incidents.
Prevention in local settings
in local communities have expanded in the past years
and take varying shapes and forms. All Member States
report different types of parents' training in the community.
For example, in Spain, 25 000 families participated
in escuelas de padres in 1999, and, in France, there
are 75 special counselling centres for young people
to provide help for emotional, family or social problems.
In the Nordic countries, groups of parents walk the
streets of their community in order to provide support
to young people on weekend nights. In Denmark, 1 300
parents are involved in this activity.
Sports and athletic associations are
given a more prominent role in drug prevention than
reported in previous years in many countries including
Belgium, Germany, Greece, Spain, France, Italy and the
United Kingdom. In Germany, cooperation between sports
clubs and drug prevention has existed since 1994 and,
in 2000, another 2 500 youth sports leaders were trained.
A conference on addiction prevention in sports clubs
focusing on the quality of drug prevention in sports
clubs and on drug use and sports clubsÕ rituals and
culture was organised in Potsdam, Germany, in March
Coordination between actors is crucial
for success. In Denmark, Greece, Finland, France, Ireland,
Italy, Portugal, Sweden and the United Kingdom agreements
within local or regional authorities on drug prevention
strategies are in place or under development countrywide.
is known about the availability of drug-free treatment
across the EU. However, drug-free treatment seems to
be dominating the treatment offered in Finland, Greece,
Norway and Sweden. The tendency in those countries is
to have shorter treatment periods of three to six months
instead of one to two years, although in Greece the
mean duration of treatment is 12 months. A recent meta-analysis
carried out in Germany and covering several European
countries concludes that there is a positive relationship
between the length of treatment and treatment success.
However, evaluation of different treatment options is
still to be improved.
Case management (low-threshold, intensive,
personalised assistance) is increasingly set up to guide
a drug user through the treatment networks, for example
in Belgium, Germany and the Netherlands. The results
of five Dutch studies on dual diagnosis (the coincidence
of drug and psychiatric problems) show that case management
has slightly positive effects on patients' satisfaction,
drug use, psychiatric symptoms, social skills and utilisation
of care services.
types of treatment
In Norway, a project is evaluating
types of treatment for drug users to find out
if some treatments obtain better results than
others and to find out which clients benefit from
which type of treatment. As drug users often use
several different treatments, the point of departure
is that each treatment builds on the achievements
of any previous treatment - the hypothesis being
that resources invested are not lost.
The Netherlands provides a somewhat
negative picture of a difficult target group who fail
to change their drug using behaviour even after several
attempts. The purpose of inpatient motivation centres
is to offer the opportunity to drug users to recuperate,
to help them develop their social skills and to structure
daily life in order to increase their motivation to
enter into regular care. However, the drop-out rate
at these centres is 60 % and it is concluded that drug
users who are not motivated cannot be helped successfully.
has been expanding moderately in the EU over the last
years. Greece, Finland, Norway and Sweden have recently
facilitated access to substitution treatment, mainly
methadone. Buprenorphine, which is the main substitution
substance in France, has been introduced in Belgium,
Denmark, Finland (for detoxification), Germany, Italy,
Luxembourg, Norway, Portugal, Austria and the United
Kingdom, whereas LAAM is prescribed in Denmark, Spain,
and Portugal. Studies are in progress in the Netherlands
concerning rapid detoxification with naltrexone as a
medical treatment, and this may be considered as an
alternative to other treatments. Naltrexone has been
used in Portugal for the last 10 years.
Heroin continues to be prescribed
on a selective basis in the United Kingdom. Experimental
heroin prescription for treatment of refractory chronic
drug users is available in the Netherlands within the
context of scientific experiment and a heroin prescription
trial will be initiated in Germany in 2001. Luxembourg
is also considering a heroin trial in 2002. Experts
agree that heroin prescription should only be considered
when all other treatment options available are exhausted.
Heroin prescription puts a heavy burden on clients and
the need to present themselves at the treatment centre
two or three times a day is disruptive to them. However,
there is evidence of its effectiveness for very deprived
drug users in terms of crime reduction, health improvement
and social integration.
work (that is contacting drug users in their own setting)
in the EU is not an easy endeavour since many activities
are carried out locally by non-governmental organisations
and by structures that tend to be quite complex.
The origins of outreach work lie in
traditional youth work (with the aim of guiding drug
users into treatment) and in public health concerns
(especially the prevention of infectious diseases).
Outreach work may include social work among addicts,
needle exchange, low-threshold services and/or special
services for ethnic minorities, prostitutes and other
hard-to-reach groups and is available to problem drug
users who are not in regular treatment services in all
Member States. Peer support among drug users has been
organised in Denmark, France, the Netherlands, Austria,
and the United Kingdom in order to respond to the needs
of drug users.
project for homeless women
In Sweden, the Stockholm Social
Services started an outreach project in 2000 targeting
homeless women, many of whom have little or no
contact with social services. One of the aims
is to motivate the women to increase their contacts
by providing them initially with simple medical
help. The project is exemplary in that it is a
joint venture between the social services, voluntary
organisations and the medical treatment sector.
Outreach work is expanding in most
Member States. However, in Sweden, outreach work was
more common some 10 to 15 years ago and a new study
reports that, owing to a reduction in resources, many
drug users are not approached by any such services.
New developments include outreach work for North-African
drug users in the Netherlands, and the introduction
of special services for women drug users in Denmark,
Norway, Austria and Sweden.
One specific outreach activity, which
has been adopted in France, the Netherlands, Austria
and Spain is on-site pill testing at dance events. Pill
testing attracts visitors because the content of pills
is always of major concern to them. Most projects also
offer information talks, harm reduction messages and
crisis intervention. A recent EMCDDA study ('An
inventory of on-site pill testing interventions in the
EU' (42KB) EMCDDA 2001) suggests that pill testing
can efficiently warn against the unexpected and dangerous
effects of dance drugs.
are expanding in most Member States. Users« rooms
that is rooms where injecting drug users can use drugs
under hygienic and safe conditions - were legalised
in Germany in February 2000, and one users' room was
introduced as a pilot project in Madrid, Spain in 2000.
In the Netherlands, they have existed for several years
where they also serve heroin smokers and cocaine and
crack users. Similar initiatives are being discussed
in Austria, Luxembourg and Portugal. In relation to
a discussion in Denmark concerning the introduction
of injection rooms in association with existing low-threshold
services, the Danish Ministry of Health has chosen to
shelve this initiative as a result of international
conventions dealing with this matter.
health responses to new synthetic drugs
These measures aim to
avert potential health problems relating to the consumption
of substances, unidentifiable to the users, who themselves
are not seeking contact with treatment and counselling
services i.e. unknown substances consumed by unknown
users. These responses are implemented either through
structural measures such as the organisation of safe
raves (staff training, provision of water and chill-out
facilities) or information measures on party drugs through
media campaigns, interactive web sites and CD-ROMS,
or by specifically providing information on the results
of on-site or off-site pill testing through the Internet
or special journals. Thus, these interventions are sometimes
linked to outreach work measures such as on-site pill
In Denmark, Spain, Ireland, Italy
and the Netherlands local authorities approach young
people's leisure venues (such as clubs, bars and discos)
to provide the staff with training and support to enable
them to respond more effectively to drug-related situations.
for nightclub staff
In Ireland, training and support
is given to nightclub staff in order to enable
them to respond more effectively to drug-related
situations in nightclubs. The first two phases
of the project involve the organisation of training
programmes for club owners/managers and door supervisors.
They focus on increasing their knowledge about
drugs, exploring their attitudes towards drugs
and examining legal, health and safety issues.
The third phase is designed to disseminate accurate
information on drugs to young club goers through
distributing a credit card-sized booklet known
as the vital information pack (VIP) in a number
of venues including third level colleges and clubs.
In phase four, a one-day conference will be organised
to gain support from the music/dance industry
for the development of acceptable policies in
dance venues. The final phase involves standardising
training for door supervisors and providing these
elements in a modular form.
The concept of 'real time' monitoring
of youth scenes is reported by Luxembourg. Following
an initial evaluation phase, the game kit 'Ecstasia'
has been applied to different youth settings and integrated
in appropriate school courses. It boosts discussion,
sharing experiences and finding alternatives to drug
use, especially as regards synthetic drugs. The group
dynamics stimulated by the game enable issues to be
addressed to which young people should be sensitised.
The evaluation suggests increasing the creative and
action-oriented elements of the game.
The Internet provides an enormous
variety of drug information reflecting all positions
on drug policy, although quality control of such information
is not possible. Most national prevention organisations
as well as NGOs have or plan their own homepage, mainly
with information but also with interactive features,
for example the Italian Io non calo la mia vita (http://www.iononcalo.it),
the Swedish Drugsmart (http://www.drugsmart.com)
and the drug search facility (http://www.drugscope.org)
provided by DrugScope in the United Kingdom. An innovative
initiative is reported from Finland where an anonymous
consultancy and self-assessment test is available on
the Internet (http://www.a-klinikka.fi/plimenu1.htm).
The EMCDDA database, EDDRA,
gives references to over 250 evaluated projects in the
field of demand reduction and is continuously growing.
treatment and testing order schemes in the United
The UK Government has introduced
drug treatment and testing order (DTTO) schemes
whereby courts can make an order requiring offenders
to undergo treatment either as an alternative
to prison or as a sentence in its own right. The
roll out of DTTO is estimated to result in some
3 425 orders being made by 2001. This is to be
compared to some 120 000 persons convicted of
drug offences in 1999. Drug prevention advisory
services, in conjunction with probation services,
will provide on-the-ground support for the national
roll out of DTTO, disseminating practice findings
from the pilot programmes and assisting local
drug action teams in developing appropriate commissioning
of drug-related crime
States have programmes for diversion to treatment under
specific conditions, for example the gravity of the
offence or the age of the offender. This is considered
to decrease the rate of subsequent crime, although evaluation
information is rarely available.
Drug users continue to pose a major
problem in the criminal justice system with up to 50
% of prisoners with drug-related problems. Given the
high turnover rate in prisons, it is estimated that
180 000 to 600 000 drug users pass through the system
annually in the EU. The prevalence of drug use varies
depending on the type of prison. It is more significant
in large and in short-stay prisons, more prevalent in
women's than in men's prisons.
Table 2 provides a rough overview
of assistance to drug users in prisons in the EU
the EMCDDA report 'Assistance
to drug users in prisons' (169KB) provides full
housing and employment are key areas in the rehabilitation
of drug users after treatment, after imprisonment or
in long-term substitution maintenance programmes. However,
it appears that this area of assistance is still rather
undeveloped even though professionals often emphasise
that aftercare and reintegration is a very important
aspect of drug treatment and that improvements in this
field would be needed.
to the future' in Finland
In Finland, the programme 'Back
to the future' (funded by the Integra programme
of the EU) has been involved in projects with
young drug addicts. The project results reinforce
the notion that people facing unemployment and
income problems after recovering from drug abuse
problems are in an extremely difficult situation.
The problems they encounter include inadequate
housing, reduced working capacity, lack of vocational
training and problems associated with work and
maintaining a drug-free lifestyle. Education was
available to the project participants but they
found it hard to approach educational systems
and work options and it was not easy for them
to find employers willing to enter into apprenticeship
contracts. Although the State automatically guarantees
the study loan, the banks refused to provide personal
loans because almost 90 % of the clients were
not credit worthy. The project found that the
actions available to social and health services
are inadequate to resolve multiple welfare problems.
Active measures are required of the rehabilitation
system which involve an individual and tailor-made
approach transcending administrative boundaries
and adequate financing.
Evaluation is the
key to ensuring the quality of drug-related responses,
as is adequate planning, infrastructure, professionalism,
supervision, training, research and networking. Quality
assurance procedures are increasingly being introduced
in the demand reduction area in the EU. Quality assurance
initiatives concerning prevention are reported from
Germany, Greece, Finland, France, Italy, the Netherlands
and Austria, and quality assurance of care from Germany,
Greece, Luxembourg, the Netherlands, Norway, Austria,
Portugal and the United Kingdom.
Training is established for general
practitioners and other health care professionals in
Belgium, Germany, Finland, Ireland, Italy, Austria and
the United Kingdom, whereas other countries - Greece,
France, Italy, Luxembourg, the Netherlands and Sweden
- state that even if some training is available for
prevention, health and criminal justice professionals,
there is still a need for courses of high quality.
assurance in demand reduction
In Austria, quality assurance
procedures are becoming increasingly important
in the field of drug demand reduction. Guidelines
for quality work and minimum standards for
all fields of addiction activities as well
as for the case management of substitution
clients have been drawn up. Minimum standards,
as quality prerequisites for drug and alcohol
counselling, have been defined and will
be implemented in a stage-by-stage plan.
In Vienna, special competence centres were
established, which are responsible for networking
and ensuring the transfer of information
to fields of activity that do not explicitly
deal with drug issues (such as youth work
and health care).
The following information has been
extracted from Europol reports.
New techniques of prompt intervention
and disruption at various levels of a criminal investigation
avoid long, drawn out and resource-intensive inquiries.
New EU judicial and law-enforcement cooperation structures
should be fully exploited by Member States, so as to
increase the sharing of information, both within Member
States and at international level.
The level of organised crime in the
EU is increasing. Production and trafficking of drugs
appear to remain the prime activities of criminal networks.
The continuing diversification and evolution of drug
routes challenge law-enforcement efforts. Criminals
continue to examine the successes and failures in the
trafficking of their illegal commodities and change
their operations accordingly, by altering routes, devising
new methods of concealment or recruiting new couriers.
According to Europol (EU situation
report on drug production and drug trafficking 1999/2000)
an encouraging project against the diversion of chemical
precursors was 'Operation purple', aimed at preventing
the diversion of potassium permanganate - a chemical
used in the production of cocaine - and bringing together
23 nations, including seven Member States, that produce,
import, export, or transit the chemical, as well as
the International Narcotics Control Board, ICPO/Interpol
and the World Customs Organisation. The project aims
at preventing chemical diversion, taking into account
that the availability of precursors plays a key role
in the production of drugs. Since the start of its operation,
248 shipments of the chemical have been tracked, involving
7 778 tonnes. As a direct result, 32 shipments of potassium
permanganate have been stopped or seized, totalling
almost 2 226 tonnes. This is supposed to represent 29
% of all shipments monitored. A similar operation will
be conducted on acetic anhydride, a chemical used in
the processing of heroin.
Further to the political developments
aimed at increasing judicial and law-enforcement cooperation,
Europol's competence will be broadened to money laundering
in general, regardless of the type of offence from which
the laundered proceeds originate.
Currently, Europol and experts from
Member States and the EMCDDA are developing a harmonised
database on drug seizures, with common definitions and
parameters, to be introduced in all Member States. This
should lead to a standardised collection of data EU-wide,
which will allow for a better comparison and analysis
of the drug situation in the various Member States.