EMCDDA analysis of implementing North American drug prevention programmes in Europe

The EMCDDA have been looking at whether prevention programmes that have been developed in North America (USA and Canada) could be delivered to effect in Europe.

The key points the EMCDDA identify are:

  • Cultural infeasibility is often seen as more of a barrier than it should be.  Where adaptations have struggled it may have more to do with low prevalence and high social protection than flaws in the programmes.
  • Adaptation needs care and consultation, but is feasible.
  • In adapting American programmes those doing so should consider culture and context separately.
  • Thinking about the social capital available may help reduce any anticipated resistance to programmes that have been developed elsewhere.
  • Adaptation needs to be careful not to change the key principles that have made the programme effective in the first place.  Changing illustrative examples to make them accessible to participants is fine, but changing the programme protocol (number and order of sessions, etc.) is likely to change the efficacy.
  • A considerable barrier to implementation may be the perceived complexity of the North American programmes – multi-component, multi-sessions, etc.

The paper gives examples of a number of the programmes that have had European trials many that will be familiar to readers of this blog – the Good Behaviour Game, Preventure, Strengthening Families Program, and Communities that Care.

From my point of view this is a very helpful resource with lots of great nuggets for any of us thinking about how we can introduce or replicate evidence based programmes that have been developed elsewhere.

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Key messages from EMCDDA Brief Interventions and Motivational Interviewing meeting

emcdda bi eventReaders may remember that I was one of a number of speakers at an EMCDDA seminar earlier in the year.

They have now published the minute of the event and some of the presentations.  The minutes include the following key messages:

  • ‘Early intervention’ is a term that should be treated with caution (e.g. in quotation marks) as it does originally not refer to intervening early in drug use trajectories, but early in lifetime and is not necessarily related to substance use.
  • More useful in this environment is the term ‘brief interventions”. These interventions have, often with a motivational interviewing element, been applied to a number of settings. 
  • Most of the literature on BI and MI is about adults, alcohol and primary health care. Implementation and effectiveness research on cannabis, other illicit drugs, young people and other-than-health-care settings is scarce.
  • Effectiveness: Brief Interventions and motivational interviewing are effective, at least in primary health care for alcohol. Also the evidence on cannabis use is very promising; as well for computerised interventions (Carey et al., 2009; Khadjesari et al., 2011; Moreira et al., 2009; Rooke et al., 2010). It seems not to matter much who delivers the interventions, in terms of basic professional training, provided they have sufficient dedicated training and motivation.
  • Roll-out: Brief interventions with a motivational interviewing are feasible to be applied in primary health care, particularly in National Health System. Experiences in UK and Spain have shown that. There are also promising experiences with young people and in street work settings. Better coordinating and streamlining existing different services (‘bust the silos’) might be an option in austerity times in order to achieve positive outcomes on health, social and substance use behaviours.
  • To implement BI in public health systems, it needs to be backed with proper specialist referral systems and training systems for front line professionals: they need to know where to send people with special needs and have sources of support and skills development.

EMCDDA | European exchange on Brief Interventions and Motivational Interviewing for people using drugs.

What’s the point of a logic model?

LST logic model

Above is a logic model for Life Skills Training that I came across via the EpisCentre in the US, you can download a copy here.  As I’m sure I don’t need to remind readers of this blog LST is one of the programmes that a recent Cochrane Collaboration meta-review of universal alcohol prevention programmes described as a viable policy and practice option.

What I like about it is that it sets out very clearly what will be delivered and how the authors hope this will impact across the sort term, medium term and the ultimate outcomes the programme is intended to achieve.

We’ve produced a short video which tries to explain logic models in a bit more detail and there’s a bit more in the EMCDDA prevention standards.

EMCDDA meeting on Brief Interventions and Motivational Interviewing

emcdda bi eventHaving been invited to make a presentation to an expert meeting at the EMCDDA I’ve returned feeling that I’ve learnt as much as I’ve contributed.

My presentation described what Mentor and Addaction did as part of our Street Talk project last year.

As anyone who was following my Tweets from the event would have seen I was preceded by contributions from Spain, Poland, Germany and Jim McCambridge from the UK.

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Spending on drugs policy

The Department for Health publish the UK Focal Point report on drugs every year.  It’s a fantastically useful document in many ways setting out the progress that has been made by government and the challenges they’ve faced.

One of the important things that the report does is quantify the amount of money that is spent on drug policy.  It’s from here that we know that spending on ‘drug education’ (in reality the FRANK budget) fell to £0.5 million last year.

But what the report doesn’t do is tell us about the spending that isn’t labelled explicitly as being about drugs, but none the less is.  In our field the money that schools have to deliver their drug education lessons for example, but more importantly all the money that is tied up in the criminal justice system.

Spending on drug policy

Here I’m grateful to Professor Alex Stevens from Kent University who tweeted a link to the EMCDDA’s estimate of how much we’re spending.

In terms of education the EMCDDA suggest that in 2005 about 1.4% of the total budget was spent on education, compared to over 60% on public order and safety.

I thought it’d be worth looking at whether we’re an exception in spending at that sort of level and so I’ve looked at what has been labelled as ‘education’, ‘prevention’ or ‘demand reduction’.  It should be noted that not all countries provide data on their spending, but where they have it is clear that the UK spending in this area whilst similar to many others is still at the lower end of the spectrum.

Spend on Education in EU

Daily Cannabis Use in Europe

The EMCDDA have just published some data about adults who are using cannabis on a daily, or almost daily, basis.

They say that on average 1% of Europeans are smoking cannabis on a daily basis, and amongst younger adults that rises to 1.9%.

But as you can see from the graph this average conceals quite big differences between countries.

What is positive, from our perspective, is that – for this drug at least – the UK is well below the European average.

Nevertheless, as you’ll appreciate small percentages can equal quite large numbers of people.  So 0.6 of the UK population is still over 30,000 people who are putting their health and well-being at risk in this way.

As the EMCDDA paper records, the research suggests that use of cannabis at this level is associated with:

other illicit drug use; alcohol and tobacco use; driving and involvement in motor vehicle accidents after using cannabis; and impairments in cognitive, memory and learning performance. Frequent cannabis use has been found to predict some mental health disorders, including the development of psychotic symptoms, and has been associated with depressive and manic symptoms and suicides (Fischer et al., 2011).

Studies also show that daily cannabis users, perhaps unsurprisingly, are at higher risk of developing dependence symptoms than less frequent users.

Drugs in Europe

The EMCDDA have just published a shedload of data about drugs in Europe.

The Statistical bulletin is published yearly by the EMCDDA and consists of over 400 tables and 100 graphs of the most recent available data on the drug situation in Europe, all available to view interactively on screen and download in Excel format.

I’ve picked through it so that you don’t have to and pulled together this presentation.

What you’ll notice is that we (the UK) come very near the top of the pile for a number of things:

  • The number of problematic drug users – both raw numbers and rate per 1,000 of population
  • Drug deaths – both for all drug deaths and amongst younger drug users
  • Teenage cannabis use

On many of the graphs I’ve not put in all the countries where there is data, so for example with the slides about the use of the law I’ve only put on countries at the top end of the scale, where the UK has the fourth highest rates of offences for possession and the third for supply.

Cannabis

I’ve put this together more as a background presentation than something that is immediately useful for our purposes, but hopefully you’ll find things in it that are beneficial to your day to day work.

As you’ll see there is data about the scale of the market for cannabis in the UK, what the motivations appear to be for growing cannabis, the changes in price and potency, and how much our fellow citizens spent on buying the drug.

As with all presentations the original can be found in the Mentor Thinks folder on the shared drive.

Drug-related research in Europe: recent developments and future perspectives

Aside

The EMCDDA have published a paper on the research into drugs taking place in Europe.  A couple of quotes stand out.

First on the difference between what nations say is their priority and where they’re investing in research:

Bühringer et al. (2009) found a considerable difference between the identified national research priorities and the number of studies available, particularly in the areas of ‘supply reduction’ and ‘policy’, which seemed to be relatively under-researched, or for which findings were not available. Under ‘demand reduction’, prevention was the least-researched area, although most countries considered it to be a national priority.

The second is around the new societies that are being set up on a pan-European basis, including the European Society for Prevention Research:

[The societies] may prove to be a way forward for overcoming limitations and gaps in drug-related research, further disseminate research findings, and influence priorities and the allocation of funding.