A rationale for an orientation towards systems of prevention

Prevention aligned with science and standards advocates for a person-focused rather than a drug-focused perspective when articulating responses and services. Such a perspective follows a narrative that early initiation to substance use is not necessarily the result of a free independent choice, misguided by a lack of knowledge on the danger of drugs. It is rather the result of un- (or un-properly) addressed or supported vulnerabilities and protective factors at the personal/individual level and at the ecological/social level during different ages of development. This de-facto developmental paradigm of response necessitates a broadening in the scope and scale of interventions and sectors engaged with individuals at different ages as they can and should be implicated in the response. It calls for a multi-sectoral culture and approach (Heikkila et al 2021).

That same science also indicates that while standards of evidence and science are needed across every sector providing preventive responses, the net result of pooling in these multi-sectoral responses, could generate multiplicative rather than an additive preventive effect on the beneficiary individual (Spoth et al 2006, Crowley et al 2014).

Furthermore, that same science also dwells on the fact that it is not only the net-sum effect of the evidence-based intervention availed on each sector that is key, but at play also is the structural mechanism availing such services for responses.

Such a structural mechanism oversees coordination across sectors (public, private, civil society based and more) to ensure a range of interventions and policies exist at national and/or local level covering the comprehensive needs at different ages of development and across different level of risk within the target group (universal, selective, and indicative). This coordination must be comprehensive and inclusive, ensuring that no one is left behind.  Such a structural mechanism also avails the supportive policy and regulatory frameworks for diverse sector to coordinate and avail evidence-based responses based on their function and needs through a common integrated agenda whether local, national or regional. This mechanism ensures that evidence-based best practice (scientific) orientation is used while availing, prioritizing, and funding interventions. It also provides a foundation for quality delivery through support of continuous training, education and certification of human resources for prevention while assuring fidelity in implementation. More valuably this structural mechanism also ensures safeguards for sustainable financial backing and opportunities for scale up of services.

The combination of these services and policies together with a well-functioning structural mechanism (the hardware and the software) are the components of prevention systems that ensure that prevention responses are effective and inclusive, meeting our goal of ensuring that no one is left behind.

It is valuable to remember that such systems help policy makers, at national or local level, to optimize the available infrastructure by orienting activities with international best practice standards and science, before investing in further supportive interventions. It also supports the culture of research and scientific documentation of evidence which enriches local and global experiences in prevention science.

Given that vulnerability and protective factors addressed in such systems are common to other health and social outcomes beyond drugs (such as violence, mental health, criminality, school delinquency and more), a larger return on investment can be generated and documented during application. Such documentation encourages further intersectoral collaborative efforts nationally and regionally that considers and maximizes the impact of respective funding.

The development of new tools supporting the analysis and establishment of such systems such as the Review of Prevention System, or to strengthen the quality and functionality of services such as the UNODC WHO International Standards, the European Drug Prevention Quality Standards, the Universal Prevention Curriculum, the European Union Prevention Curriculum begs for an urgent plea to encourage a systems-based implementation in prevention responses. This is why UNODC launched the CHAMPS (CHildren Amplified Prevention Services) initiative.

Such systems are game changers, switching the gears of engagement of stakeholders helping governments more swiftly reach their political commitments in prevention and in protecting children and youth from the harms of drugs as well as to accelerates their potential in achievement of Sustainable Development Goals. Such systems put the evidence and the science in action at scale, encourages further investment in prevention and reflects that prevention works in improving the life trajectory of its beneficiaries.

References:

Heikkila H., Maalouf W., Campello G. The United Nations Office on Drugs and Crime’s Efforts to Strengthen a Culture of Prevention in Low- and Middle-Income Countries. Prevention Science. 2021 (Jan); 22(1): 18-28. DOI: 10.1007/s11121-020-01088-5

Spoth R. Clair S., Shin C., Redmond C. Long-term effects of Universal preventive interventions on methamphetamine use among adolescents. Archives of Pediatrics and Adolescent Medicine Journal. 2006; 160 (9):  876-882. DOI : 10.1001/archpedi.160.9.876

Crowley DM, Jones DE, Coffman DL, Greenberg M. Can we build an efficient response to the prescription drug abuse epidemic, assessing the cost effectiveness of universal prevention in the prosper trial. Preventive Medicine. 2014; 62(5): 71-77. doi: 10.1016/j.ypmed.2014.01.029

UNODC WHO International Standards on Drug Use Prevention. United Nations Office on Drugs and Crime Vienna (2018). International Standards on Drug Use Prevention

UNODC Children Amplified Prevention Services. United Nations Office on Drugs and Crime (2024) CHAMPS