Drug prevention programs for young people are a good investment

Midford [1] provides an overview from a respected researcher of efforts to prevent alcohol- and drug-related harm among young people in Australia and other western nations. These efforts have included classroom approaches, parenting and whole-of-community and school approaches. Midford is in a strong position to comment, as he is a seasoned prevention researcher, with a substantial track record in developing and evaluating effective prevention programmes at the community [2] and school levels [3]. While he is an advocate for a range of prevention approaches, in this paper he emphasizes particularly the benefits of school-based drug education. He concludes his paper by forewarning of the disadvantages of stepping away from harm reduction as the mainstay for Australian prevention policy.

Midford's paper emphasizes school or classroom drug education programmes, based upon the social influence model. He appears less convinced that the cost-effectiveness of school drug education is enhanced through supplementation with additional parent education and community components. The added complexity and cost of coordinating these additional elements has failed in many evaluations to translate to additive prevention benefits [4]. However, given continuing evidence supporting the effectiveness of community supplemented interventions [5], our position is that investment in the development and evaluation of prevention programmes should continue to investigate whether or not the benefits of school-based drug education can be extended through supplementary activities with parents and in community settings outside the school.

Midford et al.[2] and others [6] have demonstrated that action at the community level, including law enforcement practices and actions to enforce minimum age laws, can reduce alcohol harms. Sports clubs are another setting that have, for many years, been neglected in community prevention efforts, but that play a potentially important role in socializing young people into excessive drinking [7–9]. Effective strategies can be employed in settings such as sports clubs to encourage harm reduction and adherence to national alcohol guidelines, including enforcing recommendations that alcohol is not used prior to the legal drinking age [10,11]. Behaviour is complex, and the broad ecological model suggests that behaviour is influenced by multiple settings and factors [12]. Reviews of the evidence for effective interventions supports the need for broad investment in prevention strategies at different levels, including price, law, regulation, enforcement, community and school prevention and harm reduction [13–16].

We welcome Midford's consideration of the potential for tension between abstinence and harm reduction within prevention policy and agree that harm reduction, rather than abstinence, should be the mainstay of prevention policy. However, our position is that there can be benefits where abstinence is given prominence within alcohol and drug prevention policies [17], as long as there is evidence that abstinence goals can improve outcomes either universally (as is the case for tobacco) or for specific groups (as for adolescents and alcohol). There is increasing evidence suggesting population benefits where Australian adolescents abstain from alcohol. A recent follow-up of a state-representative cohort revealed that adolescents maintaining abstinence from alcohol through secondary school experienced low levels of alcohol-related problems by age 24, while those adhering to moderate alcohol use guidelines in adolescence tended to escalate to significantly higher rates of young adult problems [18]. We predict that the recently revised Australian national health guidelines recommending adolescent abstinence from alcohol will lead to this behaviour growing in popularity in the coming years in Australia.

Greater investment in prevention and evaluation is warranted across a broad range of areas. We believe that abstinence objectives are compatible with harm reduction policy—when implemented appropriately. To ensure benefit, abstinence-based prevention objectives must be guided by evidence for effectiveness, a caution which applies equally to harm reduction prevention policies.

Declaration of interests

None