Roche, A.

Stockwell, Tim

English

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EDITORIALPutting prevention back on the agendaThis special section in the Drug and Alcohol Review isdevoted to the theme of prevention. It is particularlytimely that the Review should focus on prevention inearly 2004 following the recent launch of Australia’sNational Drug Strategy Prevention Agenda by theAustralian Government Department of Health andAgeing. Over recent years, there has been growingattention directed towards prevention in public policyboth in Australia and overseas. There is also increasedrecognition of the capacity of prevention initiatives tooffer protection from alcohol and other drug-relatedharms and to decrease the likelihood of a range of socialand health outcomes.Over the past two decades there have been significantexpansions in the scientific evidence base underpinningprevention [1]. The literature in this area has grownexponentially. More importantly, as reflected in thepapers included in this special section, the conceptua-lization of what constitutes ‘prevention’ has alsobroadened and taken into account perspectives from avariety of disciplines. Like Australia’s National DrugStrategy Prevention Agenda, which has taken a broadpublic health systems approach, this section is equallybroad in its sweep. We have included coverage of bothlegal and illegal drugs, and not only use of drugs butrisky use and related harms. In addition, it is not onlythe role of treatment and intervention specialists thatare considered but the crucial contributions of keypartners such as the police, general practitioners, thecriminal justice system, education and the wider arrayof human services system responses.The recent groundswell of interest in preventionculminated in targeted activities by the AustralianGovernment Department of Health and Ageing andthe Intergovernmental Committee on Drugs (IGCD),including commissioning one of the largest and mostcomprehensive reviews of prevention activities under-taken nationally or internationally [1]. Also indicativeof this interest was the Department being a majorsponsor of an International Symposium held inFremantle, Western Australia in February 2003 entitled‘Preventing substance use and harm: what is evidence-based policy?’. A selection of papers from thissymposium forms the basis for this special section.The symposium was also sponsored by the WorldHealth Organization, NCETA, NDARC, the US-basedPrevention Research Center and the WA Drug andAlcohol Office. It was also designated a ThematicMeeting of the Kettil Bruun Society for Social andEpidemiological Research on Alcohol.The papers presented in this issue reflect anacknowledgement of the complex web of influencesand processes, ranging from those at a macro-socialglobal level through to national and local forces, thatimpact on individual health outcomes. No singleprevention approach is indicated from the literature;rather, what is increasingly clear is that a range ofstrategies and approaches will be required that operateat different levels of and points on a prevention matrix.An important aspect of this issue is coverage of thepolicy development process (see papers by D’Abbs [2]and Room [3] in particular) and the settings in whichproblems are often concentrated or which form a focalpoint of attention such as licensed premises (seeGraham et al. [4] and Homel et al. [5]), schools(Caulkins et al. [6]) and primary care (Roche &Freeman [7]). Importantly, several papers also addressmethodological issues. The efficacy vs. effectivenessconundrum of basic secondary prevention measuressuch as brief interventions is examined by Roche &Freeman [7]. Caulkins et al. [6], in examining schooldrug education, also assesses the issue of efficacy vs.effectiveness and cost-effectiveness. He throws up afurther challenge about the importance of juxtaposingbehavioural outcome measures with the educationalvalue or opportunity costs of school drug education.The application of an evidence-based approach toplanning tobacco interventions for Aboriginal peopleis addressed by Ivers [8], while the paper by Stockwellet al. [9] provides an important, empirically drivenexamination of the question of whether preventioninitiatives should be targeted or universal and applied inearly in childhood and taking precedence over inter-ventions in adolescence and adults. Important ques-tions are raised in these papers that have implicationsfor both practitioners and policy makers.Several papers in this section also provide newinformation and insights about what constitutes effec-Drug and Alcohol Review (March 2004), 23, 3 – 4ISSN 0959-5236 print/ISSN 1465-3362 online/04/010003–02 # Australian Professional Society on Alcohol and Other DrugsDOI: 10.1080/09595230410001645493tive prevention under what circumstances and forwhom. Room [3] provides an overview of the uniqueand important Scandinavian experience with alcoholcontrols, including government alcohol monopolies,variations in types of liquor outlets and changes in thedays or hours of sale. Both the Graham et al. [4] and theHomel et al. [5] papers present outcomes of pioneeringinterventions designed to reduce alcohol-related vio-lence in public places.There are those that argue that prevention initiativescontinue to be based on simplistic aetiological mod-els—focusing on too limited a range of factors andplacing too much burden for countering substanceabuse on the individual.Several deficiencies in current prevention trends havebeen identified (Adelman & Taylor [10]). Theseinclude insufficient attention to:1 Greater understanding of the linkages amongpsychosocial problems2 Expanding the breadth of prevailing models ofprevention3 Increasing standards for accepting ‘efficacy’4 Moving forward to demonstrate ‘effectiveness’.We believe that the papers presented in this specialsection go some way towards addressing these identi-fied deficits. We also hope that the ideas, researchfindings and conceptual explorations offered here willform a useful contribution to improved preventionpractice.ANN M. ROCHE & TIM STOCKWELL,NCETA, Level 3B, Mark Oliphant Building,Laffer Drive, Science Park, Bedford Park SA 5042,Australia. E-mail: ann.roche@flinders.edu.auReferences[1] Loxley W, Toumbourou J, Stockwell TR et al. (2004) Theprevention of substance use, risk and harm in Australia: areview of the evidence. A report prepared for the Com-monwealth Department of Health and Ageing, NationalDrug Research Institute and the Centre for AdolescentHealth. Curtin University, Western Australia: TheNational Drug Research Institute.[2] d’Abbs P. Alignment of the policy planets: behind theimplementation of the Northern Territory (Australia) LivingWith Alcohol programme. Drug Alcohol Rev 2004;23:55 –66.[3] Room R. Effects of alcohol controls: Nordic researchtraditions. Drug Alcohol Rev 2004;23:43 – 53.[4] Graham K, Osgood DW, Zibrowski E et al. The effect of theSafer Bars programme on physical aggression in bars: resultsof a randomized controlled trial. Drug Alcohol Rev2004;23:31 – 41.[5] Homel R, Carvolth R, Hauritz M, McIlwain G, Teague R.Making licensed venues safer for patrons: what environ-mental factors should be the focus of interventions? DrugAlcohol Rev 2004;23:19 – 29.[6] Caulkins JP, Pacula RL, Paddock S, Chiesa J. What wecan—and cannot—expect from school-based drug preven-tion. Drug Alcohol Rev 2004;23:79 – 87.[7] Roche AM, Freeman T. Brief interventions: good in theorybut weak in practice. Drug Alcohol Rev 2004;23:11 – 18.[8] Ivers RG. An evidence-based approach to planning tobaccointerventions for Aboriginal people. Drug Alcohol Rev2004;23:5 – 9.[9] Stockwell T, Toumbouru JW, Letcher P, Smart D, SansonA, Bond L. Risk and protection factors for differentintensities of adolescent substance use: when does thePrevention Paradox apply? Drug Alcohol Rev 2004;23:67 –77.[10] Adelman HS, Taylor L. Creating school and communitypartnerships for substance abuse prevention programs. JPrimary Prev 2003;23:329 – 369.4 Editorial

Editorial: Putting prevention back on the agenda

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Editorial: Putting prevention back on the agenda

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