Sweden

· Drug policy. Sweden has adopted a broad concept of prevention, including drugs, alcohol and tobacco. Three different levels of prevention are conceptualised and included in their prevention policy. Primary prevention is taken to mean general preventive measures (legislation, drug education) for the public as a whole. Secondary prevention aims directly at risk groups and tertiary prevention is used to provide care, treatment and rehabilitation for drug abusers. A central idea behind the Swedish approach to primary prevention is to "vaccinate" young people against starting to use drugs at some later date. According to the Swedish National Board of Health and Welfare, centralised campaigns using large-scale mass media have little or no effect. The main function of campaigns must be to support local activities at the community level. Well organized, with many social and community organizations (an excellent climate for prevention), Sweden has adopted a prevention strategy supported by large segments of the population. Consequently, many different target groups are involved in preventive activities: pre-school children, children and youth in elementary and high schools, young men in military service, students, parents, women, immigrants etc.

· Mass media campaigns. The modest, supporting role of mass media and large scale campaigns in Sweden has already been mentioned. In the early eighties, the Swedish Ministry of Health conducted two national campaigns against alcohol and drugs. "Action mot droger2' (Action against drugs) started as a continuation of an earlier campaign to stop the sale of alcohol to minors (45). "Action mot droger' was aimed mainly at cannabis abuse, trying to stimulate discussion about lifestyles and forces underlying drug abuse. To meet this goal, a snowball strategy was developed in which mass media were the starting point for local activities. This required a strong link between the central coordinating body and the many target groups, which at the regional level, consisted in social advisors to the largest county councils, as well as county school boards. In cities and local communities the link was forged by coordinating the social service, schools, police and sports and cultural organisations. The supportive role of the mass media consisted of two television and radio programmes in which parents discussed their opinions about drug use with young people. Six programmes called "Teenagers need parents" were later broadcast by Swedish radio. The campaign included press conferences, advertisements in newspapers and magazines.

45) Alcohol and Narcotics. Preventive Measures in Sweden. Socialstyrelsen. Stockholm. 1987.

· School and community drug prevention. As a result of the mass media campaigns, a wide variety of instructional materials on drugs and alcohol were developed and distributed through national, regional and local channels. These materials not only dealt with drug information, but were more broadly designed to encourage pupils to face up to feelings of inferiority, insecurity and fear of expressing emotions and values. Different materials were published for elementary and primary schoolchildren and for junior and senior high school students. It was later decided to organise a special campaign on hashish use in cooperation with the National Association for Home and School. Parents of 14 year olds in Sweden were chosen as the target group of this campaign, and a small but striking book called "The Hash Book", was produced and mailed to them (46). To facilitate work with the book a school curriculum was developed and the material sent to key persons in education. To support the campaign, and to improve its effectiveness, the National Association for Home and School arranged a major national conference, followed by local conferences for school class representatives. The idea was that all ninth grade classes should hold discussions with parents and teachers about drugs in general and hash in particular.

46) The Hash Book. Socialstyrelsen. Stockholm. 1987

· Education and training for health professionals. For many years, Sweden has developed research in the field of substance abuse at the major universities. As a result of a curriculum reform in 1983, a two-week training course is now given four times a year at the Karolinska Institute in Stockholm, in which attention is paid to all substances, including psychoactive medicines. For one week medical students are introduced to clinical and ambulatory treatment settings, and meet self-help groups. At the pre-clinical level, introductory information on substance abuse is given during the basic courses on social medicine and medical psychology. Sweden also has specific training programmes for public health professionals (psychologists and social workers) who can participate in certain non-medical parts of training programmes for physicians. Opportunities for education and training in substance abuse problems in Sweden are still increasing.

· Evaluation of drug prevention in Sweden. Unfortunately, no quantitative data is available to show that drug prevention in Sweden is successful. On the other hand, there has been no marked increase in drug consumption during the last decade. Seven hundred thousand (700.000) of the "Hash Book" have been mailed to Swedish families. As in most other European countries there is no strong prevention- evaluation tradition in Sweden, as is the case in the USA.