Supply reduction or demand reduction?

It is worth mentioning first of all the distinction made between types or models of prevention, namely, prevention of the supply of drugs (supply reduction) and prevention of the demand for drugs (demand reduction).

Supply reduction can be achieved by national and international legal measures (of the Single Convention), police action and law enforcement. Within demand reduction strategies, drug education can function as an important tool if is applied adequately and appropriately. Both strategies can only be successful and effective if they are combined in a balanced and comprehensive approach.

The combined approaches of supply reduction and demand reduction can be demonstrated in the following model:

MODEL 1: THE EPIDEMIOLOGICAL TRIANGLE

The epidemiological triangle of prevention is a useful framework within which to illustrate relationships and determinants in drug use. The basic question it implies is that of the route through which we should channel our policy or strategy of prevention. Through that leading to the substance? That leading towards the person using drugs? Or, through that passing via the social context or environment?

Several Western, and non-Western, countries strongly emphasize substances; this stems from a concept that the substance is the main cause of the problem. Whilst probably true, the target of this focus, which is to achieve a world without drugs, seems rather unrealistic. Nor does this approach make any allowance for the beneficial effects of some mind-altering drugs for recreational, medical or therapeutical reasons. These, whether licit or illicit, have multiple effects which vary according to the dose, the individual and the context. Furthermore, the personal and social effects of drugs are influenced by the legal status of the drug, its pharmacological characteristics and patterns of use. Therefore, a compromise should probably be sought whereby availability of drugs is restricted to circumstances where the use presents only limited risks.

The second group of preventive efforts focuses on the people using or intending to use a substance, rather than on the substance itself, and is directed at discouraging people Som taking drugs. The most common method used to achieve this aim is communication: information, education and health promotion. As stated, opinions concerning the effectiveness of these measures as a means of prevention still range from optimistic to rather sceptical and are often connected with divergent views on how one should inform and educate and which methods are best suited to drug education. Politicians, police officers, media people and the general public, often claim that the only adequate approach is a warning approach, using highkey scare tactics in the media to discourage young people from experimenting with drugs. In contrast, professionals in drug prevention and health education consider this a counterproductive 4) approach.

4) Advisory Council on the Misuse of Drugs. Prevention Report. Home Office, London. 1984

The third group of preventive activities tries to mould the social environment in such a way that drug problems cannot evolve, or will be reduced. In other words, to influence or change the environmental conditions favourable to the onset and development of drug abuse. A look at the social environment of potential drug users brings to light a number of mechanisms that encourage rather than discourage continued use of drugs Firstly, many people in the entourage of an experimental or first-time drug-user panic when first discovering that a son, daughter or pupil, is using drugs. A reaction which runs the risk of leading the situation from bad to worse. Another widespread belief is that it is practically impossible to do anything about a drug problem unless one is an expert in the field. Such notions are detrimental because they block what is left of the normal means of communication between the drug taker and those around him. Bearing this in mind, during the eighties The Netherlands initiated a mass media drug information campaign to educate and inform those within the social environment of drug users parents, teachers, youth workers and health professionals. It was thought that this campaign would have a positive impact and produce more realistic attitudes, and open up and improve communication between educators and youngsters about drug use, and result in a reduction of related taboos 5).

5) Van Berkum,G. W. R. Buisman, G. J. Kok. Mass Communication and Drug Education: Evaluation of the Dutch National Campaign "What everybody ought to know about drugs". In: Journal of Alcohol and Drug Education. 1991. Vol. 36, pp. 65-74

Dilemmas of drug prevention

It seems obvious that drug education practitioners will be confronted with more than one dilemma in their daily work. In a recent article, Goodstadt '6) describes the numerous dilemmas inherent in drug prevention - abstinence versus responsible use, drug education versus skills training, individual education versus environmental education, education versus legalization - with which many prevention workers are unfamiliar or have not thought them through.

6) Goodstadt, M. S. Drug Education: The Prevention Issues. In: Journal of Drug Education. 1989. Vol. 19(3), pp. 197-208

In his explanation of the supply reduction approach versus the demand reduction model Goodstadt makes a number of comments on the supporters of these approaches and on the combination of demand and supply reduction. He writes The demand reduction component is most commonly addressed through educational strategies. The assumption is that social problems, including discrimination, war and drug abuse can be reduced through changing the minds and hearts of the people. It is of interest to notice that those who have traditionally put most emphasis on supply reduction, are increasingly concerned that supply reduction has been ineffective in stemming drug use. These agencies have begun to emphasise demand reduction through their involvement in the development and implementation of educational programmes. However, among those traditionally concerned with demand reduction through education, pessimism has been growing that drug education is ineffective. He concludes: As with most of the dichotomies and other simplifications of the real world, it is likely that the choice between supply and demand reduction is only resolvable through a marrying of the two objectives: reducing the motivation for drug use and abuse, at the same time as reducing the availability of the drugs.

Against the background of the earlier observation that no coherent, operational and effective model for drug prevention has been developed, Goodstadt's remarks imply that:

- All faith should not be pinned on demand reduction alone.
- Drug abuse prevention must not be limited to drug education.
- Availability of drugs constitutes an essential element in the prevention of drug abuse.

It can be concluded that limiting availability and discouraging abuse of drugs and other psychotropic substances are the main strategies to produce an effective drug abuse prevention policy.

The most important tools of prevention at our disposal are a well-balanced control-policy to limit the availability of substances, information and education to discourage drug abuse and treatment and care to solve drug abuse problems. This report focuses mainly on the two communication tools information and education.