United Kingdom

· Drug policy. Drug policy in the UK has undergone considerable change over the last 20 years. It used to be internationally regarded as one using treatment and opiate prescription, rather than law enforcement to control and prevent drug problems. According to Dorn (25), education, once considered almost synonymous with prevention, is now seen as a supporting system. By the late 1980s, drug prevention was effectively defined as an enforcement problem first, and a medical, social and educational problem second. The main objective now is to attack the drug problem on five fronts:

- reduce supplies from abroad;
- render enforcement even more effective;
- maintain effective deterrents and tight domestic controls;
- develop prevention and education;
- improve treatment and rehabilitation.

25) Dorn. N. British Policy on Prevention. In: Ghodse, H. et.al. Drug Misuse and Dependence. Parthenon, Lancs. 1990

The first three policy objectives deal with supply, and the last two with prevention, treatment/rehabilitation and demand reduction. An Advisory Council on the Misuse of Drug established by the British Government in 1984 recommended that preventive measures be developed according to two basic criteria:

- reduce the risk of an individual engaging in drug misuse;
- reduce the harm associated with drug misuse.

Several prevention programmes have since been carried out.

Mass Media Campaign. In February 1985, the British government commissioned a London advertising agency to develop a wide-ranging and striking anti-heroin campaign, targeted at all youngsters aged 13-20 '28), especially those running a high risk of using heroin (an estimated 15% of all youngsters). The campaign "Heroin screws you up", consisted of two TV commercials broadcast regularly on Channel 4 Television. One commercial shows a boy who proudly announces that he controls his heroin use, but slowly deteriorates. The other shows a girl who, despite her efforts with make-up, looks worse and worse. Full-page advertisements in nineteen different fashion, music and girls' magazines brought the message "Heroin screws you up" to the attention of the younger generations.

28) Irving. A. The Role of Advertising in the Prevention of Heroin Misuse: the UK experience. In: Proceedings of 15th ICAA Institute on the Prevention and Treatment of Drug Dependence. Amsterdam/Noordwikherhout. 1986

A special campaign for parents, educators and intermediaries was also developed, with especially written brochures on drugs "How to act when your child uses drugs". Three different advertisements published in some weeklies and monthlies drew attention to the heroin problem and the brochures.

The goal of the first campaign was to get across the negative short-term physical and social effects of heroin use in a penetrating way. The second campaign also demonstrated through TV commercials, posters and adverts, how youngsters can turn down an offer of drugs without losing face. During recent years this anti-drug campaign has increasingly become modified into an HIV/AIDS prevention (Anti-Injecting) campaign addressed to drug users and, on a broader level, all those concerned by drugs, to meet the policy objective of reducing the harm caused by drug misuse.

The Anti-Injecting campaign "Shooting up once can screw you up. Forever" used the different media of television, posters, teenage newspapers and radio annoucements and which focused on the risk of contamination through shared use of syringes to communicate the general idea that the syringe is a deadly weapon "Screw up your blood, your liver, your life"

- even though individual use of a syringe is never discussed. The inherent risk is amplified by the advertising slogan which reduces time to a simple equation: Once = Forever.

· School drug prevention. The UK has built up a long tradition of school drug education programmes, including low-level scare tactics, factual person-focused health promotion and mixed approaches. Most programmes and packages have been developed by Health Education Authorities or by agencies like ISDD, TACADE '29). There is, as argued in the Chapter V, no overwhelming evidence available to help in decisions as to what would be the most effective drug prevention approach in the school context. Probably this is the main reason for distributing a variety of drug education programmes and packages in primary and secondary schools, such as the two very different programmes, "Drug Wise Drug Education for Students, 14-19" developed jointly Health Education Council, TACADE and ISDD, '30 and the "High Profile Youth Work Curriculum about Drugs", developed and distributed by ISDD (31). The "Drug Wise" programme is a broad, factual person/skills focused prevention programme, including many educational methods (lecturing, discussion, peer support, materials etc.). The "High Profile Curriculum" is a rather traditional, cognitive based educational programme that fits into most subjects of the curriculum, whatever the type and level of education or professional training. Dorn illustrates this approach in the following table:

29) Free to Choose: an approach to drug education. TACADE, Salford. IRK. 1984
30) Drug Wise Drug Education for Students, 14-19. ISDD, London. 1986
31) See Note. 19

The UK also pays much attention to training teachers and school counselors how to educate their pupils and students and how to deal with young people with drug problems. Since 1986 several drug education video programmes and packages are available for a variety of educational settings.

· Training programmes for health professionals. Most of the drug prevention programmes described so far deal mainly with primary prevention. Health professionals are often confronted with substance abuse problems at an early phase, in hospitals, or during primary care and crisis intervention. Many are not familiar with coping and intervening with drug problems, scant attention having been paid to this aspect during their medical training. There are several attempts to fill this gap, one of the best known being the post-graduate "Diploma Course in Addiction Behaviour", developed and taught by the Addiction Unit of the Maudsley Hospital in London (32). This very intensive, one-year training course is addressed to physicians, psychiatric nurses, psychologists and other health professionals confronted with early addiction problems in their work. It is interesting to note the high international participation in this training course, with professionals from Africa and Asia who return to their countries and train their colleagues in education and intervention with drug misusers. An international example of the "teaching the teachers" training model.

32) Glass. I. B. Diploma Course in Addiction Behaviour. paper presented for WHO Consultation Meeting "Substance Abuse Education for Health Professionals". Vienna. 1987

· Community prevention projects. So far as this author is aware, there are no striking examples of community drug prevention projects directed at primary or secondary prevention levels. What we do have, however, are examples of projects that try to reach local drug users in big towns and cities. In Manchester, for instance, a harm reduction comic called "Smack in the Eye" has been distributed to drug users (33). It uses popular cartoons to get messages across about safe drug use and safe sexual behaviour. In Brighton, a harm minimization project using local radio and telephone lines to warn young people about the dangers of mixing sedatives, including solvents, produced wrapping paper with printed messages about drugs 34).

33) See Note. 27: p. 143
34) Dorn. N. Can Local Drug Prevention Sizzle? Druglink. 1990

· Evaluation of drug prevention in the United Kingdom. No general evaluation data is available to determine the effects of all preventive measures, either on supply reduction, or on demand reduction, to decide whether the British drug policy is a successful one. And it is virtually the same for the prevention and education programmes described above where no quantitative data is available to indicate success or failure. However, there is evidence that the British mass media campaign was successful to some extent, research findings indicating that negative attitudes of youngsters towards the use of heroin had increased by 10% after the campaign '35).

'35) Heroin Misuse Campaign Evaluation. Report of findings stages I-III. Research Bureau Limited. London. 1986